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1.
BMC Health Serv Res ; 21(1): 921, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488719

RESUMO

BACKGROUND: Language is a barrier to many patients from refugee backgrounds accessing and receiving quality primary health care. This paper examines the way general practices address these barriers and how this changed following a practice facilitation intervention. METHODS: The OPTIMISE study was a stepped wedge cluster randomised trial set within 31 general practices in three urban regions in Australia with high refugee settlement. It involved a practice facilitation intervention addressing interpreter engagement as one of four core intervention areas. This paper analysed quantitative and qualitative data from the practices and 55 general practitioners from these, collected at baseline and after 6 months during which only those assigned to the early group received the intervention. RESULTS: Many practices (71 %) had at least one GP who spoke a language spoken by recent humanitarian entrants. At baseline, 48 % of practices reported using the government funded Translating and Interpreting Service (TIS). The role of reception staff in assessing and recording the language and interpreter needs of patients was well defined. However, they lacked effective systems to share the information with clinicians. After the intervention, the number of practices using the TIS increased. However, family members and friends continued to be used to interpret with GPs reporting patients preferred this approach. The extra time required to arrange and use interpreting services remained a major barrier. CONCLUSIONS: In this study a whole of practice facilitation intervention resulted in improvements in procedures for and engagement of interpreters. However, there were barriers such as the extra time required, and family members continued to be used. Based on these findings, further effort is needed to reduce the administrative burden and GP's opportunity cost needed to engage interpreters, to provide training for all staff on when and how to work with interpreters and discuss and respond to patient concerns about interpreting services.


Assuntos
Medicina Geral , Refugiados , Austrália , Barreiras de Comunicação , Humanos , Tradução
3.
BMC Public Health ; 21(1): 1606, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465333

RESUMO

BACKGROUND: Migrants face structural, socio-political barriers in their resettlement processes that negatively affect their health. Migration also adversely impacts resources such as social capital and health literacy that are of importance for health and integration into society. Hence, there is a need for health promotion in the early post-migration phase. In Sweden, newly settled refugee migrants who have received a residence permit are offered an Introduction programme including a civic orientation course. The program is intended to facilitate access to the labour market and promote integration. The aim of the study was to explore participants' perceptions and experiences of a civic orientation course with added health communication. METHODS: We performed six focus group discussions: two in Arabic, two in Farsi and two in Somali. The discussions were facilitated by native speaking moderators. Participants were 32 men and women recruited from civic orientation classes in the county of Stockholm. We used an interview guide with semi-structured questions. The data were analysed using a method for content analysis for focus group discussions. RESULTS: Three main categories were identified: (1) 'The course gives valuable information but needs adjustments', which includes that the civic and health orientation is needed earlier, during the asylum phase, and that planning and course content need adjustments. (2) 'The health communication inspired participants to focus on their health', which includes that the health communication was useful and inspired uptake of healthier habits. (3) 'Participation in the course promoted independence and self-confidence', which includes that the course gave insights into society and values in Sweden, and promoted independence and new social contacts. CONCLUSION: This study adds knowledge about the users' perspectives on the potential of civic orientation to promote the health and integration of newly settled migrants, describing ways in which civic orientation with added health communication promoted health and empowerment. However, the content and delivery of the course need adjustment to better fit the migrants' life situations and varying pre-existing knowledge.


Assuntos
Refugiados , Migrantes , Feminino , Humanos , Masculino , Percepção , Pesquisa Qualitativa , Suécia
4.
BMC Public Health ; 21(1): 1620, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488688

