Roma Health: An Overview of Communicable Diseases in Eastern and Central Europe

Understanding the Impact of COVID-19 on Roma Vulnerable Communities in Western Romania: Insights and Predictive Factors from a Retrospective Study

BACKGROUND

The COVID-19 pandemic disproportionately affected vulnerable populations like Roma patients in Western Romania due to marginalization and limited healthcare access.

METHODS

A retrospective study analyzed COVID-19 cases between March 2020 and August 2022 using data from the Directorate of Public Health in Timis county. Demographic, epidemiological, clinical, and laboratory data were assessed, along with risk factors and biomarkers for ICU admission and mortality prediction. The following biomarkers were assessed: C-reactive protein (CRP), ferritin (FER), IL-6, D-dimers, lactate dehydrogenase (LDH), high density lipoprotein cholesterol (HDL), and 25-OH vitamin D (25-OHD).

RESULTS

In comparison with the general population (GP), Roma patients were more overweight (p = 0.0292), came from rural areas (p = 0.0001), could not recall transmission source (p = 0.0215), were admitted to the intensive care unit (ICU, p = 0.0399) more frequently, had worse symptomatology (p = 0.0490), showed more elevated levels of CRP (p = 0.0245) and IL-6 (p < 0.0001) and lower levels of HDL (p = 0.0008) and 25-OHD (p = 0.0299). A stronger, significant correlation was observed between CRP and severity (rho = 0.791 vs. 0.433 in GP), and an inverse stronger significant one was observed between HDL and severity (rho = -0.850 vs. -0.734 in GP) in the Roma patients. The male sex continues to be an important risk factor for ICU admission (OR = 2.379) and death (OR = 1.975), while heavy smoking was more important in relation to ICU admission (OR = 1.768). Although the Roma ethnicity was 1.454 times more at risk of ICU admission than the GP, this did not prove statistically significant (p = 0.0751). CRP was the most important predictive factor in regards to admission to the ICU for both Roma (OR = 1.381) and the GP (OR = 1.110) and in regards to death (OR = 1.154 for Roma, OR = 1.104 for GP). A protective effect of normal values of HDL and 25-OHD was observed in the GP for both ICU admission (OR = 0.947, 0.853, respectively) and death (OR = 0.920, 0.921, respectively), while for the Roma group, normal 25-OHD values were only considered protective in regards to death (OR = 0.703). Cutoff values for ICU admission were 28.98 mg/L for Roma and 29.03 mg/L for GP patients, with high specificity for both groups (over 95).

CONCLUSIONS

Higher rates of ICU admissions, severe symptomatology, and distinct laboratory biomarker profiles among Roma patients emphasize the critical importance of personalized care strategies and targeted interventions to mitigate the disproportionate burden of COVID-19 on vulnerable communities. CRP values at admission have had a clear impact as a risk assessment biomarker for Roma patients, while the significance of IL-6, HDL, and 25-OHD should also not be overlooked in these patients.

Assessing the Level of Knowledge and Experience Regarding Cervical Cancer Prevention and Screening among Roma Women in Romania

Background and Objectives: Romania ranks among the countries with a particularly high rate of mortality that can be prevented through prevention programs, screening, early detection, and prompt care. Cervical cancer (CC) is a major cause of these preventable deaths, affecting individuals from marginalized and rural regions, as well as the Roma population. The purpose of this article was to identify accurate and consistent information about the Roma population on the risk of CC, as well as the importance of understanding the causes of the disease and awareness of the available prevention methods. Materials and Methods: A cross-sectional study was conducted using a self-administered questionnaire applied only to Roma women in Romania. Results: We enrolled 759 patients in this study. These were divided into two groups: Group 1 comprised 289 (38.1%) women who had been tested for HPV infection, while Group 2 included 470 (61.9%) women who had never been tested for HPV infection. Characterization of women in Group 1: mostly aged between 25 and 54 years, with high school education, married, who started sexual activity under the age of 18 years, with only one sexual partner, and had over five pregnancies. Regarding contraceptive methods, 35.7% of women do not know or use any contraceptive method, and 32.2% use hormonal contraceptives. Two thirds of the women tested had heard of HPV, and 19.7% were vaccinated against HPV with at least 2-3 doses. A percentage of 8.7 had a diagnosis of CC, compared to those who were not tested (p-0.0001), whereas 63% of the tested women did not know much about CC, as opposed to 85.7% of the group of untested women. Conclusions: Cervical cancer (CC) continues to be a public health concern in Romania, particularly among vulnerable groups. Promoting campaigns to raise awareness for HPV vaccination and CC screening are necessary to reduce the associated mortality and morbidity.

