Comparing the Emergency Care of Iranian and Afghan Patients During the COVID-19 Pandemic.

BACKGROUND: This study investigated the quality of inpatient care provided to Afghan immigrants in Iran during the COVID-19 pandemic (February 2019 to March 2021). For this purpose, the services received by Afghan immigrants were compared with those received by Iranian citizens. METHODS: Two emergency services (traumas with 8080 victims and 8,686 patients hospitalized with severe COVID-19 infection) were taken into consideration. The records of all patients, including the Afghan immigrants, in two referral hospitals in Kerman were reviewed, and the main variables were the length of hospitalization (LoH), intensive care unit (ICU) admission rate, and death rate. Quantile regression, multiple logistic regression, and Cox regression were used to analyze the data. RESULTS: The median and interquartile range of LoH for Afghan and Iranian nationals admitted due to traumas were 3.0±4.0 and 2.0±4.0, respectively (P<0.01). Moreover, the chance of Afghan nationals being admitted to the ICU (38%, odds ratio=1.38; 95% confidence interval [CI]=1.12; 1.69) and the hazard of death (60%, hazard rate=1.60; 95% CI=1.03; 2.49) were higher compared to Iranian nationals, which is statistically significant. However, no significant differences were observed between the COVID-19 patients from the two nationalities in terms of the median LoH, the odds of being admitted to the ICU, and the hazard of death due to COVID-19. CONCLUSION: Afghan nationals admitted to the hospital due to traumas were more likely to be admitted to ICUs or die compared to Iranian citizens. It seems that Afghan patients who had traumas went to the hospitals with more serious injuries. There was no difference between Afghan and Iranian patients in terms of COVID-19 consequences. Following the findings of this study, it seems that justice in treatment has been fully established for Afghan patients in Iran.

Complex post-traumatic stress disorder and post-migration living difficulties in traumatised refugees and asylum seekers: the role of language acquisition and barriers.

Background: Numerous traumatic experiences and post-migration living difficulties (PMLDs) increase the risk of developing symptoms of complex post-traumatic stress disorder (CPTSD) among Afghan refugees and asylum seekers, living in Austria. Research has repeatedly associated higher levels of CPTSD with higher levels of PMLDs. Summarizing PMLDs into empirically derived factors might facilitate a further understanding of their interaction with symptom presentation within distinct clusters of CPTSD. Objective: The current study aimed to investigate homogeneous subgroups of ICD-11 CPTSD and their association with demographic variables, traumatic experiences, and empirically derived factors of PMLDs. Method: Within a randomized controlled trail (RCT) CPTSD, PMLDs, and traumatic experiences were assessed in a sample of 93 treatment-seeking Afghan refugees and asylum seekers through a fully structured face-to-face and interpreter-assisted interview using the ITQ, the PMLDC, and a trauma checklist. Underlying clusters of CPTSD, superior factors of PMLDs, and their associations were investigated. Results: In total, 19.4% of the sample met the diagnostic criteria for PTSD and 49.5% for CPTSD. We identified a 2-cluster solution consisting of two distinct subgroups as best fitting: (1) a CPTSD cluster and (2) a PTSD cluster. The multitude of PMLDs was summarized into four superior factors. CPTSD cluster membership was associated with childhood potentially traumatic experience types, and one of four PMLD factors, namely 'language acquisition & barriers'. Conclusions: The results suggest that not PMLDs in general, but rather specific types of PMLDs, are associated with CPTSD. An assumed bidirectional relationship between these PMLD factors and CPTSD symptoms might lead to a downward spiral of increasing distress, and could be considered in treatment strategies.