RESUMO

BACKGROUND: A growing literature has drawn attention to the central role that schools play in supporting the adjustment of resettled refugee youth and promoting their mental health and psychosocial wellbeing. In particular, the recent proliferation of school-based social and emotional learning (SEL) initiatives presents an opportunity to strengthen supports for resettled adolescents. This participatory research study aims to understand how high school students resettled from countries in the Middle East and North Africa region are experiencing the challenges and opportunities of acculturation and the ways in which they believe schools can better support them in this process. METHODS: We analyzed primary data collected during focus group discussions as part of the SALaMA study. During these discussions, we used participatory ranking methodology to elicit adolescents' suggestions on how high schools can better support students both academically and psychosocially after resettlement. Fourteen focus group discussions were held with male (n = 38) and female (n = 31) adolescents aged 14-20 years, who were selected purposively across six public high schools in Harrisonburg, Virginia, Austin, Texas, and Detroit, Michigan. Participants offered suggestions and then ranked them in order of importance using consensus ranking. RESULTS: Thematic analysis of the PRM results across sites produced a wealth of suggestions centered around three broad themes, namely: skills related to navigating social and academic challenges, culturally responsive teaching, and socially and culturally equitable learning environments. CONCLUSIONS: Findings reported illustrate limitations of the conventional, universal SEL model and shed light on how schools can adapt transformative SEL strategies to serve their students better, especially newcomers from conflict-affected countries.


Assuntos
Saúde Mental , Refugiados , Aculturação , Adolescente , Emoções , Feminino , Humanos , Masculino , Instituições Acadêmicas
5.
Artigo em Inglês | MEDLINE | ID: mdl-34501496

RESUMO

International mobility has increased steadily in recent times, bringing along a myriad of health, social and health system challenges to migrants themselves and the host nations. Mental health issues have been identified as a significant problem among migrants, with poor accessibility and underutilisation of the available mental health services (MHSs) repeatedly reported, including in Australia. Using a qualitative inquiry and one-on-one in-depth interviews, this study explored perspectives of African migrants and service providers on barriers to accessing MHSs among African migrants in South Australia. The data collection took place during the COVID-19 pandemic with lockdown and other measures to combat the pandemic restricting face to face meetings with potential participants. Online platforms including Zoom and/or WhatsApp video calls were used to interview 20 African migrants and 10 service providers. Participants were recruited from community groups and/or associations, and organisations providing services for migrants and/or refugees in South Australia using the snowball sampling technique. Thematic framework analysis was used to guide the data analysis. Key themes centred on personal factors (health literacy including knowledge and the understanding of the health system, and poor financial condition), structural factors related to difficulties in navigating the complexity of the health system and a lack of culturally aware service provision, sociocultural and religious factors, mental health stigma and discrimination. The findings provide an insight into the experiences of African migrants of service provision to them and offer suggestions on how to improve these migrants' mental health outcomes in Australia. Overcoming barriers to accessing mental health services would need a wide range of strategies including education on mental health, recognising variations in cultures for effective service provision, and addressing mental health stigma and discrimination which strongly deter service access by these migrants. These strategies will facilitate help-seeking behaviours as well as effective provision of culturally safe MHSs and improvement in access to MHSs among African migrants.


Assuntos
COVID-19 , Serviços de Saúde Mental , Refugiados , Migrantes , Controle de Doenças Transmissíveis , Acesso aos Serviços de Saúde , Humanos , Pandemias , Pesquisa Qualitativa , SARS-CoV-2 , Austrália do Sul
6.
BMC Public Health ; 21(1): 1659, 2021 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-34511064

