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Ibrahim AH, Hammad AM, Al-Qerem W, Alaqabani H, Hall FS, Alasmari F. Triglyceride Glucose Index as an Indicator of Cardiovascular Risk in Syrian Refugees. Diabetes Metab Syndr Obes 2024; 17:1403-1414. [PMID: 38533267 PMCID: PMC10964780 DOI: 10.2147/dmso.s455050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
Background The triglyceride glucose (TyG) index is a quick and inexpensive approach to measure insulin resistance. The aim of this study was to evaluate the TyG index's ability to predict cardiovascular risk and determine the TyG index cutoff values in Syrian refugees. Methods A retrospective research study was conducted with 756 Syrian refugees. Data on demographics and clinical laboratory assessments were obtained from refugee's files. The formula Ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg (dL)/2] was used to calculate the TyG index. The Framingham risk score was used to calculate ten-year cardiovascular risk. The TyG index cutoff point was determined using the receiver operating characteristic curve (ROC). Results Included participants had a mean age of 56.76 ± 10.78 years and a mean body mass index (BMI) of 27.42 ± 4.03 kg/m2. 28.57% of the subjects were smokers, and the majority were female (56.75%). A significant moderate correlation was observed between TyG index and Framingham score (r = 0.428, p < 0.001). ROC curve analysis for TyG index and Framingham score showed an area under the curve (AUC) of 0.741 (95% CI = 0.691-0.791; p < 0.001). The cutoff value of the TyG index to recognize intermediate/high risk Framingham risk score was 9.33, with a sensitivity of 64.3%, and specificity of 75.0%. Conclusion Our findings determine that, given a TyG index cutoff value of 9.33, the TyG index has a predictive ability to assess ten-year cardiovascular risk by comparison to the Framingham risk score in a high-risk group of Syrian refugees and can be used as an independent indicator of cardiovascular risk.
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Affiliation(s)
- Ameerah Hasan Ibrahim
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Alaa Mahmoud Hammad
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Hakam Alaqabani
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
- Strathclyde Institute of Pharmacy and Biomedical sciences, University of Strathclyde, Glasgow, UK
| | - F Scott Hall
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA
| | - Fawaz Alasmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Ay Kesgin M, Saraç M, Grede N, Çavlin Bircan A, Koç İ. Impact of financial assistance on stunting: Syrian refugee children under 5 in Türkiye. J Biosoc Sci 2024:1-27. [PMID: 38356431 DOI: 10.1017/s0021932024000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Despite the global decrease over the last two decades, stunting, also called 'chronic malnutrition', remains a public health issue affecting almost 150 million children under the age of 5 years globally. Defined by height-for-age, stunting is the consequence of poor nutrition, repeated infection, and inadequate psychosocial stimulation. Programmes and policies target undernutrition globally, and humanitarian and development actors invest great efforts to prevent stunting. This study uses multivariate analysis to examine the impact of financial assistance on the reduction of stunting in a refugee context, focusing on Syrian refugee children under the age of 5 years in Türkiye. Using a unique dataset, the 2018 Turkey Demographic and Health Survey Syrian Migrant Sample (2018 TDHS-SR), the findings indicate that financial assistance significantly reduces the incidence of stunting among refugee children under the control of economic, mother and children, environmental, health-related and nutritional and breastfeeding characteristics. However, having household members generate income is found to be another stronger predictor to reduce stunting. The paper also argues that the nutritional well-being of refugee children might improve if forced migration occurs towards a stable host country/region. In addition, adaptation over time also seems to have a positive influence.
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Affiliation(s)
| | - Melike Saraç
- Department of Social Research Methodology, Institute of Population Studies, Hacettepe University, Ankara, Turkey
| | - Nils Grede
- United Nations World Food Programme, Ankara, Turkey
| | - Alanur Çavlin Bircan
- Department of Demography, Institute of Population Studies, Hacettepe University, Ankara, Turkey
| | - İsmet Koç
- Department of Demography, Institute of Population Studies, Hacettepe University, Ankara, Turkey
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Dadras O, Diaz E. Perceived discrimination and its association with self-rated health, chronic pain, mental health, and utilization of health services among Syrian refugees in Norway: a cross-sectional study. Front Public Health 2024; 12:1264230. [PMID: 38406500 PMCID: PMC10884245 DOI: 10.3389/fpubh.2024.1264230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Background There is a scarcity of research on discriminatory experiences and their association with health outcomes among Syrian Refugees in Norway. Thus, this study aims to examine the relationship between perceived discrimination, self-rated health (SRH), chronic pain, poor mental health, and healthcare utilization among Syrian refugees resettled in Norway. Methods Cross-sectional data from the Integration for Health project were analyzed, including 154 Syrian refugees who resettled in Norway in 2018-19. Perceived discrimination, SRH, chronic pain, psychological distress, post-traumatic stress symptoms, and healthcare visits were assessed. Statistical analyses, including Poisson regression and multinomial logistic regression, were conducted. The significant statistical level was set at 0.05. Results Approximately 30% of participants reported experiencing discrimination, with no significant associations between sociodemographic factors and perceived discrimination. Perceived discrimination was significantly associated with psychological distress (adjusted PR: 2.07, 95%CI: 1.21-3.55), post-traumatic stress symptoms (adjusted PR: 11.54, 95%CI: 1.25-106.16), and 4 or more psychologist visits (adjusted OR: 12.60, 95%CI: 1.72-92.16). However, no significant associations were found between perceived discrimination and SRH; pain symptoms, or general healthcare utilization. Conclusion Experienced discrimination is highly prevalent and seems to be associated with mental health outcomes, but not clearly with SRH, pain, or general healthcare visits among Syrian refugees living in Norway. Efforts should focus on reducing discrimination, promoting social inclusion, and improving access to mental health services for refugees. Public awareness campaigns, anti-discrimination policies, and cultural training for healthcare professionals are recommended to address these issues and improve the well-being of Syrian refugees in Norway.
