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Willy C, Bröcker F. [Health economic significance of antimicrobial resistance]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2025; 68:584-592. [PMID: 40338296 PMCID: PMC12130060 DOI: 10.1007/s00103-025-04061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 04/24/2025] [Indexed: 05/09/2025]
Abstract
The global dissemination of multi-resistant pathogens represents a significant challenge for public health and the economy, given the considerable difficulties it presents in terms of disease control and economic stability. It is projected that the number of deaths associated with multi-drug-resistant organisms (MDROs) could increase significantly worldwide by 2050. MDROs are responsible for approximately 6% of healthcare-associated infections, which equates to 24,000 to 36,000 MDRO infections per year in Germany. In total, this equates to approximately 54,500 infections per year, including those acquired by outpatients. In Germany, the number of deaths directly attributable to MDROs is estimated to be 9700 per year. It is anticipated that there will be a notable rise in the number of carbapenem-resistant isolates of Klebsiella pneumoniae and Acinetobacter baumannii in the future, particularly within the context of inpatient care. A rough estimate of the total additional economic costs of a MRE infection for inpatient treatment in Germany is approximately € 27,000 per case. When economic consequences are considered, the total cost to Germany is estimated to be approximately € 4 billion. It should be noted that the data presented in the studies are usually based on estimates. There is a considerable need for research in order to adequately account for cost areas such as expenses for rehabilitation and the consequences of the large-scale use of antibiotics in animal husbandry. However, more valid data are essential in order to adequately evaluate the effectiveness of future measures to prevent and contain multi-resistance.
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Affiliation(s)
- Christian Willy
- Klinik für Unfallchirurgie und Orthopädie, Septisch-Rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum Rekonstruktion von Defektwunden, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland.
| | - Felix Bröcker
- Idorsia (Berlin) Pharmaceuticals GmbH, Berlin, Deutschland
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Cotugno S, De Vita E, Frallonardo L, Novara R, Papagni R, Asaduzzaman M, Segala FV, Veronese N, Nicastri E, Morea A, Farkas FB, Lakatos B, Iatta R, Putoto G, Saracino A, Di Gennaro F. Antimicrobial Resistance and Migration: Interrelation Between Two Hot Topics in Global Health. Ann Glob Health 2025; 91:12. [PMID: 40061583 PMCID: PMC11887466 DOI: 10.5334/aogh.4628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Accepted: 02/01/2025] [Indexed: 05/13/2025] Open
Abstract
Background: Antimicrobial resistance (AMR) and migration are two interlinked issues and both pose an escalating threat to global health. With an increasing trend, there are 281 million migrants globally, while AMR is contributing to over 5 million deaths annually, with a projected rise to 10 million by 2050 if left unaddressed. Both AMR and migration are multifaceted problems that extend beyond human health, involving animals, plants, and the environment-a fact highlighted by the One Health approach. Objective: The aim of this work is: (1) to examine the complex relationship between migration and AMR, drawing on epidemiological data, surveillance strategies, and healthcare access challenges and (2) to address an interventional strategy proposal. Methods: We performed a narrative review of the most updated literature about migration and AMR using three primary databases: PubMed, Scopus, and Embase. Findings: Migrants, particularly from low‑ and middle‑income countries, represent a unique group at increased risk of AMR due to factors such as overcrowded living conditions, limited access to healthcare, uncontrolled use of antibiotics, and high prevalence of AMR in origin countries. Studies reveal higher rates of AMR colonization and infection among migrants compared with native populations, with specific pathogens such as MRSA and multidrug‑resistant gram‑negative bacteria posing significant risks. Migratory conditions, socioeconomic vulnerability, and healthcare barriers contribute to this heightened risk. Conclusion: To address the intersection of migration and AMR, interventions must focus on improving living conditions, enhancing healthcare access, promoting appropriate antibiotic use, and strengthening microbiological surveillance. Multisectoral collaboration is essential to mitigate the spread of AMR and safeguard both migrant and global public health.
