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4.
Int J Gynaecol Obstet ; 148(1): 14-20, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31596955

RESUMEN

Lebanon invested in the prevention of maternal mortality after the civil war, which left a deficient vital registration system leading to unreliable estimates of maternal mortality ratio (MMR). Starting in 2004, the Ministry of Public Health integrated reproductive health into primary health care and established a national notification system of maternal and neonatal deaths. From 1990 to 2013, Lebanon achieved an annual change in MMR of -7.5%, which was the highest rate of reduction in the region and met the requirements of Millennium Development Goal 5. For the period 2010-2018, data collected through the national notification system indicate an MMR of 14.9, which is below the officially reported MMR of 23. Since the influx of Syrian refugees, Lebanon has experienced a rise in the number of live births with a slightly increasing trend in MMR, especially in regions with the highest concentration of refugees. Causes of maternal mortality in Lebanon align with the three-delays model, pointing to deficiencies in the quality of maternity care. More efforts are needed toward strengthening the national notification system to include cases that occur outside hospitals, identifying near-miss cases, reinforcing the emergency response system, and engaging with all stakeholders to improve quality of care.


Asunto(s)
Mortalidad Materna , Femenino , Humanos , Líbano/epidemiología , Nacimiento Vivo/epidemiología , Embarazo , Refugiados/estadística & datos numéricos
7.
Int J Equity Health ; 18(1): 158, 2019 10 16.
Artículo en Inglés | MEDLINE | ID: mdl-31619244

RESUMEN

BACKGROUND: There has been an increasing number of refugee women globally; yet, there is little recent data describing the health profile of refugee women by region of origin in the United States. It is important to monitor the health status of women by region of origin to provide needed targeted interventions. METHODS: We analyzed the Refugee Health Electronic Information System (RHEIS), a population-based dataset that included 14,060 female refugees who entered California between October 3, 2013 and February 15, 2017. We assessed differences in health status by region of origin. RESULTS: Almost one out of three women experienced a traumatic event. Women from Africa and Latin America and the Caribbean experienced higher levels of trauma compared to other regions, including sexual assault, physical, and weapon assault. More than half of women and girls (56.6%) reported experiences of persecution, with Southeast Asians reporting the highest levels. Among women of reproductive age, 7.0% of women were currently pregnant at the time of arrival to the US, 19.0% ever had a spontaneous abortion, and 8.6% reported ever having an abortion. One in three women from Africa reported female genital cutting. Moreover, 80.0% of women reported needing language assistance at the time of their health assessment. CONCLUSIONS: Refugee women and girls experience high levels of trauma and persecution, suggesting the need for trauma-informed care. Those working with refugee women, such as resettlement agencies and health providers, should be equipped with information about antenatal care, nutrition, and pregnancy to newly arrived women. Lastly, differences in health status by region of origin indicate a need for tailored interventions and linguistically appropriate health information.


Asunto(s)
Estado de Salud , Refugiados/estadística & datos numéricos , Salud de la Mujer/estadística & datos numéricos , Adolescente , Adulto , África/etnología , California , Región del Caribe/etnología , Conjuntos de Datos como Asunto , Femenino , Humanos , América Latina/etnología , Embarazo , Adulto Joven
8.
BMC Health Serv Res ; 19(1): 676, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533817

RESUMEN

BACKGROUND: Asylum seekers coming to most countries are offered a specific health examination. A previous study concluded that a considerable proportion of those taking part of it in Sweden had poor experiences of the communication in and the usefulness of this examination and had poor health literacy. The aim of this study was to explore in greater depth the experiences of the health examination for asylum seekers among Arabic- and Somali-speaking participants in Sweden. A secondary aim was to examine experiences and discuss findings using a health literacy framework. METHODS: Seven focus group discussions were conducted with 28 Arabic and Somali speaking men and women that participated in a health examination for asylum seekers. Data were analyzed by latent content analysis. RESULTS: One overarching theme - beneficial and detrimental - was found to represent the participants' experiences of the health examination for asylum seekers. Three categories were identified that deal with those experiences. The category of "gives some good" describes the examination as something that "gives support and relief" and "cares on a personal level." The category of "causes feelings of insecurity" describes the examination as something that "lacks clarity" and that "does not give protection." The category "causes feelings of disappointment" views the examination as something that "does not fulfil the image of a health examination" and "does not focus on the individual level." CONCLUSION: The health examination for asylum seekers was experienced as beneficial and detrimental at the same time. The feelings were influenced by the experiences of information and communication before, during and after the examination and on how health literate the organizations providing the HEA are. To achieve more satisfied participants, it is crucial that all organizations providing the HEA become health literate and person-centered.