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Affiliation(s)
- Omid Dadras
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Esperanza Diaz
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
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Birtan D, Akpinar A. Ethical challenges in organ transplants for refugees in a healthcare system. Nurs Ethics 2024:9697330241230528. [PMID: 38321969 DOI: 10.1177/09697330241230528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Several ethical issues are associated with providing living organ transplantation services, and there is limited information on these issues faced by the teams providing service to refugees or asylum seekers. AIM To determine the challenges healthcare professionals face in organ transplant centers providing services to Syrians under temporary protection status and discern whether these difficulties align with ethical issues in living organ transplantation. RESEARCH DESIGN This study employed a qualitative design and conducted individual semi-structured, in-depth interviews with 18 transplant team members in Istanbul between September and November 2022. Data analysis was based on Braun and Clarke's thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT The participants comprised 18 healthcare professionals, including 6 physicians and 12 nurses working in organ transplant teams in Istanbul. ETHICAL CONSIDERATIONS The University's Ethics Committee provided approval. Participants were informed regarding confidentiality and signed an informed consent form. RESULTS Three themes emerged from the data on ethical issues faced by organ transplantation services to Syrians: (a) beneficence or double equipoise, (b) autonomy, and (c) justice. Transplant teams experience problems related to preserving double equipoise in the provision of living donor organ transplantation because of language barriers, poor socioeconomic conditions, and cultural factors, which increases transplant teams' individual and indirect social burden. Although problems arise from the language barrier when obtaining informed consent in the autonomy theme, institutional and national policies in preventing donor abuse have a comforting effect. Health workers had the least problems with the justice theme, wherein national health policies are determined. CONCLUSION Fewer issues related to autonomy and justice were reported in providing organ transplantation services to Syrians, with the most intense reported issues being maintaining double equipoise. The results revealed the need to develop institutional, national, and international policies with individual solutions to prevent difficulties healthcare professionals face in this process.
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Affiliation(s)
- Deniz Birtan
- Kocaeli University
- İstanbul University-Cerrahpaşa
| | - Aslihan Akpinar
- Department of History of Medicine and Ethics, School of Medicine, Kocaeli University, Kocaeli
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Dirican AÖ, Korucu DG. A comprehensive evaluation of pregnancy and newborn outcomes in Syrian refugees in Turkey. BMC Pregnancy Childbirth 2024; 24:3. [PMID: 38166924 PMCID: PMC10759474 DOI: 10.1186/s12884-023-06168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The research was conducted to evaluate the birth and newborn outcomes of Syrian immigrant women according to maternal age groups and Vitamin D use. METHODS It was conducted retrospectively using the birth records of 2,866 Syrian migrant women, who had given birth at a tertiary center between January 2016 and May 2020. Demographic features, obstetric and neonatal outcomes were analyzed according to age groups and Vitamin D use. RESULTS The mean age of the patients included in the study was 26.22 ± 5.90, the mean gestational age at birth was 38.06 ± 2.1 weeks, and the mean newborn birth weight was 3.151 g. The mean hemoglobin value of the patients was 11.55 ± 1.54. While most of the patients were taking iron supplements (80.59%), Vitamin D (Vit D) supplement intake was 38.31%. The mean number of antenatal follow-ups was 3.40 ± 1.65. While the most common delivery method was normal vaginal delivery (61.93%), cesarean section rates were found to be 38.07%. The need for blood transfusion was significantly lower in the group that had received Vitamin D than that in the group that had not received it (2.00% vs. 8.94% p < 0.001). The rate of preterm birth was found to be 5.74% in the group that had received Vitamin D and 9.28% in the group that had not received it, which was significantly higher (p < 0.001). CONCLUSIONS We have seen that maternal and fetal outcomes can be improved with hospital follow-up and adequate vitamin supplements in refugee pregnant women.
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Affiliation(s)
- Aylin Önder Dirican
- Department of Gynecology and Obstetrics, Başkent University Konya Practice and Research Hospital, Konya, Turkey.
| | - Dilay Gök Korucu
- Department of Gynecology and Obstetrics, Konya City Hospital, Konya, Turkey
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Oweidat I, Omari A, ALBashtawy M, Al Omar Saleh, Alrahbeni T, Al-Mugheed K, Alsheikh ADI. Factors affecting the quality of working life among nurses caring for Syrian refugee camps in Jordan. Hum Resour Health 2024; 22:1. [PMID: 38167317 PMCID: PMC10763280 DOI: 10.1186/s12960-023-00884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES The global refugee crisis, exacerbated by the Syrian war, has placed tremendous strain on Jordan's healthcare system and infrastructure, notably impacting nurses working in refugee camps. The aim to identify factors influencing nurses' Quality of life at work (QWL) and understand their significance in crisis healthcare environments. METHODOLOGY A cross-sectional study was conducted in multiple healthcare facilities within Syrian refugee camps. A convenient sample of 166 nurses participated, and data were collected using the Brook's Quality of Nursing Work Life Survey. Data analysis included descriptive and inferential (one-way ANOVA) statistics. Significance level was set at 0.05. RESULTS Nurses in this study generally reported a moderate QWL, with an average score of 152.85, indicating that their overall work experience falls into the moderate range. The study found that nurses perceived their work-life/home-life balance (mean score 25.79), work design (mean score 35.71), work context (mean score 71.37), and work world (mean score 19.96) at levels indicative of moderate satisfaction. There were no statistically significant differences in QWL among participating nurses, suggesting that factors other than demographic characteristics may play a more influential role in determining nurses' QWL in the unique context of refugee caregiving. CONCLUSION This study underscores that working within refugee healthcare missions and recommends targeted interventions to enhance their well-being.