Antecedentes: Numerosas experiencias traumáticas y dificultades de vida post-migración (DVPM) aumentan el riesgo de desarrollar síntomas de trastorno de estrés postraumático complejo (TEPT-C) entre los refugiados y solicitantes de asilo afganos que viven en Austria. La investigación ha asociado repetidamente niveles más altos de TEPT-C con niveles más altos de DVPM. Resumir las DVPM en factores derivados empíricamente podría facilitar una mayor comprensión de su interacción con la presentación de síntomas dentro de distintos grupos de TEPT-C.Objetivo: El presente estudio tuvo como objetivo investigar subgrupos homogéneos de TEPT-C según la CIE-11 y su asociación con variables demográficas, experiencias traumáticas y factores derivados empíricamente de DVPM.Método: Dentro de un estudio controlado aleatorizado (ECA), se evaluaron TEPT-C, DVPM y experiencias traumáticas en una muestra de 93 pacientes, refugiados afganos y solicitantes de asilo, a través de una entrevista cara a cara totalmente estructurada y asistida por un intérprete utilizando el ITQ, el PMLDC y una lista de verificación de traumas. Se investigaron los grupos subyacentes de TEPT-C, los factores superiores de DVPM y sus asociaciones.Resultados: En total, el 19,4% de la muestra cumplió los criterios de diagnóstico de TEPT y el 49,5% de TEPT-C. Identificamos 2 grupos que constan de dos subgrupos distintos: (1) un grupo de TEPTC y (2) un grupo de TEPT. Las distintas DVPM se resumieron en cuatro factores superiores. La pertenencia al grupo de TEPT-C se asoció con tipos de experiencias potencialmente traumáticas en la infancia y uno de los cuatro factores de DVPM, denominada, 'adquisición y barreras del lenguaje'.Conclusiones: Los resultados sugieren que no las DVPM en general, sino los tipos específicos de DVPM, están asociados con el TEPT-C. Una supuesta relación bidireccional entre estos factores de DVPM y los síntomas de TEPT-C podría conducir a una espiral de angustia creciente, y podría considerarse en las estrategias de tratamiento.

Nutritional Status of Adolescent Afghan Refugees Living in Peshawar, Pakistan.

Pakistan has hosted millions of Afghan refugees over the last several decades. Due to poor socioeconomic status, food insecurity and inadequate access to health care, these refugees are considered to be at high risk of malnutrition. Previous studies on nutritional assessment of high-risk populations (refugees) have focused mainly on women and children (0-59 months). The current study aims to assess nutritional status of adolescent Afghan refugees; the population who are equally vulnerable to malnutrition and its consequences. In this cross sectional study, the nutritional status of 206 adolescent (10-19 years old) Afghans boys and girls living in a refugee camp in Peshawar, Pakistan was assessed using standard methods. The results indicate a prevalence of stunting, thinness, and overweight and obesity at 35.3%, 4.4% and 14.8%, respectively. Furthermore, there was a significantly high prevalence of micronutrient deficiencies (vitamin D, 80.5%; vitamin B12, 41.9%; and folate, 28.2%); and anemia (10.1%). Together, these findings indicate that this vulnerable population group suffers from the double burden of malnutrition and are thus at serious risk of impaired psychosocial cognitive development, general ill-health and diminished wellbeing. This study therefore highlights the urgent need to include adolescents in regular screening and intervention programs of such at-risk populations.

Forensic features and genetic legacy of the Baloch population of Pakistan and the Hazara population across Durand line revealed by Y-chromosomal STRs.

The Hazara population across Durand line has experienced extensive interaction with Central Asian and East Asian populations. Hazara individuals have typical Mongolian facial appearances and they called themselves descendants of Genghis Khan's army. The people who speak the Balochi language are called Baloch. Previously, a worldwide analysis of Y-chromosomal haplotype diversity for rapidly mutating (RM) Y-STRs and with PowerPlex Y23 System (Promega Corporation Madison, USA) kit was created with collaborative efforts, but Baloch and Hazara population from Pakistan and Hazara population from Afghanistan were missing. In the current study, Yfiler Plus PCR Amplification Kit loci were examined in 260 unrelated Hazara individuals from Afghanistan, 153 Hazara individuals, and 111 Balochi individuals from Baluchistan Pakistan. For the Hazara population from Afghanistan and Pakistan overall, 380 different haplotypes were observed on these 27 Y-STR loci, gene diversities ranged from 0.51288 (DYS389I) to 0.9257 (DYF387S1), and haplotype diversity was 0.9992. For the Baloch population, every individual was unique at 27 Y-STR loci; gene diversity ranged from 0.5718 (DYS460) to 0.9371(DYF387S1). Twelve haplotypes were shared between 178 individuals, while only two haplotypes among these twelve were shared between 87 individuals in Hazara populations. Rst and Fst pairwise genetic distance analyses, multidimensional scaling plot, neighbor-joining tree, linear discriminatory analysis, and median-joining network were performed, which shed light on the history of Hazara and Baloch populations. The results of our study showed that the Yfiler Plus PCR Amplification Kit marker set provided substantially stronger discriminatory power in the Baloch population of Pakistan and the Hazara population across the Durand line.

