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Al-Oraibi A, Hassan O, Chattopadhyay K, Nellums LB. The prevalence of non-communicable diseases among Syrian refugees in Syria's neighbouring host countries: a systematic review and meta-analysis. Public Health 2022; 205:139-149. [PMID: 35279542 DOI: 10.1016/j.puhe.2022.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/17/2021] [Accepted: 01/23/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Alarming rates of non-communicable diseases (NCDs) have been observed in low- and middle-income countries (LMICs) where most refugees reside. There is concern Syrian refugees may experience significant NCD-related health needs, which have significant health implications, including in the context of the COVID-19 pandemic, and which must be addressed by health systems in neighbouring host countries. Although primary studies on this topic exist, there has been no comprehensive synthesis of the existing evidence base. The aim of this systematic review and meta-analysis was to synthesise evidence on the prevalence of NCDs among Syrian refugees residing in neighbouring host countries. STUDY DESIGN This was a systematic review and meta-analysis. METHODS The review was carried out in line with PRISMA guidelines (PROSPERO CRD420201970430). MEDLINE, CINAHL, EMBASE and PubMed databases were searched from 1 January 2011 to 1 November 2021. Peer-reviewed studies reporting prevalence data on the five most common NCDs among adult Syrian refugees living in Turkey, Lebanon or Jordan were included. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklist for prevalence studies. Meta-analysis was carried out to estimate the pooled prevalence of these NCDs in community and primary care settings. RESULTS A total of 466 citations were identified, 18 of which were included, representing 237,723 Syrian refugees. In community settings, the prevalence of hypertension, diabetes mellitus type II, cardiovascular diseases, chronic respiratory diseases and arthritis was 24% (95% confidence interval: 17-32), 12% (8-15), 5% (3-7), 4% (3-5) and 11% (7-14), respectively. The prevalence of hypertension 35% (33-36) and diabetes mellitus type II 48% (24-72) were significantly higher in primary care settings. CONCLUSION The findings demonstrate a high prevalence of NCDs among Syrian refugees. Evidence-based preventive and management interventions for NCDs are needed in this context to address acute health needs during the COVID-19 pandemic and the longer-term health burden of NCDs.
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Affiliation(s)
- A Al-Oraibi
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom; Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.
| | - O Hassan
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
| | - Kaushik Chattopadhyay
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom; The Nottingham Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, Nottingham, United Kingdom.
| | - L B Nellums
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
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Hayward SE, Deal A, Rustage K, Nellums LB, Sweetland AC, Boccia D, Hargreaves S, Friedland JS. A systematic review of the association between mental health and tuberculosis disease risk. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Tuberculosis (TB) and mental illnesses are highly prevalent globally and often co-exist. Whilst poor mental health is known to modulate immune function, whether mental disorders causally increase TB incidence is unknown. This systematic review examines the association between mental health and TB disease risk to inform clinical and public health measures.
Methods
We carried out a systematic review following PRISMA guidelines (PROSPERO CRD42019158071). We searched MEDLINE, PsycINFO and PsycEXTRA databases alongside reference list and citation searching. Inclusion criteria were original research studies published 01/01/1970-11/05/2020 reporting data on the relationship between mental health and risk of TB disease. CASP and AXIS checklists were used to critically appraise included studies.
Results
We screened 1546 records published over 50 years, resulting in data synthesised from 607,184 individuals. Settings include Asia, South America, and Africa, and both mood (e.g. depression) and psychotic (e.g. schizophrenia) disorders are investigated. Robust evidence from cohort studies in Asia shows that depression and schizophrenia can increase risk of TB disease, with effect estimates ranging from HR = 1.15 [95% CI 1.03-1.28] to HR = 2.63 [95% CI 1.74-3.96] for depression and HR = 1.52 [95% CI 1.29-1.79] to RR = 3.04 for schizophrenia, and a dose-response relationship reported in one study. These data are consistent with data from cross-sectional studies, such as a large survey across low- and middle-income countries (n = 242,952) reporting OR = 3.36 [95% CI 3.01-4.50] for a depressive episode in those with TB versus those without.