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Affiliation(s)
- Islam Oweidat
- Community and Mental Health Nursing Department, Zarqa University, Zarqa, Jordan.
| | - Abeer Omari
- Community and Mental Health Nursing Department, Zarqa University, Zarqa, Jordan
| | | | - Al Omar Saleh
- Clinical Nursing Department, Zarqa University, Zarqa, Jordan
| | - Tahani Alrahbeni
- Molecular Toxicology and Genetics/College of Nursing, Riyadh Elm University, Riyadh, Saudi Arabia
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Inal HA, Inal ZO. Comparison of Perinatal Outcomes Between Syrian Refugees and Turkish Women in the Middle Anatolia Region of Turkey. Matern Child Health J 2023; 27:2139-2146. [PMID: 37393424 DOI: 10.1007/s10995-023-03748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To compare the results of perinatal outcomes between Syrian refugees and Turkish women between 2016 and 2020. METHODS The birth results of 17,997 participants (Syrian refugees: 3579 and Turkish women: 14,418) who delivered in the Labor Department of our hospital between January 2016 and December 2020 were retrospectively analyzed. RESULTS Maternal age was younger (24.73 ± 6.08 vs. 27.4 ± 5.91 years, p < 0.001) and adolescent pregnancy rate was higher (19.4% vs. 5.6%, p < 0.001) in Syrian refuges than in Turkish women. Bishop scores on admission (4.6 ± 1.6 vs. 4.4 ± 1.1, p < 0.001), birth weight (3088.19 ± 575.32 g vs. 3109.76 ± 540.89 g, p = 0.044), low birth weight (11.3% vs. 9.7%, p = 0.004), and the rate of primary cesarean deliveries (10.1% vs. 15.8%, p < 0.001) were also statistically different. Additionally, the rates of anemia (65.9% vs. 29.2%, p < 0.001), preeclampsia (1.4% vs. 2.7%, p < 0.001), stillbirth (1.3% vs. 0.6%, p < 0.001), preterm premature rupture of membranes (2.7% vs. 1.9%, p = 0.002), and obstetric complications were different between the groups. CONCLUSIONS This study showed that inadequate antenatal care, communication and language barrier problems in Syrian refugees caused some adverse perinatal outcomes. All birth data of Syrian refugees must be disclosed by the Ministry of Health to confirm the accuracy of our data.
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Affiliation(s)
- Hasan Ali Inal
- Departmant of Obstetric and Gynecology, Konya Training and Research Hospital, Konya, Turkey.
| | - Zeynep Ozturk Inal
- Departmant of Obstetric and Gynecology, Konya Training and Research Hospital, Konya, Turkey
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Yalcin SS, Savcı RG, Yalcin S, Eryurt MA. Accuracy of Syrain Refugee Mothers' Perceptions of Newborn's Birth Size: Insights from a National Survey in Turkey. J Immigr Minor Health 2023; 25:1363-1373. [PMID: 37402934 DOI: 10.1007/s10903-023-01519-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
This study aims to assess the accuracy of maternally perceived birth size and its associated factors among the Syrian refugees in Turkey, using the data from 2018 Turkey Demographic and Health Survey Syrian Migrant Sample (TDHS-SM-18). The study includes information on the last-born child, singleton pregnancies, births in healthcare facilities, children under 5 living with their mothers, with recorded birth weight (n = 969). The study categorizes the mother's perception of size into three groups : compatible, overestimated, and underestimated. Various factors, including sociodemographic characteristics, financial aspects, maternal characteristics, and child characteristics, are considered as explanatory variables. The analysis employs a complex sample multiple logistic regression model. The findings reveal that the majority of mothers accurately perceive the birth size, but 17.1% of them do not. Maternal factors such as region of residence, literacy, occupation, age at birth, and child factors such as birth order, birth interval, gender, and birth weight are identified as associated factors with maternal misperception. This study provides valuable insights into the accuracy of maternally perceived birth size and sheds light on the factors influencing this perception among Syrian refugee mothers in Turkey.
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Affiliation(s)
- Siddika Songül Yalcin
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Refia Gözdenur Savcı
- Departmant of Social Pediatrics, Institute of Child Health, Hacettepe University, Ankara, Turkey
| | - Suzan Yalcin
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Selçuk University, Konya, Turkey
| | - Mehmet Ali Eryurt
- Institute of Population Studies, Hacettepe University, Ankara, Turkey
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Barış M, Sert G, Önder O. Ethical challenges in accessing and providing healthcare for Syrian refugees in Türkiye. Bioethics 2023. [PMID: 37937953 DOI: 10.1111/bioe.13233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 09/16/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023]
Abstract
Türkiye hosts approximately 3.6 million Syrian refugees, which accounts for roughly 4.5% of Türkiye's population. This places undeniable pressure on public institutions, particularly on healthcare services. The objective of this study is to document the healthcare structure for Syrian refugees and various challenges faced by Syrians when seeking healthcare and to highlight the ethical concerns emerging from those challenges. To achieve this, we conducted a comprehensive review of several qualitative studies and reports conducted by various organizations and institutions, specifically focusing on health or including a dedicated chapter on health issues, published between 2011 and 2023. Following an extensive analysis of the secondary literature, we classified the challenges into three categories: procedural, cultural, and psychosocial. We argue that each of these challenges is linked to overarching medical ethics concerns. Finally, we propose three possible means to mitigate the challenges Syrians experience in accessing and uptake of healthcare services in Türkiye.
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Affiliation(s)
- Maide Barış
- Department of Medical History & Ethics, Marmara University, Istanbul, Türkiye
| | - Gürkan Sert
- Department of Medical History & Ethics, Marmara University, Istanbul, Türkiye
| | - Orhan Önder
- Department of Medical History & Ethics, Marmara University, Istanbul, Türkiye
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Bagci SC, Baysu G, Tercan M, Turnuklu A. Dealing With Increasing Negativity Toward Refugees: A Latent Growth Curve Study of Positive and Negative Intergroup Contact and Approach-Avoidance Tendencies. Pers Soc Psychol Bull 2023; 49:1466-1478. [PMID: 35856466 PMCID: PMC10478330 DOI: 10.1177/01461672221110325] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
Despite increasing contact opportunities, prejudice toward refugees persists, especially in mass immigration contexts. We investigated changes in and associations between Turkish early adolescents' (N = 687, Mage = 11.11 years) positive and negative contact with Syrian refugees and their outgroup approach-avoidance tendencies over 15 months (three waves). Univariate growth curve models demonstrated a rise in outgroup negativity indicated by increasing negative contact and avoidance tendencies, and decreasing approach tendencies, while positive contact only slightly increased over time (nonsignificantly). Combined latent growth curve models showed that increasing positive contact buffered against increasing outgroup negativity in behavioral tendencies by predicting a less steep decline in approach and a less steep increase in avoidance. Increasing negative contact was positively associated with increasing outgroup negativity so that it predicted a more steep increase in avoidance. Findings underline the importance of early contact interventions that target the fast deterioration of positive intergroup interactions in increasingly hostile intergroup contexts.