The prevalence and associated factors of adverse pregnancy outcomes among Afghan women in Iran; Findings from community-based survey.

BACKGROUNDS: An estimated 2.5 million Afghans are living in the Iran and almost half of them are young women at the childbearing ages. Although the evidence indicates lower rates of antenatal care and higher incidence of pregnancy complications in Afghan compared to Iranian women, the underlying reasons are not well defined. Therefore, in the present study, we aimed to explore the prevalence and associated sociodemographic factors of adverse pregnancy outcomes and examine the impact of intimate partner violence, food insecurity, poor mental health, and housing issues on pregnancy outcome in Afghan women living in Iran. METHODS: In July 2019, we enrolled 424 Afghan women aged 18-44 years old using the time-location sampling at three community health centers in the south region of Tehran province. The data was collected through face to face interviews using the researcher-developed questionnaire. Using bivariate and multivariate analysis, the impact of poor antenatal care, intimate partner violence, food insecurity, and poor mental health was assessed on the incidence of adverse pregnancy outcome. RESULTS: More than half (56.6%) of Afghan women reported at least one pregnancy complication in their recent pregnancy. The results showed that undocumented, illiterate, and unemployed Afghan women with lower socioeconomic status are more likely to experience adverse pregnancy outcomes. Furthermore, we observed lower prevalence of adverse pregnancy outcomes among documented immigrants with health insurance compared to those with no health insurance. It is also been found that the food insecurity [Adjusted OR = 3.35, 95% CI (1.34-8.36)], poor antenatal care [Adjusted OR = 10.50, 95% CI (5.40-20.39)], intimate partner violence [Adjusted OR = 2.72, 95% CI (1.10-6.77)], and poor mental health [Adjusted OR = 4.77, 95% CI (2.54-8.94)] could adversely impact the pregnancy outcome and we observed higher incidence of adverse outcomes among those suffering from these situations. CONCLUSION: To our knowledge, this is the first study that explored the prevalence and associated factors of adverse pregnancy outcomes and the impact of intimate partner violence, food insecurity, poor mental health on pregnancy outcome among Afghan women in Iran. Enhancing the psychosocial support and empowering Afghan women through expanding the social network and safety net should be a priority for the central government and international parties. Psychological counseling should be incorporated into routine maternity care for Afghan refugees. Access to free antenatal care is a right for all Afghan women and it should be facilitated by universal health insurance for all Afghans regardless of their legal status.

Culturally Adapted Cognitive Behavioral Therapy Plus Problem Management (CA-CBT+) With Afghan Refugees: A Randomized Controlled Pilot Study.

Culturally adapted cognitive behavioral therapy (CA-CBT) is a well-evaluated, transdiagnostic group intervention for refugees that uses psychoeducation, meditation, and stretching exercises. In the current study, we added problem-solving training to CA-CBT and evaluated this treatment (i.e., CA-CBT+) in a randomized controlled pilot trial with a sample of Farsi-speaking refugees. Participants (N = 24) were male refugees diagnosed with DSM-5 PTSD, major depressive disorder, and anxiety disorders who were randomly assigned to either a treatment or waitlist control (WLC) condition. Treatment components were adapted both to the specific cultural background and the current social problems of asylum seekers. Assessments were performed pretreatment, 12-weeks posttreatment, and 1-year follow-up. The primary treatment outcome was the General Health Questionnaire (GHQ-28); secondary outcome measures included the Posttraumatic Stress Disorder Checklist, Patient Health Questionnaire, Somatic Symptom Scale, World Health Organization Quality of Life, and Emotion Regulation Scale. Eleven of 12 participants were randomized to CA-CBT+ completed treatment. Based on intent-to-treat data, large between-group effect sizes were seen at posttreatment in the GHQ-28, d = 3.0, and for most secondary outcome measures. Improvements for individuals in the treatment group decreased at 1-year follow-up, but effect sizes demonstrated continued large improvements on all measures as compared to pretreatment levels. In summary, CA-CBT+ led to large improvements in general psychopathological distress and quality of life, which were maintained in the long term. In addition, the dropout rate was very low, with delivery in group format. Thus, problem-solving training appears to be a promising addition to CA-CBT.