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Affiliation(s)
- Sergio Cotugno
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe‑J), Unit of Infectious Diseases, University of Bari ‘A. Moro’, Polyclinic Hospital, Bari, Italy
| | - Elda De Vita
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe‑J), Unit of Infectious Diseases, University of Bari ‘A. Moro’, Polyclinic Hospital, Bari, Italy
| | - Luisa Frallonardo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe‑J), Unit of Infectious Diseases, University of Bari ‘A. Moro’, Polyclinic Hospital, Bari, Italy
| | - Roberta Novara
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe‑J), Unit of Infectious Diseases, University of Bari ‘A. Moro’, Polyclinic Hospital, Bari, Italy
| | - Roberta Papagni
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe‑J), Unit of Infectious Diseases, University of Bari ‘A. Moro’, Polyclinic Hospital, Bari, Italy
| | - Muhammad Asaduzzaman
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe‑J), Unit of Infectious Diseases, University of Bari ‘A. Moro’, Polyclinic Hospital, Bari, Italy
| | - Nicola Veronese
- Saint Camillus International University of Health Sciences, Rome, Italy
| | - Emanuele Nicastri
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, 00149, Rome, Italy
| | - Anna Morea
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Ferenc Balázs Farkas
- Institute of Medical Microbiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary; Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Botond Lakatos
- Semmelweis University Department of Internal Medicine and Hematology, Departmental Group of Infectious Diseases, Budapest, Hungary
| | - Roberta Iatta
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padova, Italy
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe‑J), Unit of Infectious Diseases, University of Bari ‘A. Moro’, Polyclinic Hospital, Bari, Italy
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe‑J), Unit of Infectious Diseases, University of Bari ‘A. Moro’, Polyclinic Hospital, Bari, Italy
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Chukwudile B, Pan D, Silva L, Gogoi M, Al-Oraibi A, Bird P, George N, Thompson HA, Baggaley RF, Hargreaves S, Pareek M, Nellums LB. Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis - update from 2017 to 2023. EClinicalMedicine 2024; 75:102801. [PMID: 39296945 PMCID: PMC11408055 DOI: 10.1016/j.eclinm.2024.102801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/17/2024] [Accepted: 08/12/2024] [Indexed: 09/21/2024] Open
Abstract
Background Antimicrobial resistance (AMR) is a critical global health concern. A previous systematic review showed that migrants in Europe are at increased risk of AMR. Since the COVID-19 pandemic there have been rapid changes in patterns of antibiotic use, AMR, and migration. We aimed to present an updated evidence synthesis on the current distribution of AMR among migrants in Europe. Methods We carried out a systematic review and meta-analysis in accordance with PRISMA guidelines (PROSPERO ID: CRD42022343263). We searched databases (MEDLINE, Embase, PubMed and Scopus) from 18 January 2017 until 18 January 2023 to identify primary data from observational studies reporting any laboratory-confirmed AMR among migrants in the European Economic Area (EEA) and European Union-15 (EU-15) countries using over 7 key search terms for migrants and over 70 terms for AMR and countries in Europe. Outcomes were infection with, or colonisation of AMR bacteria. Methodological quality was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Observational Studies. We meta-analysed the pooled-prevalence of infection and/or colonisation of AMR organisms. Findings Among 630 articles, 21 observational studies met the inclusion criteria and were included in this review. The pooled prevalence for any detected AMR was 28.0% (95% CI 18.0%-41.0%, I 2 = 100%) compared to a 25.4% seen in the previous review; gram-negative bacteria 31.0% (95% CI 20.0%-44.0%, I 2 = 100%), and methicillin-resistant staphylococcus aureus 10.0% (95% CI 5.0%-16.0%, I 2 = 99%). Drug-resistant bacteria were more prevalent in community settings in large migrant populations (pooled prevalence: 41.0%, 95% CI 24.0%-60.0%, I 2 = 99%) than in hospitals (21.0%, 95% CI 12.0%-32.0%, I 2 = 99%). AMR estimates in 'other' migrants were 32.0%, (95% CI 12.0%-57.0%, I 2 = 100%) and 28.0% (95% CI 18.0%-38.0%, I 2 = 100%) in forced migrants. No firm evidence of AMR acquisition with arrival time or length of stay in the host country was found. Interpretation Studies investigating AMR in migrants are highly heterogenous. However, since the COVID-19 pandemic, migrants may be at higher risk of acquiring resistant bacteria, particularly gram-negative bacteria, within community settings such as refugee camps and detention centres in Europe. Our study highlights the importance of infrastructure and hygiene measures within these settings, to mitigate transmission of resistant pathogens. Policy-makers should screen for AMR in migrants prior to departure from countries of origin, where feasible, and upon arrival to a new country to ensure optimal health screening, infection control and effective treatment. Funding There was no funding source for this study.