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Mourtada R, Melnikas AJ. Syrian refugee women's access to family planning services and modern contraception during overlapping crises in Bekaa, Lebanon. BMC Womens Health 2023; 23:475. [PMID: 37674178 PMCID: PMC10481481 DOI: 10.1186/s12905-023-02613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/17/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Political, financial, and pandemic crises in Lebanon have affected both provision of reproductive health services including family planning and modern contraception methods as well as women's interest and ability to seek those services. This study aims to explore the impact of the compounding crises on the provision and use of family planning services including modern contraception methods for Syrian refugees in Lebanon focusing on the perspectives of Syrian refugee women. METHODS We carried out 12 Focus Group Discussions (FGDs) with 119 Syrian refugee women recruited from two cities in West Bekaa, Lebanon from inside and outside the informal tented settlements. We used Skype video calls to moderate the FGDs due to the limited mobility at the time of the study because of Covid-19. We used thematic analyses to analyse the data. RESULTS The crises seemed to exacerbate supply side barriers, which influenced provision of family planning services and women's demand for them. These included Covid-19 regulations and maltreatment by staff at public health facilities, disruption of outreach reproductive health services that provide family planning and modern contraception, and reduced supply of modern contraception methods. On the demand side, women reported financial limitations in accessing and paying for services, concern over being infected with Covid-19, and concerns about insecurity. CONCLUSIONS We suggest possible interventions to address these challenges and better reach these populations. These include using mobile health technology (mHealth) that may provide contraceptive counselling and/or can inform refugee women about where they may receive family planning and modern contraception. These services may also support Syrian refugees to access care they are entitled to receive and may also address disruptions in service provision due to overlapping crises, including availability and rising costs of contraceptives. These can be coupled with mobile outreach reproductive health services that provide family planning. We also suggest considering the provision of Long Acting Reversible Contraception (LARC) for Syrian refugee women, which would reduce a barrier of needing to revisit health facilities to obtain an additional supply of contraception pills.
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Affiliation(s)
- Rima Mourtada
- Population Council. One Dag Hammarskjold Plaza, New York, NY, 10017, USA.
| | - Andrea J Melnikas
- Population Council. One Dag Hammarskjold Plaza, New York, NY, 10017, USA
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Siviş S. The use of cultural repertoires of everyday nationhood and citizenship in national identity boundary-drawing: The case of Syrian refugees in Turkey. Br J Sociol 2023; 74:657-672. [PMID: 37219323 DOI: 10.1111/1468-4446.13038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/07/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023]
Abstract
Elaborating on salient contextual factors, such as historical conditions, national history, militarised masculinity, and language, this study looks at how repertoires of everyday nationhood are deployed in relation to boundary-drawing in the context of the recent refugee influx in Turkey. Drawing on ethnographic observations, semi-structured interviews and focus groups with ordinary Turkish citizens in Adana, this paper sheds light on the complexities of everyday understandings of citizenship and nationhood with regards to the emergence of 'insider versus outsiders' notions. Results suggest that ordinary citizens evoke various notions of nationhood in everyday life in drawing boundaries against 'outsiders' (i.e., refugees) by deploying historically rooted national identity constructions (militaristic, unitary) and symbols (language, flag). This article, therefore, reveals a national identity boundary-drawing mechanism involving widespread adherence to a militarised sense of nationhood, related more to other ideas of belonging than ethnicity. It further indicates that ordinary citizens, in their narratives, link such constructions and symbols with historical and current political contexts (e.g., the conflict between Turks and Arabs during WW1, or; current military operations in Syria).
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Affiliation(s)
- Selin Siviş
- Population Health Studies, Bristol Medical School, University of Bristol, Bristol, UK
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Yalçın SS, Erat Nergiz M, Yalçın S. Evaluation of breastfeeding and infant feeding attitudes among syrian refugees in Turkey: observations of Syrian healthcare workers. Int Breastfeed J 2023; 18:38. [PMID: 37559070 PMCID: PMC10413606 DOI: 10.1186/s13006-023-00579-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The influx of Syrian refugees into Turkey has highlighted the importance of supporting breastfeeding practices among this vulnerable population. We aimed to evaluate the breastfeeding and infant feeding attitudes of Syrian mothers based on the observations of Syrian healthcare workers (HCWs). METHODS An online form including 31 questions was prepared in Turkish, Arabic, and English languages and distributed to HCWs, working in refugee health centers via e-mail, WhatsApp, or text message with the help of Ministry of Health in Turkey between January 2020 and March 2020. The questions were about HCWs' characteristics (occupation, region of employment, duration of employment, participation in breastfeeding counseling course) and about HCWs' observations of Syrian mothers' breastfeeding and infant feeding practices. RESULTS A total of 876 HCWs were included in the study; about 37.3% were physicians. Only 40.0% of HCWs reported that babies were predominantly fed with breast milk in the first three days after birth, 45.2% of HCWs indicated that mothers typically used sugary water as a prelacteal food, and 30.5% believed that breastfeeding was discontinued before 12 months. The main barriers to breastfeeding identified by HCWs included the lack of education, mental and physical health issues in the mother, food insecurity, low income, inadequate housing, lack of family planning, sociocultural environment, and limited access to quality health services. For complementary feeding, 28.0% of HCWs stated early introduction and 7.4% remarked delayed. HCWs believed grains, fruits and vegetables, and dairy products as top three foods for starting complementary food (59.5%, 47.8%, and 30.3% respectively). Healthcare challenges of Syrian pregnant and lactating mothers were reported to be associated primarily with "food, finance, and housing difficulties", low maternal education, and cultural and environmental issues. HCWs recommended various solutions, such as supporting breastfeeding, offering nutrition and health support, promoting family planning, improving healthcare systems through legislation, and addressing cultural barriers. CONCLUSIONS To address breastfeeding issues among Syrian mothers, it is crucial to provide breastfeeding training to both HCWs and mothers. Expanding interventions that support breastfeeding-friendly practices, including community support and food aid for breastfeeding mothers, should also be considered to address the social determinants of breastfeeding.