Residence in segregated settlements (colonies) rather than Roma identity increases the risk of unfavourable mental health in Hungarian adults

Background

Roma are the largest and most disadvantaged minority in Europe, but there is few research on how mental health and social support of Roma people living in segregated settlements compares to the majority population. Our aim was to compare the subjective well-being, life satisfaction, mental status, and social support of representative samples of adults living in segregated settlements (colonies) and identifying as Roma with those of the general population in Hungary.

Methods

A cross-sectional study was conducted with random samples of 417 individuals from the general Hungarian adult population (55.6% female, mean age = 43.89 ± 12.61 years) and 394 adults living in segregated settlements (colonies) (73.9% female, mean age = 42.37 ± 12.39 years). Demographic questions were used as well as the WHO Well-Being Index (WBI-5), the single item Life Satisfaction Scale, the 12-item version of the General Health Questionnaire (GHQ-12), and the Oslo Social Support Scale (OSSS-3).

Results

Residents of colonies reported significantly lower levels of subjective well-being and life satisfaction than the general population. The proportion of individuals at high risk for mental morbidity was more than twice as high among colony dwellers (16.4%) as in non-colony dwellers (7.6%). Similar unfavorable differences were seen at the expense of self-identified Roma compared to self-identified Hungarians but no difference was found in terms of social support either by type of residence or ethnicity. 32.2% of colony-dwellers self-identified themselves as Hungarian. Mental health assessed by principal component was directly determined by settlement type of permanent residence, age, educational attainment, employment, financial status, and social support but not ethnic identity.

Conclusion

The study based on representative data shows that residents of segregated settlements are in worse mental health than those not living in colonies; that housing segregation is not limited to Roma people, and that housing conditions and financial status are major social determinants of mental health for which data must be collected to avoid using self-reported Roma identity as a proxy measure of socioeconomic deprivation.

Assessment of health status and cardiovascular risk factors in a Roma population sample from South Bulgaria

OBJECTIVES

Roma population is one of the major ethnic groups in the Central and Eastern Europe, having high rates of chronic diseases and associated risk factors related to their poor social conditions, unhealthy lifestyle and low educational level. The purpose of our study was to assess the health status of Roma from South Bulgaria by means of blood indicators and determine the prevalence of some cardiovascular (CV) risk factors in the Roma population sample.

METHODS

The study group consisted of 60 Roma (23 men and 37 women), mean age 53.7 ± 15.9 years, and the control group consisted of 68 non-Roma from the majority population (29 men and 38 women), mean age 45.8 ± 12.2 years. The data were collected via questionnaire, anthropometric measures, and venous blood samples analyses after an overnight fasting.

RESULTS

The Roma population subjects were slightly but significantly older compared to the non-Roma group and both study groups included more women. The fasting glucose, body mass index (BMI), triglycerides (TG), total cholesterol (TC), and LDL-cholesterol (LDL-C) levels were significantly higher, and HDL-cholesterol (HDL-C) levels were significantly lower in Roma compared to the control non-Roma group. The values of cardiovascular risk markers such as TC/HDL-C and TG/HDL-C ratios, atherogenic index of plasma (AIP) and lipoprotein combine index (LCI) were significantly higher in Roma compared to non-Roma subjects. The prevalence of obesity in Roma was 35%, diabetes mellitus was recorded in 16.7% of the entire Roma sample, and hyperglycaemia in non-diabetics was recorded in 32%. Hypercholesterolaemia was found in 90% and hypertriglyceridaemia was found in 88.3%. The prevalence of cardiovascular diseases (CVD) was high and was encountered in 71.7% of the Roma participants and most of the subjects (96.7%) reported family history of CVD. The studied population showed high smoking rates with 33.3% active smokers.

CONCLUSIONS

Our study confirmed high prevalence of CV risk factors among Roma population, such as abnormal lipid profile parameters, obesity and heavy smoking and very high cardiovascular morbidity rate. Therefore, adequate measures and healthcare programmes aiming at the early identification, treatment and prevention of CVD risks among Roma are necessary.