Conclusions
Individuals with mental illnesses including depression and schizophrenia experience increased TB incidence and represent a high-risk population to target for screening and treatment. Integrated care for mental health and TB is needed, and interventions tackling mental illnesses and underlying drivers may help reduce TB incidence globally.
Key messages
This systematic review examines data from 607,184 individuals and finds evidence that mental health is a risk factor for TB disease. Those suffering from depression and schizophrenia are an at-risk population that could be identified and targeted for TB screening and treatment.
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Affiliation(s)
- SE Hayward
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - LB Nellums
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - AC Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, USA
| | - D Boccia
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - JS Friedland
- Institute for Infection and Immunity, St George's, University of London, London, UK
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Gogoi M, Armitage R, Brown G, Ryan B, Eborall H, Qureshi N, O'Donnell CA, Ciftci Y, Pareek M, Nellums LB. Putting the voices and insights of migrants and diverse ethnic groups at the centre of our response to COVID-19. Public Health 2021; 197:e1-e3. [PMID: 33741187 PMCID: PMC7547632 DOI: 10.1016/j.puhe.2020.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022]
Affiliation(s)
- M Gogoi
- University of Leicester, UK.
| | | | - G Brown
- University of Leicester, UK.
| | - B Ryan
- University of Leicester, UK.
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Armitage R, Nellums LB. COVID-19, physical distancing, and young adults living alone. Perspect Public Health 2021; 141:131-132. [PMID: 34015995 DOI: 10.1177/1757913920975810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- R Armitage
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
| | - L B Nellums
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham City Hospital, Nottingham, UK
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Armitage R, Nellums LB. Disease X: availability bias, biotechnology and seeing beyond zoonotic risk. Public Health 2021; 190:e25. [PMID: 33349433 PMCID: PMC7816604 DOI: 10.1016/j.puhe.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/15/2020] [Indexed: 01/27/2023]
Affiliation(s)
- R Armitage
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - L B Nellums
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
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Hargreaves S, Himmels J, Nellums LB, Biswas G, Gabrielli AF, Gebreselassie N, Zignol M, Schellenberg D, Norris SL, Ford N, Maher D. Identifying research questions for HIV, tuberculosis, tuberculosis-HIV, malaria, and neglected tropical diseases through the World Health Organization guideline development process: a retrospective analysis, 2008-2018. Public Health 2020; 187:19-23. [PMID: 32889228 PMCID: PMC7660115 DOI: 10.1016/j.puhe.2020.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES World Health Organization (WHO) guidelines for health programmes and healthcare delivery are the foundation of its technical leadership in public health and essential to decision-making globally. A key function of guideline development is to identify areas in which further evidence is needed because filling these gaps will lead to future improvements in population health. The objective of this study was to examine the knowledge gaps and research questions for addressing those gaps generated through the WHO guideline development process, with the goal of informing future strategies for improving and strengthening the guideline development process. STUDY DESIGN We did a systematic, retrospective analysis of research questions identified in the published guidelines. METHODS We analyzed guidelines published between January 1, 2008, and December 31, 2018, by the Communicable Diseases Cluster in five disease areas: tuberculosis (TB), HIV, malaria, TB-HIV, and neglected tropical diseases (NTDs). Research questions were extracted independently by two researchers. We analyzed the distribution of research questions by disease and by topic category and did a qualitative assessment of optimum practice for research question generation during the guideline development process. RESULTS A total of 48 guidelines were included: 26 on HIV, 1 on malaria, 11 on TB, 5 on TB/HIV, and 5 on NTDs. Overall, 36 (75%) guidelines encompassed a total of 360 explicit research questions; the remainder did not contain specific research questions. The number of research questions that focused on TB was 49, TB/HIV was 38, HIV was 250, and NTDs was 23. The number of research questions that focused on diagnosis was 43 (11.9%) of 360, prevention was 62 (17.2%), treatment was 103 (28.6%), good practice was 12 (3.3%), service delivery was 86 (23.8%), and other areas was 54 (15%). Research questions were often not formulated in a specific or actionable way and were hard to identify in the guideline. Examples of good practice identified by the review team involved the generation of specific and narrowly defined research questions, with accompanying recommendations for appropriate study design. CONCLUSIONS The WHO must strengthen its approach to identifying and presenting research questions during the guideline development process. Ensuring access to research questions is a key next step in adding value to the guideline development process.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, UK