RESUMO

BACKGROUND: The emergence of the new causative agent of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the city of Wuhan, China, in December 2019, and its spread worldwide, led the World Health Organization (WHO) to declare a pandemic. The disease has caused high mortality among traditional populations and the most socially vulnerable groups such indigenous and refugees. The present study aims to investigate the prevalence of anti-SARS-CoV-2 IgG antibodies in the population of Venezuelan indigenous Warao refugees residing in private and public shelters in the city of Belem, capital of Para State, in the Brazilian Amazon. METHODS: One hundred one individuals of both sexes (43 men and 58 women) with ages varying from 18 to 77 years (average of 36 years) were investigated. Whole blood samples were collected and subsequently separated into plasma and leukocytes. Serological analysis was performed using an enzyme-linked immunosorbent assay - ELISA (Anti-SARS-COV-2 S1 IgG, EUROIMMUN, USA). RESULTS: The results indicate a positive serum prevalence of 83.2% (84), of which 77.6% (45/58) were females and 90.7% (39/43) were males. An indeterminate profile was observed in 6.9% (7), where it was not possible to confirm the presence of antibodies, and 9.9% (10) individuals were negative for IgG antibodies. CONCLUSIONS: The finding of the high seroprevalence of IgG anti-SARS-CoV-2 antibodies reveals a high exposure of the Warao population in Belem to infection with the new coronavirus. These results underscore the importance of maintaining epidemiological surveillance with testing in traditional populations due to the high possibility of spreading the virus, especially among the most socioeconomically vulnerable groups, which depend exclusively on the Unified Health System (SUS), such as refugees and indigenous people.


Assuntos
COVID-19 , Refugiados , Adolescente , Adulto , Idoso , Anticorpos Antivirais , Brasil/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Estudos Soroepidemiológicos , Adulto Jovem
7.
Praxis (Bern 1994) ; 110(12): 681-688, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34521270

RESUMO

CME: Traumatized Refugees in Family Practice - A Quick Reference Guide Abstract. Traumatic experiences, flight and life in exile do not constitute an illness per se, but are associated with an increased risk of mental illness. In view of the lack of specialized treatment units, the general practitioner's office often remains the only place of treatment for traumatized refugees. Particularly challenging is the combination of complex complaints, multidimensional psychosocial stress factors and difficult treatment conditions which face managerial and organizational limitations in the dense daily practice routine. In this article, recommendations for working with this heterogeneous group of patients are discussed.


Assuntos
Refugiados , Transtornos de Estresse Pós-Traumáticos , Medicina de Família e Comunidade , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia
8.
Glob Health Action ; 14(1): 1969117, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34486956

RESUMO

BACKGROUND: Forced evictions are common in conflict-affected settings. More than 500 internally displaced persons (IDPs) are evicted daily in Mogadishu. Context specific research is necessary to inform responsive humanitarian interventions and to monitor the effectiveness of these interventions on IDPs health. OBJECTIVE: This study explored the causes of forced evictions and their health impacts among IDPs in southern Somalia. METHODS: We used a qualitative approach, conducting 20 semi-structured interviews, six key informant interviews and four focus group discussions. We used maximum variation sampling to include a wide range of participants and used the framework approach and Nvivo software to analyse the data. RESULTS: In this context, landlords often rented land without proper tenure agreements, resulting in risk of forced evictions. Informal tenure agreements led to fluctuations in rent, and IDPs were evicted because tenancy laws were inadequate and failed to protect IDP rights. IDP settlements often increased the value of land by clearing scrub, and landlords often sought to profit from this by evicting IDPs at short notice if a buyer was found for the land. The effect of eviction on an already marginalised population was wide ranging, increasing their exposure to violence, loss of assets, sexual assault, disruption of livelihoods, loss of social networks and family separation. Evicted IDPs reported health issues such as diarrhoea, malaria, pneumonia, measles and skin infections, as well as stress, anxiety, psychological distress and trauma. CONCLUSION: Forced evictions remain one of the biggest challenges for IDPs as they exacerbate existing vulnerabilities. Prioritizing implementation of legal protection for IDP tenure rights is necessary to prevent unlawful evictions of IDPs. Humanitarian agencies should aim to respond more effectively to protect evictees and provide support to prevent poor health outcomes. Further quantitative research is needed to further examine the relationship between forced evictions and health outcomes.