Genetic Determinants of Leisure-Time Physical Activity in the Hungarian General and Roma Populations

Leisure-time physical activity (LTPA) is one of the modifiable lifestyle factors that play an important role in the prevention of non-communicable (especially cardiovascular) diseases. Certain genetic factors predisposing to LTPA have been previously described, but their effects and applicability on different ethnicities are unknown. Our present study aims to investigate the genetic background of LTPA using seven single nucleotide polymorphisms (SNPs) in a sample of 330 individuals from the Hungarian general (HG) and 314 from the Roma population. The LTPA in general and three intensity categories of it (vigorous, moderate, and walking) were examined as binary outcome variables. Allele frequencies were determined, individual correlations of SNPs to LTPA, in general, were determined, and an optimized polygenetic score (oPGS) was created. Our results showed that the allele frequencies of four SNPs differed significantly between the two study groups. The C allele of rs10887741 showed a significant positive correlation with LTPA in general (OR = 1.48, 95% CI: 1.12-1.97; p = 0.006). Three SNPs (rs10887741, rs6022999, and rs7023003) were identified by the process of PGS optimization, whose cumulative effect shows a strong significant positive association with LTPA in general (OR = 1.40, 95% CI: 1.16-1.70; p < 0.001). The oPGS showed a significantly lower value in the Roma population compared with the HG population (oPGS_Roma: 2.19 ± SD: 0.99 vs. oPGS_HG: 2.70 ± SD: 1.06; p < 0.001). In conclusion, the coexistence of genetic factors that encourage leisure-time physical activity shows a more unfavorable picture among Roma, which may indirectly contribute to their poor health status.

Development and evaluation of an intervention to promote the use of eyeglasses among Romani families in Bulgaria

Objective

Uncorrected refractive error (i.e., lack of eyeglasses for the treatment of refractive error) is one of the leading causes of visual impairment in Eastern Europe. Limited information is available on how to promote the use of eyeglasses among Romani families in Bulgaria. In step 1, the objective was to obtain suggestions by Romani mothers on how to promote the use of eyeglasses among children. In step 2, the objective was to evaluate an intervention to promote the use of eyeglasses based on suggestions received during step 1.

Methods

During step 1, 5 focus groups with Romani mothers took place in one neighborhood in Bulgaria. During step 2, the intervention used a one-group pre-test, post-test design. Families received eye examinations. Those who needed eyeglasses chose attractive eyeglasses. Parents received education on how to encourage their children to wear eyeglasses.

Results

During step 1, 54 mothers participated. Mothers suggested that the whole family should receive eye examinations and eyeglasses. During step 2, of 33 family members, 14 did not have refractive errors and 19 did. Of the 19 family members with refractive error, none had eyeglasses at pre-test. Approximately 6 months following the end of the intervention, 11 of the 19 family members (57.9%) wore eyeglasses and the remaining 8 (42.1%) did not.

Conclusion

Romani family members needed eyeglasses but did not have any at pre-test of the intervention. Future interventions that offer education on the importance of eye examinations may increase receipt of eye examinations and adherence to wearing eyeglasses.

Laboratory Findings and Clinical Outcomes of ICU-admitted COVID-19 Patients: A Retrospective Assessment of Particularities Identified among Romanian Minorities

The Roma population accounts for over 3% (approximately 10 to 15 million) of Romania's permanent population, and it represents one of Europe's most impoverished populations. Due to poverty and unemployment, Romania's Roma minority may have diminished access to healthcare and preventive medicine. The limited existing evidence suggests that the European Roma group has been at a higher risk of becoming ill and dying during the pandemic owing to their lifestyle choices, socioeconomic circumstances, and genetic pathophysiological traits. As a result, the purpose of the present research was to investigate the link between the inflammatory markers implicated and the clinical progression of COVID-19 in Roma patients who were brought to the intensive care unit. We considered 71 Roma patients admitted to the ICU with SARS-CoV-2 infection and 213 controls from the general population with the same inclusion criteria. The body mass index of patients was statistically significantly higher among Roma patients, with more than 57% being overweight, compared with 40.7% in the control group. Frequent smoking was more prevalent in patients of Roma ethnicity admitted to the ICU and the number of comorbidities. We observed a significantly higher proportion of severe imaging features at admission in the group of cases, although this difference may have been associated with the higher prevalence of smoking in this group. The mean duration of hospitalization was longer by 1.8 days than the control group. Elevated ESR levels were observed in 54.0% of Roma patients at admission, compared with 38.9% in the control group. Similarly, 47.6% of them had elevated CRP levels. IL-6 increased significantly at the time of ICU admission, similarly to the significant rise in the CRP levels, compared with the general population. However, the proportion of intubated patients and mortality did not differ significantly. On multivariate analysis, the Roma ethnicity significantly influenced the CRP (β = 1.93, p-value = 0.020) and IL-6 (β = 1.85, p-value = 0.044). It is necessary to plan different healthcare strategies aimed at special populations, such as the Roma ethnicity, to prevent the reduced disparities presented in in this study.