| | - J Himmels
- Institute for Infection and Immunity, St George's, University of London, UK
| | - L B Nellums
- Institute for Infection and Immunity, St George's, University of London, UK
| | - G Biswas
- World Health Organization, Geneva, Switzerland
| | | | | | - M Zignol
- World Health Organization, Geneva, Switzerland
| | | | - S L Norris
- World Health Organization, Geneva, Switzerland
| | - N Ford
- World Health Organization, Geneva, Switzerland
| | - D Maher
- World Health Organization, Geneva, Switzerland.
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Hargreaves S, Nellums LB, Powis J, Jones L, Miller A, Rustage K, Russell N, Friedland J. Exploring the views of undocumented migrant women on access to maternity services in the UK. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Migrant women face inequalities in access to health-care services and are known to experience poorer maternal and child outcomes than women born in the UK. The development of more restrictive health policies in the UK and Europe, including being denied or charged for healthcare at maternity services, may be exacerbating these outcomes, particularly among undocumented migrant women without permission to reside. We investigated undocumented migrant women's experiences of accessing maternity services in the UK and their impact on health outcomes.
Methods
We did semi-structured in-depth qualitative interviews with a purposive sample of migrant women (born outside the UK) who were aged 18 and over, and had experiences of pregnancy in the UK whilst undocumented. Participants were recruited through the Doctors of the World UK clinic. Interviews were transcribed and analysed using thematic analysis.
Results
We did interviews with 20 undocumented women (age range 31-40 years; mainly from Africa and Asia). Among participants, of whom 13 were pregnant at the time of interview, 10 (50%) first accessed antenatal care late (after the national target of 13 weeks). Women described an ongoing cycle of precariousness, defined by their legal status, social isolation, and poor economic status. Women reported receiving bills of up to £11,500 for maternity services (range £3,072 to £11.500). The impact of their experiences meant that they were deterred from seeking timely health care and were reluctant to present to health services, with women reporting fear and loss of trust in the health system.
Conclusions
These women's narratives illustrated the potential deterrent and detrimental impact of increasingly restrictive health policies on women's access to care and their health. UK and European health policies must be equitable, non-discriminatory, and better align with our commitments to promote universal health coverage among all individual residing in the region.
Key messages
Increasingly restrictive health policies may have a deterrent and detrimental impact on migrant women’s access to health care. Undocumented migrant women in the UK reported fear and loss of trust in the health system.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - L B Nellums
- Institute for Infection and Immunity, St George's University of London, London, UK
- University of Nottingham, London, UK
| | - J Powis
- Imperial College London, London, UK
| | - L Jones
- Doctors of the World UK, London, UK
| | - A Miller
- Doctors of the World UK, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - N Russell
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - J Friedland
- Institute for Infection and Immunity, St George's University of London, London, UK
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8
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Hayward SE, van der Werf MJ, Noori T, Nellums LB, Boccia D, Friedland JS, Hargreaves S. Extrapulmonary tuberculosis among migrants in the EU/EFTA: Implications for policy and practice. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The proportion of tuberculosis (TB) cases in the European Union/European Free Trade Association (EU/EFTA) that occur in migrants is increasing. Extrapulmonary TB poses challenges in diagnosis and treatment and causes serious morbidity and mortality. To date, there has been no in-depth exploration of extrapulmonary TB in migrants across Europe.