Assuntos
Refugiados , Grupos Focais , Humanos , Pesquisa Qualitativa , Somália , Violência
9.
Glob Health Action ; 14(1): 1968124, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34493163

RESUMO

BACKGROUND: In 2017 hundreds of thousands of 'Rohingya' fled to camps for Forcefully Displaced Myanmar Nationals (FDMN) in Cox's Bazar, Bangladesh. OBJECTIVE: To describe the FDMNs presenting for care at public health facilities in Bangladesh so as to understand the health problems faced by the FDMNs and the burden on these public health facilities. METHODS: This study combined a retrospective review of existing hospital and clinic data with prospective surveillance in government health care centres. FINDINGS: The retrospective data showed a 26% increase in the number of consultations at the Kutupalong community clinic, the primary health facility closest to the camps, from 19,567 in 2015 to 26,309 in 2019. There was a corresponding 11% increase in admissions to health facilities in the area, from 80,991 in 2017 to 91,424 in 2019. Prospective surveillance of 9,421 FDMNs seeking health care from July 2018 to December 2019 showed that 29% had an infectious disease, 20% nutritional problems, 12% pregnancy-related conditions and 7% trauma or injury. CONCLUSIONS: Great uncertainty remains regarding the return of FDMN to their home country of Myanmar. The current on-going protests following the military coup adds further insecurity to the status of the Rohingya. The presence of a large migrant population relative to a smaller host community burdens the limited facilities and resources of the public health sector. Continued support by the international public health community and civil society organizations is needed.


Assuntos
Saúde Pública , Refugiados , Bangladesh , Hospitais Públicos , Humanos , Mianmar , Estudos Prospectivos , Estudos Retrospectivos
10.
Front Public Health ; 9: 704678, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34485230

RESUMO

Lebanon is in the midst of a rapidly escalating, unprecedented humanitarian crisis that is plunging the country deep into poverty and threatens population well-being, economic development, social welfare and national and regional stability. The dire situation is due to the compounding effects of the August 2020 Beirut blast, massive economic collapse and the COVID-19 pandemic, in a setting of longstanding entrenched political corruption and a dysfunctional, mismanaged crisis response by the state. This current emergency occurs on the background of a turbulent history and complex regional geopolitical context - including the Syrian refugee crisis, the ongoing influence of foreign actors and their local proxies, the United-States-imposed sanctions, endemic corruption, a culture of nepotism and entitlement among the political dynasties, dysfunctional power-sharing and deep-seated sectarian divides. With over half the population now living in poverty, a generation of children are among those at risk. This Perspective provides a brief overview of Lebanon's current complex humanitarian crisis, discusses the impacts of the evolving situation on youth and proposes a suite of recommendations to mitigate the effects.


Assuntos
COVID-19 , Refugiados , Adolescente , Criança , Humanos , Líbano/epidemiologia , Pandemias , SARS-CoV-2
11.
Artigo em Inglês | MEDLINE | ID: mdl-34444226

RESUMO

Previous cross-sectional studies showed that immigrants from low-income to high-income countries have higher risk of cardiovascular disease and type 2 diabetes mellitus. We investigated the association between weight gain during the resettlement in South Korea and risk of metabolic syndrome (MetS) among North Korean refugees (NKRs) in this cross-sectional study. In total, 932 NKRs aged 20-80 years in South Korea voluntarily underwent health examination from 2008 to 2017. We compared the risk of MetS and its components between the weight gain group (gained ≥5 kg) and the non-weight gain group (gained <5 kg, maintained or lost body weight) during resettlement in South Korea after defection from North Korea. Multiple logistic regression analysis predicted odds ratio of MetS on the basis of weight change, adjusting for covariates and current body mass index (BMI). We also evaluated the difference in body composition of NKRs between two groups. The prevalence of MetS in the weight gain group was 26%, compared to 10% in the non-weight gain group (p-value < 0.001). The weight gain group had a two-fold higher risk of MetS than the non-weight gain group after adjusting for current BMI (odds ratio 1.875, p-value = 0.045). The prevalence of central obesity, impaired fasting glucose, elevated blood pressure, and hypertriglyceridemia were higher in the weight gain group than the non-weight gain group (36% vs. 12%, p-value < 0.001; 32% vs. 19%, p-value < 0.001; 34 vs. 25%, p-value = 0.008; 19% vs. 13%, p-value = 0.025, respectively). The analysis of body composition showed that the percentage of body fat in the weight gain group was higher than in the non-weight gain group, indicating increased fat mass rather than muscle mass in the weight gain group as their body weight increased during resettlement (33.4 ± 6.53% vs. 28.88 ± 7.40%, p < 0.005). Excess weight gain after defection from North Korea increased the risk of MetS among NKRs in South Korea. It is necessary to monitor weight change among NKRs and their effect on their metabolic health in the long term.