Asunto(s)
Alfabetización en Salud , Refugiados/psicología , Adulto , Anciano , Árabes , Comunicación , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Organizaciones , Satisfacción Personal , Refugiados/estadística & datos numéricos , Somalia/etnología , Suecia , Adulto Joven
9.
Rev Saude Publica ; 53: 78, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31553381

RESUMEN

OBJECTIVE: To synthesize data about the prevalence of sexual violence (SV) among refugees around the world. METHODS: A systematic review was conducted from the search in seven bibliographic databases. Studies on the prevalence of SV among refugees and asylum seekers of any country, sex or age, whether in English, French, Spanish and Portuguese, were eligible. RESULTS: Of the 2,906 titles found, 60 articles were selected. The reported prevalence of SV was largely variable (0% to 99.8%). Reports of SV were collected in all continents, with 42% of the articles mentioning it in refugees from Africa (prevalence from 1.3% to 100%). The rape was the most reported SV in 65% of the studies (prevalence from 0% to 90.9%). The main victims were women in 89% of the studies, all the way, especially when still in the countries of origin. The SV was perpetrated particularly by intimate partners, but also by agents of supposed protection. Few studies have reported SV in men and children; the prevalence reached up to 39.3% and 90.9%, respectively. Approximately one-third of the studies (32%) were carried out in refugee camps and more than half (52%) in health services using mental health assessment tools. No study has addressed the most recent migratory crisis. Meta-analysis was not performed due to the methodological heterogeneity of the studies. CONCLUSIONS: SV is a prevalent problem affecting refugees of both sexes, of all ages, throughout the migratory journey, particularly those from Africa. Protection measures are urgently needed, and further studies, with more appropriate tools, may better measure the current magnitude of the problem.


Asunto(s)
Refugiados/estadística & datos numéricos , Delitos Sexuales/estadística & datos numéricos , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , Factores Sexuales
10.
J Glob Health ; 9(2): 020404, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31489187

RESUMEN

Background: Displacement after a war or an armed conflict always leads to unexpected health problems, both among migrating people and in places to which new people have migrated. This study aimed to determine the health care needs and trends of Syrian patients. Methods: This retrospective study was conducted in a secondary care hospital in the city of Nevsehir, in central Turkey, between January 2013 and December 2017. All Syrian patients who visited the outpatient clinics and emergency department (ED) were enrolled in the study. Results: Over a span of five years, 41 723 Syrian patients visited the hospital's outpatient clinics and ED. The patients' median age was 23 (inter-quartile range (IQR) = 7-34), and 57.7% of them were female. In 2017, one-third of the Syrian patients visited the ED, a rate that was higher than that found among local patients (30.3% vs 25.0%, P < 0.001, respectively). The rate of pediatric clinic admissions among Syrian patients was about four times greater than the rate of local patients (20.1% vs 5.2%, P < 0.001, respectively), and Syrians' rate of admission to the obstetrics and gynecology clinic was about three times greater than the rate of local patients' admissions (12.3% vs 4.3%, P < 0.001, respectively). Conclusions: This study showed that Syrian patients' visits to the hospital, and especially the ED, are increasing. Further, the needs and expectations of these patients in terms of health care are different from local demands. New approaches should be applied to provide an appropriate use of health care facilities.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Refugiados/estadística & datos numéricos , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Estudios Retrospectivos , Siria/etnología , Turquia , Adulto Joven
13.
Int J Equity Health ; 18(1): 130, 2019 08 22.
Artículo en Inglés | MEDLINE | ID: mdl-31438966