A Retrospective Assessment of Laboratory Findings and Cytokine Markers in Severe SARS-CoV-2 Infection among Patients of Roma Population

Growing research data suggests that the severity of COVID-19 is linked with higher levels of inflammatory mediators, such as cytokines, chemokines, tumor necrosis factor, C-reactive protein, ferritin, and D-dimers. In addition, it was evident from the existing research data that the severity of SARS-CoV-2 infection differs according to independent risk factors such as race and ethnicity. Some scarce evidence shows that the European Roma community is likely to be at an elevated risk of illness and death during the pandemic due to their lifestyle, social factors, and economics. Assuming that precautions must be taken to protect this population from coronavirus infections and from widening existing disparities in comparison with the Romanian ethnic population, the current study aimed to observe the clinical evolution of the Roma patients with severe SARS-CoV-2 infection in correlation with the laboratory findings and inflammatory markers involved. After calculating the sample size requirements, we included 83 Roma patients admitted to the hospital with severe COVID-19 and 236 patients of Romanian ethnicity with the same inclusion criteria. Patients were selected from the period stretching from March 2020 to December 2021, before COVID-19 vaccines were introduced. Compared with the general population, the Roma patients with severe SARS-CoV-2 infection had a higher unemployment rate (39.8%), and most of them were residing in rural regions (65.4%). There were significantly more overweight patients in the Roma group than in the control group (57.8% vs. 40.7%), and it was also observed that high blood pressure and diabetes mellitus were significantly more prevalent in the Roma patients. They had significantly longer mean duration of hospitalization was significantly longer in the group of Roma patients (18.1 days vs. 16.3 days). IL-6 and CRP levels were significantly more elevated during admission in the group of Roma patients (43.4% vs. 28.4%); however, IL-6 levels normalized at discharge, but ESR remained high. Although ICU admissions were significantly more frequent in this group, the mortality rate was not significantly higher than in the general population. It is necessary to plan different healthcare strategies aimed at special populations, such as the Roma ethnicity to prevent disparities in negative outcomes reflected in this study. The results imply that community-health collaborations between organizations of minority groups and healthcare professionals can mitigate the disproportionate consequences of the pandemic on Roma.

Desirable but not feasible: Measures and interventions to promote early childhood health and development in marginalized Roma communities in Slovakia

Roma are the largest and most disadvantaged ethnic minority in Europe often facing generational poverty, and limited access to education, employment, housing, and various types of services. Despite many international and national initiatives, children from marginalized Roma communities face multiple risks and are being disadvantaged as early as from conception onward. We, therefore, aimed to identify measures and/or interventions targeting equity in early childhood health and development in marginalized Roma communities which implementation is considered to be urgent but not feasible. We used a group concept mapping approach-a participatory mixed research method-and involved 40 experts and professionals from research, policy and practice. From 90 measures and interventions proposed to achieve early childhood equity for children from marginalized Roma communities, 23 measures were identified as urgent but not feasible. These concerned particularly measures and interventions targeting living conditions (including access to income, access to housing, and basic infrastructure for families) and public resources for instrumental support (covering mainly topics related to financial and institutional frameworks). Our results reflect the most pressing issues in the area of equality, inclusion and participation of Roma and expose barriers to implementation which are likely to arise from public and political discourses perpetrating a negative image of Roma, constructing them as less deserving. Measures to overcome persistent prejudices against Roma need to be implemented along with the measures targeting equity in early childhood health and development.

