Exploring the Mental, Social, and Lifestyle Effects of a Positive COVID-19 Infection on Syrian Refugees in Jordan: A Qualitative Study

Exploring the use of COVID-19 antigen rapid diagnostic tests among displaced populations in Iraq: findings from a pilot project in four IDP camps

BACKGROUND

IOM piloted the use of Ag RDTs for COVID-19 in Iraq, in collaboration with FIND, the Global Alliance for Diagnostics, to facilitate access to testing and understand barriers and opportunities for testing in a displacement context. The purpose was to (i) evaluate the performance metrics of the Sure Status COVID-19 Antigen Card Test in this population; (ii) compare Ag RDT results across high- and low-probability cases, vaccination status, and symptom severity; and (iii) report participant perspectives on Ag RDT use for COVID-19 and other diseases.

METHODS

Secondary analysis was conducted using de-identified cross-sectional data collected from November 2022-March 2023 in four IDP camps in the Kurdistan region of Iraq. Data was collected during the recording, reporting, and monitoring processes of the pilot project using Ag RDTs for COVID-19 among displaced populations. Descriptive statistics and bivariate analyses were conducted in Stata (version 17).

RESULTS

9,346 Sure Status Ag RDTs were performed from November 2022-March 2023. Observed performance metrics were as follows: sensitivity = 72.73% (95% CI: 69.56-75.80%); specificity = 99.74% (95% CI: 99.39-100%), PPV = 92.31% (95% CI: 92.31-94.15%), and NPV = 98.85% (95% CI: 98.11-99.58%). Ag RDT uptake was higher among women and symptomatic individuals, and preference for Ag RDTs was especially strong among illiterate respondents. The overall positivity of Ag RDTs and PCR results in this population remained lower than national averages. Concerningly, 23.39% of respondents declined an Ag RDT because they did not believe in COVID-19.

CONCLUSIONS

This pilot program was among the first to explore Ag RDT use in Iraqi Kurdistan. Over 99% of respondents reported satisfaction with their experience, and over 90% wanted to see Ag RDTs available for other diseases. Findings can inform implementation of RDTs and screening protocols for other infectious diseases, and patient perspectives on Ag RDTs for testing and screening of COVID-19 among displaced populations can inform health programming within Iraq and globally.

Feasibility, Uptake, and Results of COVID-19 Antigen Rapid Diagnostic Tests among Refugees and Migrants in a Pilot Project in North-West Syria

North-west Syria (NWS) is a conflict-affected and unstable area. Due to its limited health infrastructure, accessing advanced COVID-19 testing services is challenging. COVID-19 antigen rapid diagnostic tests (Ag-RDTs) have the potential to overcome this barrier. A pilot project was implemented to introduce Ag-RDTs in NWS, aiming to determine the feasibility, uptake, and results of Ag-RDTs and identify facilitators and barriers to testing with Ag-RDTs. A cross-sectional study design involving secondary analysis of data collected during the project was employed. A local non-governmental organization implemented 25,000 Ag-RDTs that were conducted cross-border by trained community health workers. In total, 27,888 eligible individuals were enrolled, 24,956 (89.5%) consented to test, and 121 (0.5%) were COVID-19-positive. The highest positivity was observed among those with severe COVID-19 symptoms (12.7%), with respiratory illnesses (2.5%), enrolled at hospitals in Afrin (2.5%), and healthcare workers (1.9%). A non-random sample of 236 individuals underwent confirmatory RT-PCR testing. Observed sensitivity, specificity, and positive and negative predictive values were 80.0%, 96.1%, 91.4%, and 90.3%, respectively. Challenges included obtaining informed consent and conducting confirmatory testing. Ag-RDTs represent a feasible screening/diagnostic tool for COVID-19 infections in NWS, with nearly 90% uptake. Embedding Ag-RDTs into COVID-19 testing and screening strategies would be highly beneficial.

Prevalence of Malnutrition among Syrian Refugee Children from Lebanon

Today, the situation of Syrian refugees is one of the world's worst humanitarian crises. To estimate the prevalence of malnutrition among pediatric populations of Syrian refugees, 176 Syrian refugee children, with stays of more than two years at three refugee camps (Zalhé, Deddeh, and Kfar Jouz) or from the town of Yohmor, Lebanon were authorized by their parents to participate in this study. The children were anthropometrically evaluated and height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and weight-for-height (WHZ) Z-scores were obtained and compared with WHO standards. Furthermore, mid-upper arm circumference (MUAC) was analyzed for screening children 6-59 months old. According to the anthropometric measures, no child met the criteria for chronic, global, acute malnutrition (CGAM), severe acute malnutrition (SAM), or moderate acute malnutrition (MAM). In the total sample, 49.4% of participants were moderately thin, with girls presenting a higher prevalence of thinness than that of boys. Thus, the absence of high rates of malnutrition was verified despite the magnitude of the Syrian refugee's problem. The data provided by this study identify the need to carry out further research to assess anthropometric growth and nutritional status among long-staying refugee children in order to prevent any health issues that may arise in the future.