RESUMEN

BACKGROUND: Refugees are potentially at an increased risk for health problems due to their past and current migration experiences. How migration factors shape refugee health is not well understood. We examined the association between migration factors and the self-rated general health of adult humanitarian refugees living in Australia. METHODS: We analyzed the first three waves of data from the 'Building A New Life In Australia' longitudinal survey of 2399 humanitarian refugees resettled in Australia. The study outcome was self-rated health measured by the 36-Item Short Form Health Survey. Predictors were migration process and resettlement factors. We used generalized linear mixed models to investigate the relationship between predictor and outcome variables. RESULTS: Poor general health persisted among this refugee population at high levels throughout the three-year follow-up. At baseline, 35.7% (95% CI: 33.8-37.7%) of the study population reported poorer general health. Female gender, increasing age and post-migration financial stressors were positively associated with poorer general health. Having a university degree and absence of chronic health conditions were seemingly protective against declining general health (OR: 0.50; 95% CI: 0.65-1.81 and OR: 0.15, 95% CI: 0.09-1.04, respectively). CONCLUSION: Our results show that there is persisting high prevalence of poorer general health among adult refugees across the initial years of resettlement in Australia. This finding suggests unmet health needs which may be compounded by the challenges of resettlement in a new society, highlighting the need for increased clinical awareness of this sustained health burden to help inform and prepare refugee health care and settlement service providers.


Asunto(s)
Emigrantes e Inmigrantes , Emigración e Inmigración , Estado de Salud , Refugiados , Adolescente , Adulto , Factores de Edad , Anciano , Altruismo , Australia/epidemiología , Enfermedad Crónica , Estudios de Cohortes , Autoevaluación Diagnóstica , Escolaridad , Femenino , Encuestas Epidemiológicas , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Refugiados/estadística & datos numéricos , Factores Sexuales , Adulto Joven
14.
Artículo en Inglés | MEDLINE | ID: mdl-31349639

RESUMEN

BACKGROUND: While Turkey hosts the largest number of Syrian refugees, the provision of health services for chronic disease among Syrian refugees in Turkey has been inadequate and understudied. This paper explores Turkish healthcare policies surrounding Syrian refugees' access to health services for chronic diseases. METHODS: We conducted a literature review and supplementary stakeholder interviews to evaluate the provision of chronic health services and the most common barriers to healthcare access among Syrian refugees in Turkey. RESULTS: Though access to treatment for displaced Syrians has improved throughout the past five years, five primary barriers persist: registration procedure regulations, navigation of a new health system, language barriers, fear of adverse treatment, and cost. CONCLUSIONS: To drive improvements in healthcare for chronic diseases among Syrian refugees in Turkey, we recommend making registration procedures more accessible, developing more healthcare options in patients' native language, increasing human resources, and advocating for more research surrounding chronic health conditions among refugees.


Asunto(s)
Enfermedad Crónica/terapia , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/estadística & datos numéricos , Política de Salud , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Refugiados/estadística & datos numéricos , Barreras de Comunicación , Humanos , Siria , Turquia
16.
Sleep Health ; 5(4): 335-343, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31320291

RESUMEN

BACKGROUND: Worldwide, 68.5 million individuals are refugees, asylum seekers, or internally displaced. Although many studies have examined mental health concerns in this population, few studies have assessed sleep or examined the relationship between sleep and mental health or psychosocial functioning. OBJECTIVES: The objectives were to (1) examine the prevalence of sleep disturbance within refugees and asylum seekers from diverse backgrounds, (2) examine mental health and psychosocial factors associated with sleep disturbance, and (3) explore whether symptoms cluster together in unique subsets of individuals. METHODS: Clinician-administered interview data (N = 2703) were obtained from a large mental health service in greater Melbourne, Australia. Data included patient demographics, sleep disturbance, mental health (anxiety, depression, traumatic stress symptoms), and psychosocial concerns (family dysfunctions, interpersonal difficulties, social isolation). RESULTS: A total of 75.5% of the sample reported moderate or severe sleep disturbance. Severity of sleep disturbance was positively correlated with severity of mental health symptoms, psychosocial concerns, age, and migration status. This was true in both refugee and asylum seeker populations and in both adults and children. Cluster analyses revealed 3 subsets of individuals: those with "severe sleep and anxiety symptoms," "mild to moderate symptoms," and "mild symptoms." Using "mild symptoms" as the comparator, being a refugee and increasing age were associated with a 1.57- and 1.02-fold increase, respectively, in the likelihood of classification as "severe sleep and anxiety problems" and 1.70- and 1.02-fold increase, respectively, in the likelihood of classification as "mild to moderate symptoms." CONCLUSION: These findings suggest that systematic screening of sleep disturbance among refugees and asylum seekers during health-related visits is needed.