Methods
We analysed 22 years of data from the European Centre for Disease Prevention and Control's European Surveillance System (TESSy) for 32 EU/EFTA countries between 1995 and 2017. We investigated whether the proportion of TB cases that were extrapulmonary varied between migrants and non-migrants, and whether this varied by a) country/region of origin, b) reporting country/region, and c) site of disease.
Results
1,270,896 TB cases were included in the analysis, comprising 326,987 (25.7%) migrants, and 943,909 (74.3%) non-migrants. The proportion of TB that is extrapulmonary is significantly higher in migrants than in non-migrants: 45.2% (n = 147,814) of cases in migrants were extrapulmonary, compared to 21.7% (n = 204,613) in non-migrants (χ2=6.7x104, p < 0.001). A relatively low proportion of extrapulmonary TB was seen in Eastern (17.4%) and Southern (29.6%) Europe compared with Western (35.7%) and Northern (41.8%) Europe, with migrants having a greater proportion of extrapulmonary TB only in Northern/Western Europe. Migrants from South-East Asia and Sub-Saharan Africa were at highest risk of extrapulmonary TB, with over half of all cases being extrapulmonary (62.0% and 54.5% respectively).
Conclusions
Among TB cases in the EU/EFTA, extrapulmonary disease is significantly more common in migrants than non-migrants, which has clinical and policy implications for patient detection and management. There is a need to improve clinical awareness of extrapulmonary TB, integrate detection of extrapulmonary TB into latent TB infection screening programmes, and harmonise data collection on migrant status in health systems.
Key messages
Migrants in the EU/EFTA are disproportionately affected by extrapulmonary TB compared to non-migrants. This has clinical and policy implications for diagnosis, screening, and data collection.
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Affiliation(s)
- S E Hayward
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - M J van der Werf
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - T Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - L B Nellums
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
| | - D Boccia
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - J S Friedland
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
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Affiliation(s)
- R Armitage
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - L B Nellums
- Division of Epidemiology & Public Health, University of Nottingham, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
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Hargreaves S, Himmels J, Nellums LB, McGuire E, Friedland JS. Vaccination status of migrant populations in EU/EEA countries and implications for VPD control. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Migrant populations in the EU/EEA are increasingly being associated with outbreaks of vaccine-preventable diseases (VPDs), including the large-scale measles outbreak currently ongoing across Europe; however, it is unclear to what extent migrants represent an under-immunised group in the European context and implications for VPD control. Ensuring high levels of vaccination coverage is a key priority for all countries through the European Vaccine Action Plan, with EU/EEA Member States committed to eliminating measles and rubella, sustaining polio-free status, and controlling hepatitis B infection. We synthesised existing EU/EEA data to assess under-immunisation in migrants (defined as foreign born) residing in EU/EEA countries.
Methods
We did a systematic review and meta-analysis (PROSPERO CRD42018103666) in accordance with PRISMA guidelines. Inclusion criteria were primary research studies pertaining to vaccination status (measles, mumps, rubella, diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b [Hib]) in migrants residing in all EU/EEA countries. Pooled prevalence (95% CIs) were calculated for the meta-analysis using a random effects model.
Results
56 studies met our criteria (14 EU/EEA countries); 36 studies, which included data from 80,432 migrants, were included in the meta-analysis. Vaccination status of migrants for key VPDs varied substantially, with pooled immunisation coverage well below the herd immunity threshold (HIT) targets for measles 80% (95% CI: 73-87%; HIT 92-95%), mumps 65% (95% CI: 48-82%; HIT 75-86%), and diphtheria 51% (95% CI: 29-73%; HIT 83-86%). Polio type 1 and 2 coverage was high (97% [95% CI: 95-98%]; 95 [95% CI: 92-97%], respectively).