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Affiliation(s)
- Bridget Chukwudile
- Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Daniel Pan
- Development Centre for Population Health, University of Leicester, Leicester, United Kingdom
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester, Leicester, NHS Trust, United Kingdom
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, Oxford, University of Oxford, United Kingdom
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Sing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Luisa Silva
- Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Mayuri Gogoi
- Development Centre for Population Health, University of Leicester, Leicester, United Kingdom
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Amani Al-Oraibi
- Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Development Centre for Population Health, University of Leicester, Leicester, United Kingdom
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Paul Bird
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Nisha George
- Development Centre for Population Health, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Hayley A Thompson
- Department of Medicine, Imperial College London, London, United Kingdom
- Global Health Programs Division, PATH, Seattle, WA, USA
| | - Rebecca F Baggaley
- Development Centre for Population Health, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
- Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, United Kingdom
| | - Manish Pareek
- Development Centre for Population Health, University of Leicester, Leicester, United Kingdom
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester, Leicester, NHS Trust, United Kingdom
- NIHR Applied Research Collaboration East Midlands, Leicester, United Kingdom
| | - Laura B Nellums
- Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
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Tiwari A, Lehto KM, Paspaliari DK, Al-Mustapha AI, Sarekoski A, Hokajärvi AM, Länsivaara A, Hyder R, Luomala O, Lipponen A, Oikarinen S, Heikinheimo A, Pitkänen T. Developing wastewater-based surveillance schemes for multiple pathogens: The WastPan project in Finland. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 926:171401. [PMID: 38467259 DOI: 10.1016/j.scitotenv.2024.171401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
Wastewater comprises multiple pathogens and offers a potential for wastewater-based surveillance (WBS) to track the prevalence of communicable diseases. The Finnish WastPan project aimed to establish wastewater-based pandemic preparedness for multiple pathogens (viruses, bacteria, parasites, fungi), including antimicrobial resistance (AMR). This article outlines WastPan's experiences in this project, including the criteria for target selection, sampling locations, frequency, analysis methods, and results communication. Target selection relied on epidemiological and microbiological evidence and practical feasibility. Within the WastPan framework, wastewater samples were collected between 2021 and 2023 from 10 wastewater treatment plants (WWTPs) covering 40 % of Finland's population. WWTP selection was validated for reported cases of Extended Spectrum Beta-lactamase-producing bacterial pathogens (Escherichia coli and Klebsiella pneumoniae) from the National Infectious Disease Register. The workflow included 24-h composite influent samples, with one fraction for culture-based analysis (bacteria and fungi) and the rest of the sample was reserved for molecular analysis (viruses, bacteria, antibiotic resistance genes, and parasites). The reproducibility of the monitoring workflow was assessed for SARS-CoV-2 through inter-laboratory comparisons using the N2 and N1 assays. Identical protocols were applied to same-day samples, yielding similar positivity trends in the two laboratories, but the N2 assay achieved a significantly higher detection rate (Laboratory 1: 91.5 %; Laboratory 2: 87.4 %) than the N1 assay (76.6 %) monitored only in Laboratory 2 (McNemar, p < 0.001 Lab 1, = 0.006 Lab 2). This result indicates that the selection of monitoring primers and assays may impact monitoring sensitivity in WBS. Overall, the current study recommends that the selection of sampling frequencies and population coverage of the monitoring should be based on pathogen-specific epidemiological characteristics. For example, pathogens that are stable over time may need less frequent annual sampling, while those that are occurring across regions may require reduced sample coverage. Here, WastPan successfully piloted WBS for monitoring multiple pathogens, highlighting the significance of one-litre community composite wastewater samples for assessing community health. The infrastructure established for COVID-19 WBS is valuable for monitoring various pathogens. The prioritization of the monitoring targets optimizes resource utilization. In the future legislative support in target selection, coverage determination, and sustained funding for WBS is recomended.
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Affiliation(s)
- Ananda Tiwari
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Kirsi-Maarit Lehto
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Dafni K Paspaliari
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland; ECDC Fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Ahmad I Al-Mustapha
- University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland; Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Anniina Sarekoski
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland; University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland.
| | - Anna-Maria Hokajärvi
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Annika Länsivaara
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Rafiqul Hyder
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Oskari Luomala
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Anssi Lipponen
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland.
| | - Sami Oikarinen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Annamari Heikinheimo
- University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland; Finnish Food Authority, Seinäjoki, Finland.
| | - Tarja Pitkänen
- Finnish Institute for Health and Welfare, Department of Health Security, Kuopio and Helsinki, Finland; University of Helsinki, Faculty of Veterinary Medicine, Helsinki, Finland.
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5
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Taylor SL, Papanicolas LE, Flynn E, Boyd MA, Wesselingh SL, Rogers GB. Preventing empirical antibiotic treatment failure in migrant populations: screening by infection risk, not ethnic background. Int J Infect Dis 2023; 134:168-171. [PMID: 37343782 DOI: 10.1016/j.ijid.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/14/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023] Open
Abstract
Multidrug-resistant organisms (MDROs) are a major international health threat. In many low and middle-income countries poorly regulated antibiotic use, limited surveillance, and inadequate sanitation give rise to high rates of antibiotic resistance. A resulting reliance on last-line antibiotic options further contributes to the emergence of MDROs. The potential for these pathogens to spread across international borders is a matter of considerable concern. However, this problem is commonly framed as primarily a threat to the health security of countries where resistance is not yet endemic. In fact, it is little acknowledged that those at greatest risk from antibiotic treatment failure are individuals who move from regions of high MDRO prevalence to settings where standard empirical treatment options remain largely effective. In this perspective, we highlight the poor treatment outcomes for disseminated bacterial infections in individuals who have moved from settings in which MDROs are common to those where MDROs are currently less common. We discuss MDRO screening strategies that could avoid stigmatizing vulnerable populations by focusing on future risk of disseminated infection, rather than past risk of acquisition. In practical terms, this means screening individuals before childbirth, immunosuppressive treatments, major surgery, or other events associated with disseminated infection risk, rather than prioritizing screening for individuals from regions with high carriage rates. We argue that such measures would reduce antibiotic treatment failure and improve outcomes while protecting migrant populations from the divisive consequences of targeted screening programs.