Assuntos
Diabetes Mellitus Tipo 2 , Síndrome Metabólica , Refugiados , Índice de Massa Corporal , Estudos Transversais , Humanos , Síndrome Metabólica/epidemiologia , Prevalência , República da Coreia/epidemiologia , Fatores de Risco , Ganho de Peso
12.
Artigo em Inglês | MEDLINE | ID: mdl-34444235

RESUMO

The centrality of the collective to Syrian identity and the ability of war to disrupt community ties have led to significant violations of Syrians' pre-war assumptions about themselves, the world, and their place in the world. Guided by the integrated meaning-making model, this qualitative cross-sectional study assessed Syrian refugees' meaning trajectories through their reappraisals of the war, attempts to repair community-informed shattered meanings, and those processes' outputs (i.e., meanings-made) and outcomes (i.e., perceived psychological adjustment). We conducted semi-structured cognitive interviews with 39 Syrian war-exposed adults living in urban communities across Portugal, most of whom were beneficiaries of higher education programs for refugees. Interviews were analyzed through thematic analysis. Results suggest that the war severely disrupted Syrians' sense of collective self, and that they repeatedly engaged in search for meaning, appraisals of the war, and reappraisals of shattered beliefs, life goals, and sense of purpose, both during wartime and in resettlement. In Portugal, despite persistent negative beliefs about the collective and ongoing and distressing searches for meaning, participants' lived experiences concomitantly informed positive meaning reappraisals, including progressive restoration of worldviews, new opportunities for self-realization, and newly-found purpose, leading to perceived psychological benefits and growth. These findings suggest that meaning-making is both a trajectory and a dynamic process, informed by place and sociopolitical context. Clinical work to facilitate adaptive meaning-making and meaning-informed psychosocial interventions that help restore refugees' shattered beliefs about safety, predictability, trust, and belonging, may be helpful directions to promote positive psychological adjustment and improve long-term integration prospects in refugees.


Assuntos
Refugiados , Adaptação Psicológica , Adulto , Estudos Transversais , Humanos , Portugal , Síria
13.
Artigo em Inglês | MEDLINE | ID: mdl-34360147

RESUMO

Background: The assignment of newly arrived refugee children to the differentiated German school system represents a major challenge for the responsible municipalities. In this explorative research approach, the current assignment procedure, in addition to the necessary assessment of performance and the detection of learning, mental, or social disabilities of newly arrived refugee children in North Rhine-Westphalia (NRW), Germany, were investigated. Methods: Eight staff members of six relevant Communal Integration Centers (CICs) in NRW were interviewed and a qualitative content analysis was conducted. Results: The current assignment practices varied widely. The binding to guidelines differed; additionally, the school assignment or recommendation largely depended on personal engagement, connections, and attitudes of the relevant CIC staff. None of the CICs used standardized instruments. Instead, the staff assessed the performance with self-developed strategies such as free and playful approaches or self-developed worksheets, and counted on their 'gut feeling' and professional experience. Conclusion: The school career and education of newly arrived refugee children in NRW is largely inconsistent and dependent on the responsible CIC (e.g., the allocation of the family) and on the counseling staff member. Additionally, it must be assumed that relevant disabilities remain largely undetected.