Conclusions
Migrants represent an under-immunised group in Europe, thus a high priority group for catch-up vaccination. Innovative strategies to engage them in vaccine uptake will be critical if we are to make European targets for the elimination and/or control of key VPDs.
Key messages
Migrants represent an under-immunised group in Europe and a high priority group for catch-up vaccination campaigns. Innovative strategies to engage them in vaccine uptake will be critical if we are to make European targets for the elimination and control of vaccine-preventable diseases.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - J Himmels
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - L B Nellums
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - E McGuire
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - J S Friedland
- Institute for Infection and Immunity, St George’s University of London, London, UK
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Nakken CS, Skovdal M, Nellums LB, Friedland JS, Hargreaves S, Norredam M. Vaccination status and needs of asylum-seeking children in Denmark: a retrospective data analysis. Public Health 2018; 158:110-116. [PMID: 29653865 PMCID: PMC5947822 DOI: 10.1016/j.puhe.2018.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 01/30/2018] [Accepted: 02/04/2018] [Indexed: 11/23/2022]
Abstract
Objectives Asylum seekers to Europe may come from war-torn countries where health systems have broken down, and there is evidence that asylum-seeking children have low coverage of childhood vaccinations, as well as uptake of immunisations in host countries. Such gaps in immunisation have important implications for effective national vaccination programmes. How we approach vaccination in children and adults entering Western Europe, where as a group they face barriers to health services and screening, is a growing debate; however, there are limited data on the vaccination status of these hard-to-reach communities, and robust evidence is needed to inform immunisation strategies. The aim of this study was to explore the vaccination status and needs of asylum-seeking children and adolescents in Denmark. Study design We conducted a retrospective data analysis of anonymised patient records for asylum-seeking children and adolescents extracted from the Danish Red Cross database. Methods We retrospectively searched the Danish Red Cross database for children and adolescents (aged 3 months–17 years) with active asylum applications in Denmark as of October 28, 2015. Data were extracted for demographic characteristics, vaccination status and vaccinations needed by asylum-seeking children presenting to Red Cross asylum centres for routine statutory health screening. Results We explored the vaccination status and needs of 2126 asylum-seeking children and adolescents. About 64% of the study population were male and 36% were female. Eight nationalities were represented, where 33% of the total of children and adolescents were not immunised in accordance with Danish national guidelines, while 7% were considered partly vaccinated, and 60% were considered adequately vaccinated. Afghan (57% not vaccinated/unknown) and Eritrean (54% not vaccinated/unknown) children were the least likely to be vaccinated of all nationalities represented, as were boys (37% not vaccinated/unknown) compared with girls (27% not vaccinated/unknown) and children and adolescents aged between 12 and 17 years (48% not vaccinated/unknown) compared with 6- to 11-year olds (26%) and 0- to 5-year olds (22%). The health screenings resulted in 1328 vaccinations. The most commonly needed vaccines were diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b, (DTaP/IPV/Hib) which comprised 49% of the vaccines distributed, followed by the pneumococcal vaccine (Prevnar) (28%) and measles, mumps and rubella (MMR) vaccine (23%). Conclusions The finding that nearly one-third of asylum-seeking children and adolescents in Denmark were in need of further vaccinations highlights the gaps in immunisation coverage in these populations. These results point to the need to improve access to health services and promote national vaccine programmes targeted at these communities to facilitate vaccination uptake and increase immunisation coverage to reduce the risk of preventable infectious diseases among asylum-seeking children. Little is known on the state of immunisation of refugees arriving in Western receiving countries. Variations in status on arrival to Denmark were associated with gender, country of origin and age groups. Vaccination needs were found to be associated with country of origin, while gender did not act as a significant determinant. Immunisations for vaccine-preventable diseases is critical for protecting refugee health and host communities.