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Affiliation(s)
- Siddika Songül Yalçın
- Departmant of Social Pediatrics, Faculty of Medicine, Institute of Child Health, Hacettepe University, Ankara, Turkey.
| | - Meryem Erat Nergiz
- Department of Pediatrics, Yenimahalle Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Suzan Yalçın
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Selçuk University, Konya, Turkey
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Chevrier J, Lane G, Khakpour M, Vatanparast H, Batal M. Food Security Among Syrian Refugee Families in Quebec, Canada. Ecol Food Nutr 2023:1-26. [PMID: 37345879 DOI: 10.1080/03670244.2023.2228704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
This study aims to understand how socioeconomic, geographic and cultural factors affect the food security status of Syrian refugee households in Quebec, Canada. Using a mixed methods study design, 49 households were assessed for their food security and socioeconomic status, followed by structured interviews with 35 households and 9 service providers. 52% of refugee households were food insecure, and although not significantly different, food insecurity was higher among privately sponsored refugee households in the Montreal area. Food insecurity appears mainly due to food access issues. Syrian refugees possess agricultural and cooking skills that could be beneficial in promoting community food security.
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Affiliation(s)
- Joanie Chevrier
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Ginny Lane
- College of Agricultural and Life Sciences, Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, Idaho, USA
| | - Mahasti Khakpour
- Department of Health, Saint Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Malek Batal
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Al-Shatanawi TN, Khader Y, ALSalamat H, Al Hadid L, Jarboua A, Amarneh B, Alkouri O, Alfaqih MA, Alrabadi N. Identifying psychosocial problems, needs, and coping mechanisms of adolescent Syrian refugees in Jordan. Front Psychiatry 2023; 14:1184098. [PMID: 37426088 PMCID: PMC10325618 DOI: 10.3389/fpsyt.2023.1184098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
Background Refugees who have fled war zones are at a heightened risk of psychosocial problems that can impact their ability to function in day-to-day life and place a significant burden on the family structure. This study aimed to assess the psychosocial problems and needs and coping mechanisms of Adolescent Syrian refugees in Jordan. Methods Between October and December 2018, we conducted a qualitative study using semi-structured interviews with a sample of key and individual informants. Our sample included 20 primary healthcare professionals, 20 schoolteachers, 20 Syrian parents, and 20 adolescents aged 12-17 years. All interviews were transcribed verbatim, and we utilized thematic analysis to group, categorize, and analyze the original Arabic language transcripts. To ensure thorough analysis, we adopted a bottom-up inductive approach that covered the six-phase iterative process proposed by Braun and Clarke. Results The main psychosocial problems encountered by Syrian adolescents included stress, depression, loneliness, lack of a sense of security, isolation, aggressiveness, fear of war, and family disintegration. Almost all schoolteachers reported that they observed that Jordanian adolescents are more settled, self-confident, and financially stable relative to their Syrian peers. The Jordanian government and community were praised for their support, including education, recreational centers, health services, and awareness campaigns. Going to school, praying and reading the Holy Quran, listening to music, and talking to friends and engaging with them were reported as the main coping mechanisms. The majority of respondents said that more services are still needed for adolescents, including more places for entertainment, psychosocial support and psychological counseling, medical care, job creation, and providing health insurance. Conclusion Syrian refugees are aware of the psychological aspects of their situation, but they are not always able to access clinic-based humanitarian assistance for mental health and psychosocial support. Stakeholders must interact with refugees to learn about their needs and develop services that are appropriate for their culture.
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Affiliation(s)
- Tariq N. Al-Shatanawi
- Department of Public Health and Community Medicine, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Yousef Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Husam ALSalamat
- Department of Public Health and Community Medicine, Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | | | - Alaa Jarboua
- Department of Legal Medicine, Toxicology and Forensic Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Basil Amarneh
- Department of Community and Mental Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Alkouri
- Faculty of Nursing, Yarmouk University, Irbid, Jordan
| | - Mahmoud A. Alfaqih
- Department of Physiology and Biochemistry, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- Department of Biochemistry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Karhan O, Secmeler Ş, Sezgin Y, Ileri S, Yerlikaya H. Are Syrian refugee breast cancer patients diagnosed at advanced stage and do they have treatment delays? Future Oncol 2023. [PMID: 37170860 DOI: 10.2217/fon-2022-1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Aim: To compare the clinicopathological features and time to reach treatment of patients with breast cancer among Syrian refugees (SRs) and Turkish citizens (TCs). Methods: Retrospective data from 2014 to 2021 were extracted from the hospital database. Student's t-test, Mann-Whitney U test and χ2 test were used to compare the two groups. Results: Data of 88 SR and 402 TC patients were analyzed. The mean age was 45 years for SRs and 50 years for TCs. Breast cancer subtypes were similar in both groups. The de novo metastatic ratio was 23% in SRs and 21.3% in TCs and the time to reach treatment was similar between the two groups. Conclusion: Provided the absence of any obstacle in the healthcare system, SRs are diagnosed and treated like the citizens of their host nation.