Using the Omaha System to Determine Health and Social Problems of Roma Population in Istanbul: Secondary Data Analysis

The aim of this study was to determine the health and social problems and related behaviors of the Roma population by using the Omaha System. The data were collected from 650 Roma individuals. This study was a cross-sectional secondary data analysis and the data were collected in two stages. First, the "Technical Assistance for Promoting Social Inclusion in Densely Roman Populated Areas Project (SIROMA)" Act team evaluated health problems among Roma individuals. Second, data were reanalyzed using the Omaha System. When sociodemographic and economic characteristics were evaluated, low education level, adolescent marriages, a high number of live births, soiled living areas, unemployment, and substance use were found in the Roma population. In this context, using the Omaha System, the frequently diagnosed health and social problems were Sanitation (13.5%), Healthcare supervision (11.8%), Nutrition (11.0%), Income (9.8%), Respiration (8.3%), Substance use (7.3%), and Neighborhood/workplace safety (6.0%). This study results found out that the Roma population is less prone than natives to have healthy lifestyle behaviors and more prone to experience a deterioration in both their general and mental health. The Omaha System is a valid method used to collect and analyze data for a vulnerable population in the community. Also, it has been proven that the Omaha System Problem Classification Scheme can provide a more detailed and comprehensive assessment.

Health inequalities between Roma and non-Roma populations in Europe: A study of 118,834 individuals combining the UNDP Roma and the EU-SILC surveys

AIMS

This study aimed to compare the self-rated health status of the Roma and of the general population by gender and educational level in six Central and Eastern European countries.

METHODS

We analysed the United Nations Development Program Regional Roma Survey and EUROSTAT's European Union Statistics on Income and Living Conditions surveys from 2011 for Bulgaria, Croatia, Czechia, Hungary, Romania and Slovakia. Using logistic regression, predicted probabilities of good or very good self-rated health were estimated for the Roma (n=11,401), Roma neighbours (n=5857) and the general population (n=101,579) stratified by gender, and adjusted by age, country and educational level.

RESULTS

There was a distinctive social gradient in self-rated health between the groups among both men and women, and a gap between primary versus secondary or tertiary education among all three groups, but Roma (men) and their neighbours with secondary or higher education had significantly worse predicted self-rated health compared to the general population with similar qualifications.

CONCLUSIONS

These results strongly suggest that ethnicity and gender should be considered as fundamental causes that explain structural health inequalities. Consequently, future research and policy initiatives to reduce health inequities should acknowledge the impact of ethnic minorities and how these fundamental causes extend the general population's social gradient in health. Study designs enabling direct comparisons between ethnic groups and the general population should be applied. More and better data about ethnic minorities are needed to document and monitor existing health inequalities.

Raising employment and quality of life among people with disadvantages - results of a Hungarian project

BACKGROUND

People with disadvantages are a high-risk group of unemployment or underemployment. Disadvantages include disability, under-education, or being a member of a minority, etc. Effective labor market programs could be a key in raising employment and quality of life among this high-risk group of society. The TOP 6.8.2.-15-NA1 project is one of the main Hungarian labor market programs. The project's primary aims are increasing the employability of disadvantaged unemployed and supporting the efficiency of job-seeking.

METHODS

Our goal was to analyze the effects and methodology of the TOP 6.8.2.-15-NA1 project in Hungary. The sample of our study contains participants of the project (n = 300), based in Zala County, Hungary.

RESULTS

After 28 days, 53.3% of participants had a job. At the 180th day status, the rate of employed people was 47.3%. We could identify low-educated participants and older participants as higher-risk groups of long-term unemployment.

CONCLUSIONS

We emphasize the role of these services (job-seeking clubs, organization of job fairs, and mentorship) in the long-term individual success of participants. Improving the employment rate for people with disadvantages is a critical factor for enhancing the quality of life for individuals with disadvantages.

Parasitic zoonoses in the Roma population

Roma people are the largest minority group in Europe. The vast majority live in substandard conditions in segregated settlements, overcrowded with people and animals that predispose them to various, especially zoonotic diseases. Parasitic zoonotic diseases remain a challenge in this vulnerable population group, especially among Roma children. PubMed was searched using the keywords Roma with combination of names of different parasites to get all available studies on prevalence of parasitic zoonoses among European Roma, published between years 2000 and 2020. After application of exclusion criteria, data were extracted from the studies that made the final sample. Parasitic zoonoses are common among Roma. Cryptosporidium, Toxoplasma gondii, soil-transmitted helminths and Giardia spp. are more common in Roma children compared to non-Roma children, and Toxoplasma gondii and soil-transmitted helminths are also more common in Roma adults compared to non-Roma adults. Data on prevalence of trichinellosis, echinococcosis, and taeniasis among Roma show that they do not affect Roma more often compared to the general population. Roma people, particularly children, are more susceptible to parasitic zoonoses. Substandard sanitary conditions and close contact with infected animals are important risk factors in this population and should be aimed with preventive measures.