Determinants of Refugee and Migrant Health Status in 10 European Countries: The Mig-HealthCare Project.

In this study, we collect and synthesize information on the health status of the refugee/migrant population in ten European countries in order to map refugee/migrant health needs. With this information, we identify areas of intervention and healthcare system strengthening to provide the basis for future health planning and effective healthcare provision to migrants, asylum-seekers and refugees in the European Union (EU). METHODS: 1407 migrants in ten European Union countries (consortium members of the Mig-HealthCare project) were surveyed on general health, mental health, and specific diseases using an interviewer-administered questionnaire. Descriptive statistics and multivariable linear regression analyses were conducted to investigate the risk factors on general quality of life for migrants and refugees in the EU. RESULTS: Mean age was 31.9 (±11.05) years and 889 (63.1%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Having a mental health disorder or a chronic disease such as a heart or respiratory disease was associated with worse general health. On the other hand, having permission to stay in the country of interview and being interviewed in the country of final destination was associated with better general health. Access to health care services was fragmented or unavailable for some interviewees because of linguistic, cultural, or administrative barriers. CONCLUSIONS: The management of chronic diseases and mental health conditions in European migrants and refugees is a key priority for health service provision. Further efforts should be made to guarantee healthcare access for migrant and refugee populations.

[Welcoming an Afghan in a French family: reactions and analysis]. / Accueil d'un Afghan au sein d'une famille française : réactions et analyse.

The family provides a holding and benevolent environment, allowing the subject to construct himself psychically. Beyond the family, the group of belonging allows an individual to feel that he or she exists. During migration, belonging can be broken: loss of country, language, family, social status, etc. In France, a reception programme for migrants in families helps them to integrate and rebuild their lives. The initial family dynamic is modified. Some important points need to be taken into account during this reception: motivations, consequences on family dynamics and psychological reshuffling.

The Influence of Premigration Trauma Exposure and Early Postmigration Stressors on Changes in Mental Health Over Time Among Refugees in Australia.

As a result of the precarious conditions in which they migrate, refugees are likely to have experiences that increase their risk of mental health problems. Refugees tend to be predisposed to relatively high levels of distress upon resettlement, and a key predictor of these issues is traumatic experiences that occur before their arrival. Despite high initial levels of ill-health, on average, refugees tend to experience mental health recovery over time. However, both levels of mental health upon settlement and recovery over time may be negatively influenced by stressors in the postsettlement period. The present study examined changes in psychological distress and posttraumatic stress symptoms over 5 years among 2,169 refugees from various backgrounds, predominately from Iraq and Afghanistan, who participated in the Building a New Life in Australia (BNLA) study. A multivariate latent growth curve model found mental ill-health decreased on average, ß = -.21 for distress and ß = -.31 for PTSD, ps < .001, and premigration trauma exposure predicted more initial PTSD symptoms and reduced recovery over time, ßIntercept = .21, ßSlope = -.54, p < .001. Postmigration stressors, such as loneliness, financial concerns, and cultural integration, predicted higher levels of mental health problems as well as reduced recovery over time. These findings suggest that beyond trauma exposure, the mental health of refugees upon resettlement and their recovery over time is impacted by stressors in the early resettlement period, which has important implications for interventions and services to support and encourage well-being in refugee populations.

Receipt of routine preventive care among infant daughters and sons of immigrant mothers in Ontario, Canada: a retrospective cohort study.