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Affiliation(s)
- Ogur Karhan
- Mehmet Akif Inan Training & Research Hospital, Medical Oncology, Sanliurfa, 63040, Turkey
| | - Şaban Secmeler
- Mehmet Akif Inan Training & Research Hospital, Medical Oncology, Sanliurfa, 63040, Turkey
| | - Yasin Sezgin
- Siirt Training & Research Hospital, Medical Oncology, Siirt, 5600, Turkey
| | - Serdar Ileri
- Dicle University School of Medicine, Medical Oncology, Diyarbakır, 21280, Turkey
| | - Halis Yerlikaya
- Diyarbakır Memorial Hospital, Medical Oncology, Diyarbakır, 21070, Turkey
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17
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Pries L, Zulfikar Savci BS. Syrian refugees arriving in Germany: choice of corridor and individual characteristics of forced migrants. Front Sociol 2023; 8:1070065. [PMID: 37250436 PMCID: PMC10210136 DOI: 10.3389/fsoc.2023.1070065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/13/2023] [Indexed: 05/31/2023]
Abstract
In 2015 and 2016, almost two and a half million forced migrants entered the European Union. Most of them arrived in the European Union from Syria, but there were also forced migrants from Iraq, Afghanistan, and other countries. While many of these migrants used the so-called Balkan route after passing through Turkey, others arrived in Greece via Lebanon or Turkey, and some traveled via North African countries, mainly Egypt and Libya. Why did refugees use such different migration corridors? Was it a matter of economic resources, of education and knowledge, or of family ties and social networks? In this paper, we statistically analyze the migration corridors used by Syrian refugees who arrived in Germany between 2014 and 2016. Using a unique dataset of 3,125 refugees, we identify the main migration corridors used Syrian forced migrants and analyze the sociodemographic and journey-related contextual factors associated with the use of these routes. Use of different escape routes was found to correlate with person-related variables and with journey-related contextual factors. The study contributes the debate on the dynamics of forced migration and onward migration.
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18
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Postmes JJ, Rolim Medeiros RL. Respected physician in Syria, unemployed refugee in the Netherlands: An analysis of the integration of Syrian refugees with a medical degree in the Dutch medical field. Soc Sci Med 2023; 323:115836. [PMID: 36965202 DOI: 10.1016/j.socscimed.2023.115836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023]
Abstract
Refugees in the Netherlands are expected to integrate in society and find employment. Despite years of education, Syrian refugees who graduated in medicine (SRGMs') struggle to enter the Dutch medical field. To ensure patient safety, physicians with a medical degree obtained outside Europe are obliged to finish an 'assessment procedure' (AP) and might be forced to redo clinical internships, before being allowed to practice medicine. In this research, SRGMs' experiences were analysed using Bourdieu's capital theory. Semi-structured interviews were conducted with 17 SRGMs. In Syria, they acquired much capital as physicians, in the shape of financial means (economic capital), connections (social capital), medical degrees and skills (cultural capital), and status (symbolic capital). Their medical skills often provide the only capital that remains when arriving in the Netherlands, but it loses value as they have to prove their competence first in the AP. This is a long and arduous process. The mean duration, for those who had yet finished the AP, from arrival to employment was 4.5 years (n = 5, range 2.7-5.8 years). SRGMs experience difficulties in these AP years because they are forced to study from home and feel excluded from medical practice. They are unable to regain their economic, social and symbolic capital, whilst struggling to get their cultural capital acknowledged. Mentally this is challenging and when they do finish, this capital gap leaves them at a disadvantage when applying for competitive job applications. Once employed, SRGMs need time to adjust but are finally rebuilding their capital and integrating in Dutch society. Both SRGMs and Dutch society benefit when SRGMs' integration in the Dutch medical field improves. Although certain challenges for SRGMs seem inevitable, by offering a clinical internship before the assessment of SRGMs' skills, their capital acquisition might improve which would facilitate their integration.
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Affiliation(s)
- J J Postmes
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062, PA, Rotterdam, the Netherlands.
| | - R L Rolim Medeiros
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062, PA, Rotterdam, the Netherlands.
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AlArab N, Nabulsi D, El Arnaout N, Dimassi H, Harb R, Lahoud J, Nahouli L, Abou Koura A, El Saddik G, Saleh S. Reproductive health of Syrian refugee women in Lebanon: a descriptive analysis of the Sijilli electronic health records database. BMC Womens Health 2023; 23:81. [PMID: 36823589 PMCID: PMC9951425 DOI: 10.1186/s12905-023-02231-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The Syrian conflict has been responsible for the highest exodus of refugees, with Lebanon hosting the greatest number of refugees per capita, which placed a significant strain on an already overburdened healthcare system. Women are the most vulnerable group in times of conflict and displacement, with sexual and reproductive health and rights often neglected. This study focuses on the obstetric characteristics and pregnancy outcomes of Syrian Refugee (SR) women in Lebanon, in Comparison to their pre-displacement data. METHODS This study is a secondary analysis of de-identified data from the Sijilli database. The data reported and analyzed were the refugees' socio-demographics, obstetric history, pregnancy outcomes, experienced maternal and neonatal complications, breastfeeding history and duration, and contraception use and types. Data were reported in both frequencies and means/medians. Chi-square test, t-test, and ANOVA tests were used to compare pregnancies in Syria to those that happened in Lebanon. RESULTS A total of 1065 female records were included in this study, with 634 ever-pregnant women and the total number of pregnancies being 3272. SR women were shown to get pregnant in Lebanon at a younger age compared to cases in Syria. The number of gravidities is equal in women who got pregnant in Syria and those who moved later to Lebanon. The mean spacing between pregnancies has decreased comparing SR women who got pregnant in Syria only versus those who got pregnant in Lebanon only. Among the mixed group, the mean spacing between pregnancies as well as the prevalence of spontaneous abortions significantly increased after displacing to Lebanon. C-section rate was higher among SR women after moving to Lebanon. Also, maternal complications and not breastfeeding have increased after moving to Lebanon. A prior pregnancy was significantly associated with higher contraception use rate. The most common methods of contraception were oral contraceptive pills and intra-uterine devices. CONCLUSION The C-section deliveries, spontaneous abortions and maternal complications have all increased among SR women after being displaced to Lebanon. While the age at first pregnancy, mean spacing between their pregnancies and breastfeeding rates have decreased after moving to Lebanon. SR women are less likely to use contraceptives after their displacement. It is necessary to address access to reproductive healthcare and antenatal care delivery among displaced refugee women living in informal tented settlements.
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Affiliation(s)
- Natally AlArab
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- grid.411323.60000 0001 2324 5973School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Ranime Harb
- grid.411323.60000 0001 2324 5973School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Julien Lahoud
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Lara Nahouli
- grid.411654.30000 0004 0581 3406Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdulghani Abou Koura
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghaidaa El Saddik
- grid.18112.3b0000 0000 9884 2169Beirut Arab University, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon. .,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon.