Asunto(s)
Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Refugiados/psicología , Trastornos del Sueño-Vigilia/epidemiología , Adolescente , Adulto , Anciano , Australia/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Prevalencia , Refugiados/estadística & datos numéricos , Factores de Riesgo , Adulto Joven
17.
Niger J Clin Pract ; 22(7): 913-919, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31293254

RESUMEN

Background: Non-communicable diseases (NCDs) are a major challenge to health and social development in the 21st century, and North Korea is no exception. However, there is a lack of information concerning NCDs in North Korea, and a different approach is needed to understand the NCDs burden there. This study examines the perceptions and experiences of refugee doctors from North Korea concerning the NCDs burden in North Korea. Methods: Focus group discussions were conducted with 10 refugee doctors from North Korea who had been recruited through snowball sampling. Results: North Korean refugee doctors participating in this study indicated that NCDs are the highest priority diseases, that North Koreans did not appear to have a high level of understanding and knowledge of NCDs, that economic breakdown was the primary cause of the NCDs burden, and that a high priority should be assigned to targeting NCDs in North Korea. Discussion: Although the North Korean refugee doctors were medical professionals, they faced serious challenges accessing and managing patients with NCDs. South Korea needs to prepare for a potentially large number of people with NCDs should a freer movement of peoples occur between the two countries.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Enfermedades no Transmisibles/epidemiología , Médicos/psicología , Refugiados/psicología , Adulto , República Popular Democrática de Corea/etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Percepción , Refugiados/estadística & datos numéricos , República de Corea/epidemiología
18.
Pan Afr Med J ; 32: 188, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31312300

RESUMEN

Introduction: This study explored the differences on the level of medical care required by camp and non-camp resident patients during utilisation of the health services in Mae La refugee camp, Tak province, Thailand during the years 2006 and 2007. Methods: Data were extracted from camp registers and the Health Information System used during the years 2006 and 2007 and statistical analysis was performed. Results: The analysis showed that during 2006 and 2007 non-camp resident patients, coming from Thailand as well as Myanmar, who sought care in the outpatient department (OPD) of the camp required at a significantly higher proportion admission to the inpatient department (IPD) or referral to the district hospital compared to camp resident patients. Although there was a statistically significant increased mortality of the non-camp resident patients admitted in the IPD compared to camp resident patients, there was no significant difference in mortality among these two groups when the referrals to the district hospital were analysed. Conclusion: Non-camp resident patients tended to need a more advanced level of medical care compared to camp resident patients. Provided that this it is further validated, the above observed pattern might be potentially useful as an indirect indicator of unaddressed health needs of populations surrounding a refugee camp.


Asunto(s)
Servicios de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Campos de Refugiados/estadística & datos numéricos , Refugiados/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Tailandia
19.
Parasitol Res ; 118(9): 2679-2687, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31289943

RESUMEN

Turkey is one of the leishmaniasis endemic countries, and according to the recent reports, more than 45% of the cases were reported from the Southeastern part of Turkey. The disease is endemic in Syria with annually 25,000 cases, and it is emphasized by WHO that the actual number was estimated to be 2-5-fold higher than the reported numbers. Due to the civil war in Syria, more than seven million people were displaced and migrate to neighboring countries. The population structure of Leishmania tropica was investigated in the present study using clinical samples, which were obtained from Syrian patients residing in Turkey. Previously reported database was used to compare the results obtained in the present study. According to the multilocus microsatellite typing profiles, three populations (Sanliurfa, Mediterranean, and Syrian/Turkish) were identified. Syrian/Turkish population, which is a new structure and identified for the first time in the present study, was comprised of clinical samples obtained from Syrian patients. The newly described population structure was homogeneous and solid comparing to previously identified population structures in Turkey. Further analyses revealed two sub-populations under the main Syrian/Turkish population structure. The findings of the present study revealed that the epidemiological status of leishmaniasis is more complicated than it is estimated. We believe that the data presented here will provide valuable information on the leishmaniasis epidemiology.


Asunto(s)
Leishmania tropica/aislamiento & purificación , Leishmaniasis Cutánea/parasitología , Humanos , Leishmania tropica/clasificación , Leishmania tropica/genética , Leishmaniasis Cutánea/epidemiología , Repeticiones de Microsatélite , Tipificación de Secuencias Multilocus , Filogenia , Refugiados/estadística & datos numéricos , Siria/epidemiología , Turquia/epidemiología
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