Assuntos
Refugiados , Criança , Cidades , Alemanha , Humanos , Projetos de Pesquisa , Instituições Acadêmicas
14.
Nutrients ; 13(7)2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34371942

RESUMO

Food security among migrants and refugees remains an international public health issue. However, research among ethnic minorities in Australia is relatively low. This study explored the factors that influence the understanding of food labelling and food insecurity among Libyan migrants in Australia. An online survey was completed by 271 Libyan migrant families. Data collection included the 18-item US Household Food Security Survey Module (for food security) and a question from the Food Standards Australia New Zealand Consumer Label Survey (for food labelling comprehension). Multivariable logistic regression modelling was utilised to identify the predictors of food label comprehension and food security. Food insecurity prevalence was 72.7% (n = 196) while 35.8% of families (n = 97) reported limited food label understanding. Household size, food store location, and food affordability were found to be significantly related to food insecurity. However, gender, private health insurance, household annual income, education, and food store type and location were found to be significantly related to food labelling comprehension. Despite the population's high educational status and food labelling comprehension level, food insecurity remained an issue among the Libyan migrants. Policy makers should consider the incorporation of food label comprehension within a broader food security approach for migrants.


Assuntos
Compreensão , Emigrantes e Imigrantes , Insegurança Alimentar , Rotulagem de Alimentos , Abastecimento de Alimentos , Proficiência Limitada em Inglês , Leitura , Refugiados , Adulto , Austrália/epidemiologia , Comportamento do Consumidor , Estudos Transversais , Feminino , Insegurança Alimentar/economia , Abastecimento de Alimentos/economia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Líbia/etnologia , Masculino , Pessoa de Meia-Idade , Pobreza , Inquéritos e Questionários
15.
BMC Public Health ; 21(1): 1537, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380444

RESUMO

BACKGROUND: Turkey hosts nearly four million refugees and 99% live in urban areas. Research in urban settings pose different challenges and opportunities than research in refugee camps. In this article, we aimed to share the challenges and experiences we encountered in a mixed-methods study to assess mental health problems and barriers to accessing mental health care among refugees in urban areas of Turkey. DISCUSSION: In our case, the main challenges in conducting research with refugees were collecting data from a highly traumatized population, difficulties with contacting undocumented asylum seekers including trust issues and the fear of deportation, the risk of secondary traumatization among data collectors, and the bureaucracy during study approval processes. Targeting a representative sample was not feasible, because of the lack of publicly available demographic data on a district level, presence of undocumented asylum seekers and high mobility among the refugees. Although respondents with significant psychological symptoms were routinely referred to available mental health services, we were able to do less for unregistered refugees with problems in accessing health care. Language/alphabet differences and differing dialects of Arabic posed another challenge in both translation and administration of the scales. Based on cultural characteristics, a gender-balanced team was used and the interviewers were gender-matched whenever needed. Also, the research team had to work after work hours and during weekends to be able to interview male refugees, since most refugee men were at work during working hours and most days of the week. CONCLUSIONS: The research team's experience showed that refugee population characteristics including level of trauma, language, culture, gender, legal status, and urban setting characteristics including places of living, mobility, availability of publicly available demographic data, and outreach-related barriers lead to different challenges and ethical responsibilities of researchers and affect the research costs in terms of time, human resources and finance. Even in a host country with geographical, religious and cultural proximity to the refugees, profound challenges exist in conducting mental health research in urban settings. Learning from previous experience and collaborating with local researchers and institutions are vital for better public health research and practice outcomes.