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20
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Atrooz F, Aljararwah SM, Acquati C, Khabour OF, Salim S. Breast Cancer Beliefs and Screening Practices among Syrian Refugee Women and Jordanian Women. Int J Environ Res Public Health 2023; 20:3645. [PMID: 36834339 PMCID: PMC9963797 DOI: 10.3390/ijerph20043645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Despite significant declines in breast cancer (BC) incidence in the West, this disease is widespread in Jordan, where cancer detection occurs at much advanced stages. This is particularly concerning for Syrian refugee women resettled in Jordan, who are less likely to undergo cancer preventative procedures because of poor health literacy and lack of health services access. The present work assesses and compares breast cancer awareness and breast cancer screening behaviors among Syrian refugee women and Jordanian women residing close to the Syrian-Jordanian border city of Ar-Ramtha. A cross-sectional survey was conducted using a validated Arabic version of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ). A total of 138 Syrian refugee women and 160 Jordanian women participated in the study. Results indicate that 93.6% of Syrian refugee women and Jordanian women ≥ 40 years of age reported never having undergone a mammogram. Syrian refugee women and Jordanian women reported low attitudes toward general health checkup (mean score for Syrian refugees 45.6 vs. 42.04 among Jordan women; p = 0.150). Barriers for BC screening were higher among Syrian refugees (mean score = 56.43) than Jordanian women (mean score = 61.99, p = 0.006). Women with higher education were more likely to report fewer barriers to screening (p = 0.027). The study documents a significant lack of BC screening awareness among Syrian refugee women and Jordanian women, indicating that future work is needed to alter current attitudes towards mammograms and early detection measures especially for Syrian refugee women and Jordanian women residing in rural areas of Jordan.
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Affiliation(s)
- Fatin Atrooz
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX 77204, USA
| | - Sally Mohammad Aljararwah
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX 77204, USA
- Department of Clinical Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX 77204, USA
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Holcombe Blvd, Houston, TX 77030, USA
| | - Omar F. Khabour
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Samina Salim
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX 77204, USA
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21
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Atrooz F, Aljararwah SM, Chen TA, Khabour OF, Salim S. Understanding Mental Health Status of Syrian Refugee and Jordanian Women: Novel Insights from a Comparative Study. Int J Environ Res Public Health 2023; 20:2976. [PMID: 36833672 PMCID: PMC9959545 DOI: 10.3390/ijerph20042976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: War and displacement are well-known predictors of negative mental health outcomes among affected populations. This is especially relevant for refugees of war, particularly women, who often repress their mental health needs due to family responsibilities, social stigma, and/or cultural pressures. In this study, we compared the mental health status of urban Syrian refugee women (n = 139) with local Jordanian women (n = 160). (2) Methods: Psychometrically validated Afghan Symptom Checklist (ASC), Perceived Stress Scale (PSS), and Self-Report Questionnaire (SRQ) examined psychological distress, perceived stress, and mental health, respectively. (3) Results: According to independent t-tests, Syrian refugee women scored higher than Jordanian women on the ASC [mean score (SD): 60.79 (16.67) vs. 53.71 (17.80), p < 0.001], PSS [mean score (SD): 31.59 (8.45) vs. 26.94 (7.37), p < 0.001], and SRQ [mean score (SD): 11.82 (4.30) vs. 10.21 (4.72), p = 0.002]. Interestingly, both Syrian refugee and Jordanian women scored higher than the clinical cutoff in the SRQ. Regression analyses indicated that more educated women were less likely to score high on the SRQ (β = -0.143, p = 0.019), particularly in the anxiety and somatic symptoms subscale (β = -0.133, p = 0.021), and were less likely to exhibit symptoms of ruminative sadness (β = -0.138, p = 0.027). Employed women were more likely to exhibit high coping ability than unemployed women (β = 0.144, p = 0.012). (4) Conclusions: Syrian refugee women scored higher than Jordanian women in all used mental health scales. Access to mental health services and enhancing educational opportunities would help mitigate perceived stress and may enhance stress-coping abilities.
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Affiliation(s)
- Fatin Atrooz
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX 77204, USA
| | - Sally Mohammad Aljararwah
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Tzuan A. Chen
- Department of Psychological Health and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Omar F. Khabour
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Samina Salim
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX 77204, USA
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Al-Qadi M, Al-Hussami M, Riza E, Athamnah E, Shehadeh J, Kleisiaris C, Almegewly WH, Karavasileiadou S. Indicators of Healthcare Services Utilization among the Syrian Refugee Population in Jordan: An Observational Study. Healthcare (Basel) 2023; 11:healthcare11040478. [PMID: 36833012 PMCID: PMC9956226 DOI: 10.3390/healthcare11040478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Sufficient healthcare services utilization among the Syrian refugee population is one of the most important human rights. Vulnerable populations, such as refugees, are often deprived of sufficient access to healthcare services. Even when healthcare services are accessible, refugees vary in their level of utilization of these services and their health-seeking behavior. PURPOSE This study aims to examine the status and indicators of healthcare service access and utilization among adult Syrian refugees with non-communicable diseases residing in two refugee camps. METHODS The cross-sectional descriptive design was conducted by enrolling 455 adult Syrian refugees residing in the Al-Za'atari and Azraq camps in northern Jordan, using demographical data, perceived health, and the "Access to healthcare services" module, which is a part of the Canadian Community Health Survey (CCHS). A logistic regression model with binary outcomes was used to explore the accuracy of the variables influencing the utilization of healthcare services. The individual indicators were examined further out of 14 variables, according to the Anderson model. Specifically, the model consisted of healthcare indicators and demographic variables to find out if they have any effect on healthcare services utilization. RESULTS Descriptive data showed that the mean age of the study participants (n = 455) was 49.45 years (SD = 10.48), and 60.2% (n = 274) were females. In addition, 63.7% (n = 290), of them were married; 50.5% (n = 230) held elementary school-level degrees; and the majority 83.3% (n = 379) were unemployed. As expected, the vast majority have no health insurance. The mean overall food security score was 13 out of 24 (±3.5). Difficulty in accessing healthcare services among Syrian refugees in Jordan's camps was significantly predicted by gender. "Transportation problems, other than fee problems" (mean 4.25, SD = 1.11) and "Unable to afford transportation fees" (mean 4.27, SD = 1.12) were identified as the most important barriers to accessing healthcare services. CONCLUSION Healthcare services must imply all possible measures to make them more affordable to refugees, particularly older, unemployed refugees with large families. High-quality fresh food and clean drinking water are needed to improve health outcomes in camps.