OBJECTIVES: To explore gender disparities in infant routine preventive care across maternal countries of birth (MCOB) and by mother tongue among infants of Indian-born mothers. SETTING: Retrospective population-based administrative cohort in Ontario, Canada (births between 2002 and 2014). PARTICIPANTS: 350 366 (inclusive) healthy term singletons belonging to families with a minimum of one opposite gender child. OUTCOME MEASURES: Fixed effects conditional logistic regression generated adjusted ORs (aORs) for a daughter being underimmunised and having an inadequate number of well-child visits compared with her brother, stratified by MCOB. Moderation by maternal mother tongue was assessed among children to Indian-born mothers. RESULTS: Underimmunisation and inadequate well-child visits were common among both boys and girls, ranging from 26.5% to 58.2% (underimmunisation) and 10.5% to 47.8% (inadequate well-child visits). depending on the maternal birthplace. Girls whose mothers were born in India had 1.19 times (95% CI 1.07 to 1.33) the adjusted odds of inadequate well-child visits versus their brothers. This association was only observed among the Punjabi mother tongue subgroup (aOR: 1.26, 95% CI 1.08 to 1.47). In the Hindi mother tongue subgroup, girls had lower odds of underimmunisation than their brothers (aOR: 0.73, 95% CI 0.54 to 0.98). CONCLUSIONS: Gender equity in routine preventive healthcare is mostly achieved among children of immigrants. However, daughters of Indian-born mothers whose mother tongue is Punjabi, appear to be at a disadvantage for well-child visits compared with their brothers. This suggests son preference may persist beyond the family planning stage among some Indian immigrants.

Barriers and associated factors for adequate antenatal care among Afghan women in Iran; findings from a community-based survey.

BACKGROUND: Almost a third of Afghan women living in Iran are at childbearing age. Antenatal care (ANC) is an inextricable part of healthy pregnancy and could prevent the adverse birth outcomes. Almost 97% of Iranian expectant women are receiving adequate ANC (4 or more visits). However, the situation for pregnant Afghan women is unclear. Some studies indicated low access to ANC among Afghan women. In the present study, we aimed to explore the sociodemographic factors and potential barriers associated with adequate ANC among Afghan women in Iran. METHODS: A cross sectional study was conducted between June 2019 and August 2019. Using time location sampling (TLS), we recruited 424 Afghan women aged 18-45 years old at three health centers in south region of Tehran. The data were collected on sociodemographic characteristics and the reported reasons for inadequate ANC using a questionnaire and analyzed applying bivariate, and multivariate analyses. Factor analysis was performed to reduce the number of potential reasons for inadequate ANC in order to improve the precision of regression analysis. RESULTS: Almost a third of Afghan women in this study had adequate ANC (≥ 8 visits). The women in older age group, those with higher education and family income, women with longer length of stay, those of legal status were more likely to have adequate ANC. In multivariate analysis, the poor knowledge and attitude toward ANC (AOR = 0.06; 95% CI [0.03-0.15]), the poor quality of services (AOR = 0.17 95% CI [0.07-0.41]); and to some extent, the difficulties in access (AOR = 0.33; 95% CI [0.11-1.00]) were the main obstacles toward adequate ANC among the study population. CONCLUSION: Our study emphasized the important role of the personal knowledge and attitude toward ANC with adequate antenatal care among Afghan women in Iran. This could be addressed by well-oriented interventions and health education for Afghan women. The collaboration between central government with international agencies should be directed toward enhancing the social support, promoting the awareness and knowledge, and expanding the safety net services to improve the access and quality care among Afghan women in Iran.

Perspectives of Afghan refugee mothers on the experience of caring for a child with cancer: a qualitative analysis.