Assuntos
Refugiados , Acesso aos Serviços de Saúde , Humanos , Masculino , Saúde Mental , Campos de Refugiados , Turquia
16.
Lancet Glob Health ; 9(9): e1286-e1295, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34416214

RESUMO

BACKGROUND: People in humanitarian emergencies are likely to experience excess mortality but information on the causes of death is often unreliable or non-existent. This study aimed to provide evidence on the causes of death among children younger than 5 years in camps for internally displaced people in southern Somalia, during periods of protracted displacement and emergency influx amid the 2017 drought and health emergency. METHODS: We did a prospective, cohort study in 25 camps in the Afgooye corridor, on the outskirts of Mogadishu, Somalia. All internally displaced children aged 6-59 months were included and followed up with monthly household visits by community health workers. Nutrition, health, and vaccination status were ascertained and verbal autopsy interviews were done with the caregivers of deceased children. We calculated death rates in these children and used verbal autopsy to establish the cause-specific mortality fraction (CSMF). Bayesian InterVA software was used to assign likely causes to each death. FINDINGS: Between March, 2016, and March, 2018, 3898 children were followed up. 153 deaths were recorded during 34 746 person-months of observation. The death rate among children younger than 5 years exceeded emergency thresholds (>2 deaths per 10 000 children per day), reaching a peak of seven deaths per 10 000 children per day during the emergency influx. Verbal autopsy data were gathered for 80% of deaths, and the CSMF for the three leading causes of death were diarrhoeal diseases (25·9%), measles (17·8%), and severe malnutrition (8·8%). Coverage of measles vaccination during the first 3 months of the emergency was 42% and the CSMF for measles doubled during the influx. During protracted displacement, symptoms that could be attributable to HIV/AIDS related deaths accounted for 1·6% of the CSMF. INTERPRETATION: It is feasible to establish a health and nutrition surveillance system that ascertains causes of death, using verbal autopsy, in this humanitarian context. These data can inform policy, response planning, and priority setting. The high mortality rate from infectious diseases and malnutrition among children younger than 5 years suggests the need for strengthening a range of public health interventions, including vaccination and provision of water, sanitation, and hygiene. FUNDING: UK Department of International Development.


Assuntos
Autopsia , Mortalidade da Criança , Campos de Refugiados , Refugiados/estatística & dados numéricos , Causas de Morte , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Somália/epidemiologia
17.
Can Fam Physician ; 67(8): 575-581, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34385202

RESUMO

OBJECTIVE: To guide clinicians working in a range of primary care clinical settings on how to provide effective care and support for refugees and newcomers during and after the coronavirus disease 2019 (COVID-19) pandemic. SOURCES OF INFORMATION: The described approach integrates recommendations from evidence-based clinical guidelines on refugee health and COVID-19, practical lessons learned from Canadian Refugee Health Network clinicians working in a variety of primary care settings, and contributions from persons with lived experience of forced migration. MAIN MESSAGE: The COVID-19 pandemic has amplified health and social inequities for refugees, asylum seekers, undocumented migrants, transient migrant workers, and other newcomers. Refugees and newcomers face front-line exposure risks, difficulties accessing COVID-19 testing, exacerbation of mental health concerns, and challenges accessing health care, social, and settlement supports. Existing guidelines for clinical care of refugees are useful, but creative case-by-case strategies must be employed to overcome additional barriers in the context of COVID-19 and new care environments, such as the need for virtual interpretation and digital literacy skills. Clinicians can address inequities and advocate for improved services in collaboration with community partners. CONCLUSION: The COVID-19 pandemic is amplifying structural inequities. Refugees and newcomers require and deserve effective health care and support during this challenging time. This article outlines practical approaches and advocacy priorities for providing care in the COVID-19 context.


Assuntos
COVID-19 , Refugiados , Teste para COVID-19 , Canadá , Acesso aos Serviços de Saúde , Humanos , Pandemias , SARS-CoV-2
18.
BMJ Glob Health ; 6(8)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34348932