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Affiliation(s)
- Steven L Taylor
- South Australian Health and Medical Research Institute, Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Lito E Papanicolas
- South Australian Health and Medical Research Institute, Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Erin Flynn
- South Australian Health and Medical Research Institute, Adelaide, Australia; National Centre for Epidemiology & Population Health, The Australian National University, Canberra, Australia
| | - Mark A Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Geraint B Rogers
- South Australian Health and Medical Research Institute, Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Stich A. [Infectious diseases in migrants]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:415-425. [PMID: 37140630 PMCID: PMC10158686 DOI: 10.1007/s00108-023-01520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/05/2023]
Abstract
The current influx of refugees and the high rate of immigration increase the prevalence and impact of infectious diseases in Europe. Infections may be detected at first contact, as a result of systematic screening or as part of general medical care. Diagnosis and treatment require special expertise and, in some cases, special precautions. The spectrum of imported infections is determined by the countries of origins of the migrants and the circumstances associated with their escape to Germany. In this article, diagnosis and treatment of the most important infectious diseases will be presented. As far as infectious diseases are concerned, refugees and migrants are not a threat to the host population, but instead have to be perceived and cared for as a highly vulnerable group.
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Affiliation(s)
- August Stich
- Klinik für Tropenmedizin, Klinikum Würzburg Mitte gGmbH, Salvatorstr. 7, 97074, Würzburg, Deutschland.
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Behboudi-Gandevani S, Bidhendi-Yarandi R, Panahi MH, Mardani A, Prinds C, Vaismoradi M. Perinatal and Neonatal Outcomes in Immigrants From Conflict-Zone Countries: A Systematic Review and Meta-Analysis of Observational Studies. Front Public Health 2022; 10:766943. [PMID: 35359776 PMCID: PMC8962623 DOI: 10.3389/fpubh.2022.766943] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/03/2022] [Indexed: 12/16/2022] Open
Abstract
Objectives There are controversies regarding the risk of adverse pregnancy outcomes among immigrants from conflict-zone countries. This systematic review and meta-analysis aimed to investigate the risk of perinatal and neonatal outcomes among immigrants from conflict-zone countries compared to native-origin women in host countries. Methods A systematic search on the databases of PubMed/MEDLINE, Scopus, and Web of Science was carried out to retrieve studies on perinatal and neonatal outcomes among immigrants from Somalia, Iraq, Afghanistan, Yemen, Syria, Nigeria, Sudan, Ethiopia, Eritrea, Kosovo, Ukraine, and Pakistan. Only peer-reviewed articles published in the English language were included in the data analysis and research synthesis. The odds ratio and forest plots were constructed for assessing the outcomes of interests using the DerSimonian and Laird, and the inverse variance methods. The random-effects model and the Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results. Results The search process led to the identification of 40 eligible studies involving 215,718 pregnant women, with an immigration background from the conflict zone, and 12,806,469 women of native origin. The adverse neonatal outcomes of the risk of small for gestational age (Pooled OR = 1.8, 95% CI = 1.6, 2.1), a 5-min Apgar score <7 (Pooled OR = 1.4, 95% CI = 1.0, 2.1), stillbirth (Pooled OR = 1.9, 95% CI = 1.2, 3.0), and perinatal mortality (Pooled OR = 2, 95% CI = 1.6, 2.5) were significantly higher in the immigrant women compared to the women of native-origin. The risk of maternal outcomes, including the cesarean section (C-S) and emergency C-S, instrumental delivery, preeclampsia, and gestational diabetes was similar in both groups. Conclusion Although the risk of some adverse maternal outcomes was comparable in the groups, the immigrant women from conflict-zone countries had a higher risk of neonatal mortality and morbidity, including SGA, a 5-min Apgar score <7, stillbirth, and perinatal mortality compared to the native-origin population. Our review results show the need for the optimization of health care and further investigation of long-term adverse pregnancy outcomes among immigrant women.
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Affiliation(s)
- Samira Behboudi-Gandevani
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- *Correspondence: Samira Behboudi-Gandevani
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Christina Prinds
- Department of Clinical Research, University South Denmark, Odense, Denmark
- Department of Midwifery Education, University College South Denmark, Esbjerg, Denmark
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