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Affiliation(s)
- C S Nakken
- Danish Research Center for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - M Skovdal
- Danish Research Center for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - L B Nellums
- Infectious Diseases and Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, W12 0NN, London, UK.
| | - J S Friedland
- Infectious Diseases and Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, W12 0NN, London, UK
| | - S Hargreaves
- Infectious Diseases and Immunity, Department of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, W12 0NN, London, UK
| | - M Norredam
- Danish Research Center for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark; Section of Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
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Anjara SG, Nellums LB, Bonetto C, Van Bortel T. Stress, health and quality of life of female migrant domestic workers in Singapore: a cross-sectional study. BMC Womens Health 2017; 17:98. [PMID: 29017558 PMCID: PMC5634837 DOI: 10.1186/s12905-017-0442-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a global increase in migrant workers. In Singapore, there are over 230,000 migrant domestic workers (MDWs). Female MDWs may experience high levels of stress and social isolation, which may negatively impact on their health and quality of life. There have also been documented cases of abuse and exploitation. However, there is a lack of empirical research with this population. This study aimed to investigate factors impacting on the health and quality of life of female MDWs in Singapore, including socio-demographic and job related characteristics, stress, social isolation, and working management style. METHODS A cross-sectional survey was carried out with 182 female MDWs in Singapore. The survey examined health and quality of life (WHOQoL-Bréf), social connectedness (the Friendship Scale), and preferred and experienced working management style (the Theory X and Theory Y Questionnaire). Descriptive analyses were carried out in addition to ANOVA, t-tests, and chi-square tests, followed by a multivariate analysis using linear regression. RESULTS Participants were found to have good overall quality of life and satisfaction with health. Age and working experience were found to be significantly (p < 0.05) associated with overall quality of life and three domains (psychological, social, and environmental health). Agreement between experienced and preferred working management style was also found to be associated with higher quality of life scores (with the exception of the social relationships domain). Though women reported relatively good overall quality of life, more than half of participants reported feeling stressed. In addition, nearly 20% of participants reported being isolated or very isolated. Stress was identified to be associated with isolation. In the multivariate analysis, stress was found to contribute to worse quality of life in all domains except social relationships, after adjusting for confounders. Social connectedness was positively associated with all domains of quality of life, and agreement of working management style was positively associated with physical health, psychological health and environmental quality of life. CONCLUSIONS The findings serve as an evidence-base pointing to the need for policies aimed at decreasing stress and social isolation among female MDWs in order to improve their health and quality of life.
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Affiliation(s)
- S. G. Anjara
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
| | - L. B. Nellums
- Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, 8th Floor Commonwealth Building, Hammersmith Hospital, Du Cane Road, London, W12 0NN UK
| | - C. Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - T. Van Bortel
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Institute for Health and Human Development, University of East London, Stratford Campus, Suite 250, University House, The Green, Water Lane, London, E15 4LZ UK
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Hargreaves S, Lönnroth K, Nellums LB, Olaru ID, Nathavitharana RR, Norredam M, Friedland JS. Response to Letter to the Editor by M. van der Werf, V. Hollo and C. Ködmön concerning 'Multidrug-resistant tuberculosis and migration to Europe'. Clin Microbiol Infect 2017; 23:580. [PMID: 28257900 DOI: 10.1016/j.cmi.2017.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
Affiliation(s)
- S Hargreaves
- Infectious Diseases & Immunity, Imperial College London, UK
| | - K Lönnroth
- Karolinska Institutet, Stockholm, Sweden; Global TB Programme, WHO, Geneva, Switzerland
| | - L B Nellums
- Infectious Diseases & Immunity, Imperial College London, UK
| | - I D Olaru
- Division of Clinical Infectious Diseases, Research Centre, Borstel, Germany; German Center for Infection Research, Clinical Tuberculosis Centre, Borstel, Germany
| | - R R Nathavitharana
- Infectious Diseases & Immunity, Imperial College London, UK; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M Norredam
- Danish Research Centre for Migration Ethnicity and Health, University of Copenhagen, Denmark; Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital, Hvidovre, Denmark
| | - J S Friedland
- Infectious Diseases & Immunity, Imperial College London, UK.
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