RESUMO

BACKGROUND: Jordan hosts the largest Palestine refugee population in the world. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is the primary healthcare provider for Palestine refugees. To better inform UNRWA's health programme, we conducted this study to assess the prevalence and determinants of malnutrition among Palestine refugee children in Jordan and to analyse caregiver perceptions of food insecurity and structural barriers to accessing food. METHODS: A cross-sectional study was conducted with a randomly selected sample of 405 households, for children under 5 years old in two refugee camps in Jordan, Jerash and Souf. Sociodemographic, food insecurity, diet quality and child anthropometric data were collected. Also, twenty in-depth interviews were conducted with children's caregivers, along with two focus group discussions with UNRWA staff. RESULTS: Out of the 367 participants, the prevalence of stunting was 23.8% in Jerash and 20.4% in Souf (p=0.46), and overweight was 18.2% versus 7.1%, respectively (p=0.008). However, high food insecurity in Jerash was 45.7% and 26.5% in Souf (p=0.001), with no significant difference after multivariable adjustment. Qualitative perspectives saw food insecurity and low-quality children's diets as largely mediated by job and income insecurity, especially marked in Jerash due to the lack of Jordanian citizenship. CONCLUSION: We found a moderate-to-high prevalence of stunting and overweight levels among Palestine refugee children, which are three times higher than the 2012 Demographic and Health Survey data for Jordanian non-refugee children. High rates of household food insecurity were closely tied to households' lack of essential civil and economic rights. We call for international collective efforts to expand economic livelihoods for Palestine refugees and to support UNRWA's ongoing operations.


Assuntos
Desnutrição , Refugiados , Pré-Escolar , Estudos Transversais , Humanos , Jordânia/epidemiologia , Desnutrição/epidemiologia , Oriente Médio
19.
Artigo em Inglês | MEDLINE | ID: mdl-34444576

RESUMO

The Syrian conflict has led to a mass migration of Syrians to other countries and exposed them to many possible traumatic events and stressors in their country of origin and in the resettlement process. The possibility of positive psychological effects of adverse life events is less documented among Syrian refugees. Thus, the current study aimed to develop preliminary evidence for the identifying factors: traumatic experiences, post-migration stressors and coping strategies that are associated with post-traumatic growth (PTG) of Syrian refugees residing in Turkey. Structural equation modeling (SEM) was used in the current study to assess the associations among these factors. Data were obtained from Syrian refugees residing in the governorates of Hatay and Mardin. A total of 528 Syrians, aged between 18-77 years (M = 35.60, SD = 11.65) participated in this cross-sectional study. Results from the SEM indicated that past traumatic experiences and post-migration stressors were indirectly related to PTG. The results from the current study provide support for that the association between refugees' traumatic experiences, post-migration stressors and PTG appear to be explained through the presence of coping strategies which could be addressed in the psychotherapies and psychosocial interventions for refugees to promote positive psychological change. Future studies should address the effects of post-migration stressors on PTG in detail.


Assuntos
Crescimento Psicológico Pós-Traumático , Refugiados , Transtornos de Estresse Pós-Traumáticos , Adaptação Psicológica , Adolescente , Adulto , Idoso , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Síria , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-34444623

RESUMO

The burden of oral diseases and need for dental care are high among refugees and asylum seekers (humanitarian migrants). Canada's Interim Federal Health Program (IFHP) provides humanitarian migrants with limited dental services; however, this program has seen several fluctuations over the past decade. An earlier study on the experiences of humanitarian migrants in Quebec, Canada, developed the dental care pathways of humanitarian migrants model, which describes the care-seeking processes that humanitarian migrants follow; further, this study documented shortfalls in IFHP coverage. The current qualitative study tests the pathway model in another Canadian province. We purposefully recruited 27 humanitarian migrants from 13 countries in four global regions, between April and December 2019, in two Ontario cities (Toronto and Ottawa). Four focus group discussions were facilitated in English, Arabic, Spanish, and Dari. Analysis revealed barriers to care similar to the Quebec study: Waiting time, financial, and language barriers. Further, participants were unsatisfied with the IFHP's benefits package. Our data produced two new pathways for the model: transnational dental care and self-medication. In conclusion, the dental care needs of humanitarian migrants are not currently being met in Canada, forcing participants to resort to alternative pathways outside the conventional dental care system.


Assuntos
Refugiados , Migrantes , Assistência Odontológica , Acesso aos Serviços de Saúde , Humanos , Ontário
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