BACKGROUND: Cancer in children causes many challenges for the family. When a refugee family experiences it, its impacts may be different and more specific considerations for care may be needed. AIMS: This study aimed to explore the experiences of Afghan mothers living in the Islamic Republic of Iran who had a child with cancer. METHODS: This was a qualitative study, conducted in 2017, of Afghan refugee women with children diagnosed with cancer and referred to a cancer referral hospital in Tehran; they were selected through purposive sampling. Face-to-face, semi-structured and in-depth interviews were conducted for data collection until data saturation was reached. Conventional content analysis was done. MAXQDA 10 was used for organizing the data. RESULTS: Nine Afghan mothers were interviewed. They were aged 24-44 years and the children were aged 2-9 years. A primary theme called "passive acceptor" was found with five subthemes: chronic suffering, health issues, lack of skills, maladaptive coping and enthusiasm. The mothers were struggling to cope with the challenges of caring for a child with cancer both financially, physically and emotionally. CONCLUSION: In spite of many issues in common with similar groups in other countries, Afghan mothers appear to need to greater assistance when it comes to seeking help and understanding for the care for their child with cancer, possibly because of cultural barriers to self-empowerment. Tailored care plans are recommended for Afghan refugee mothers in the Islamic Republic of Iran.

Changing Patterns in Epidemiology of Malaria Between 2006 and 2018 in the South of Fars Province, Southern Iran: The Fall and Rise of Malaria.

Background: Malaria is one of the major human health problems that have become increasingly important in recent decades. Objective: The present study aimed to identify the epidemiological status of malaria in the years 2006-2018 in the southern region of Fars province in southern Iran. Methods: This is a cross-sectional descriptive-analytical study. The study population consisted of all persons with malaria referred to the Center for Disease Control in the four cities of Larestan, Gerash, Evaz and Khonj in the south of Fars province, Southern Iran, between 2006 and 2018. Frequency (%) was used to report descriptive statistics and mean and standard deviation for quantitative variables. The trend of malaria incidence during these years was analyzed using the Cochran Armitage Test. The significance level was considered 5%. Findings: A total of 190 cases of malaria in the period of 2006 to 2018 occurred in the southern region of Fars province; 77.9% were men, more than 95% were Afghans, and most of them were workers. The incidence of malaria in one hundred thousand people per month showed that most of the new malaria cases were in the months of July to October. The peak incidence was in August, with 19.88 cases per 100,000 people. Cochran-Armitage test results showed that this trend was not statistically significant (P = 0.399), despite an almost upward trend in malaria incidence in the south of Fars province. Conclusion: The results of this study showed that the trend of malaria in the south of Fars province was ascending; therefore, increasing surveillance activities to prevent and control malaria in such area is of utmost importance.

Tuberculosis screening of asylum seekers in Finland, 2015-2016.

BACKGROUND: In Finland, asylum seekers from countries with high tuberculosis (TB) incidence (> 50/100,000 population/year) and those coming from a refugee camp or conflict area are eligible for TB screening. The aim of this study was to characterise the TB cases diagnosed during screening and estimate the yield of TB screening at the reception centres among asylum seekers, who arrived in Finland during 2015-2016. METHODS: Voluntary screening conducted at reception centres included an interview and a chest X-ray. Data on TB screening and health status of asylum seekers was obtained from the reception centres' national health register (HRS). To identify confirmed TB cases, the National Infectious Disease Register (NIDR) data of foreign-born cases during 2015-2016 were linked with HRS data. TB screening yield was defined as the percentage of TB cases identified among screened asylum seekers, stratified by country of origin. RESULTS: During 2015-2016, a total of 38,134 asylum applications were received (57% were from Iraq, 16% from Afghanistan and 6% from Somalia) and 25,048 chest x-rays were performed. A total of 96 TB cases were reported to the NIDR among asylum seekers in 2015-2016; 94 (98%) of them had been screened. Screening identified 48 (50%) cases: 83% were male, 56% aged 18-34 years, 42% from Somalia, 27% from Afghanistan and 13% from Iraq. Furthermore, 92% had pulmonary TB, 61% were culture-confirmed and 44% asymptomatic. TB screening yield was 0.19% (48/25048) (95%CI, 0.14-0.25%) and it varied between 0 and 0.83% stratified by country of origin. Number needed to screen was 522. CONCLUSIONS: TB screening yield was higher as compared with data reported from other European countries conducting active screening among asylum seekers. Half of the TB cases among asylum seekers were first suspected in screening; 44% were asymptomatic. TB yield varied widely between asylum seekers from different geographic areas.