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Affiliation(s)
| | - Mahmoud Al-Hussami
- Community Nursing Department, School of Nursing, The University of Jordan, Amman 11942, Jordan
| | - Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece
| | - Esra’a Athamnah
- Health Center Medical Laboratory Technician, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Jumana Shehadeh
- Community Nursing Department, School of Nursing, The University of Jordan, Amman 11942, Jordan
| | - Christos Kleisiaris
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Wafa Hamad Almegewly
- Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
- Correspondence:
| | - Savvato Karavasileiadou
- Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
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Jeremias T, Abou-Rizk J, Burgard L, Entenmann I, Nasreddine L, Jomaa L, Hwalla N, Frank J, Scherbaum V. Anemia among Syrian Refugee Children Aged 6 to 23 Months Living in Greater Beirut, Lebanon, including the Voices of Mothers' and Local Healthcare Staff: A Mixed-Methods Study. Nutrients 2023; 15. [PMID: 36771406 DOI: 10.3390/nu15030700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
Globally, the prevalence of anemia among children during the period of complementary feeding is high. A cross-sectional, mixed-methods study was conducted to examine the main determinants of anemia among Syrian refugee children aged 6 to 23 months (n = 215) and to illuminate the knowledge, attitudes and perceptions of their mothers and Lebanese healthcare staff on its causes and available treatment options. 42% of the children and 20% of their mothers were anemic. Determinants of child anemia were the mother having anemia or not knowing that fish/seafood is a source of iron; the child having been acutely ill the last two weeks or receiving cow's milk, but not consuming iron-rich infant formula, added fats/oils, or fruits in the previous 24 hours. Several Syrian mothers knew some causes of anemia and named dizziness as a leading symptom but did not mention flesh foods as a key source of heme iron. They reported financial constraints in accessing iron-rich foods and supplements. Lebanese doctors largely gave appropriate dietary advice and prescribed iron supplements as treatment. Multisectoral interventions are needed that combine medical and financial support with nutrition counseling for mothers to reduce the high burden of anemia among young children living in a multiple crises situation.
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Dietrich H, Estramiana JLÁ, Luque AG, Reissner V. Effects of Posttraumatic Stress Disorder and Mental Disorders on the Labor Market Integration of Young Syrian Refugees. Int J Environ Res Public Health 2023; 20:2468. [PMID: 36767834 PMCID: PMC9916024 DOI: 10.3390/ijerph20032468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Civil war experience in the Syrian home country, insecurity and critical life events during migration, or adverse events in the receiving country might affect refugees' mental health. This paper addresses the effects of psychological distress and mental disorders on refugees' labor market integration in Germany between 2016 and 2021. We employ survey data from about 2700 young Syrians, delivering information on individuals' experience of migration and arrival in Germany in 2016. The survey data were successfully merged with register data, delivering detailed information regarding individuals' process of labor market integration and employment status from 2016 to 2021. Overall, the labor market integration of young refugees improved remarkably over time. In 2021, about 69% of the study population was integrated in a wider sense, and 30% was employed in fulltime contracts in 2021. However, the results indicate long-lasting effects of PTSD and mental disorders on individuals' labor market integration, whilst individuals' characteristics related to migration and arrival lose relevance over time and hardly affect labor market integration around five years after arrival. High PTSD scores in 2016 indicate a significantly reduced full-time employment probability in 2021. Anxiety and depression show significant negative effects on individuals' labor market integration, but with a less severe impact compared to a PTSD diagnosis.
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Affiliation(s)
- Hans Dietrich
- Institute for Employment Research (IAB), Regensburger Str. 104, 90478 Nürnberg, Germany
| | - José Luis Álvaro Estramiana
- Departamento de Antropología Social y Psicología Social, Universidad Complutense de Madrid, 28223 Madrid, Spain
| | - Alicia Garrido Luque
- Departamento de Antropología Social y Psicología Social, Universidad Complutense de Madrid, 28223 Madrid, Spain
| | - Volker Reissner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Wickenburgstr. 21, 45147 Essen, Germany
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Matos L, Indart MJ, Park CL, Leal I. "I'm Going to Tell You Something I Never Told Anyone": Ethics- and Trauma-Informed Challenges of Implementing a Research Protocol with Syrian Refugees. Int J Environ Res Public Health 2023; 20:1261. [PMID: 36674012 PMCID: PMC9859552 DOI: 10.3390/ijerph20021261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
As research subjects, refugees have numerous potential vulnerabilities. This study aimed to examine the ethics- and trauma-informed challenges of implementing a mental health research protocol with Syrian refugees living in Portugal. Guided by the integrated meaning-making model, the research project "Journeys in Meaning" employed a mixed-methods cross-sectional design to explore posttraumatic cognitive processing in refugees using two phases of data collection: two focus groups (Phase 1) to test the protocol and 39 in-depth individual interviews (Phase 2) to implement the protocol. Results examine the strategies used to address the following: methodological challenges related to protocol design, participant recruitment, and language; ethics- and trauma-informed challenges aimed at minimizing harm and maximizing benefit to participants that followed social justice principles; and perceived compassion fatigue on the part of the researcher following repeated empathetic exposure to traumatic content. Findings suggest the need for adaptive approaches to research with refugee populations that challenge strict compliance with the traditional principles of "do no harm" and researcher neutrality, and that accommodate individual and community complexities.
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Affiliation(s)
- Lisa Matos
- William James Center for Research, ISPA—Instituto Universitário, 1149-041 Lisbon, Portugal
| | - Monica J. Indart
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ 08901, USA
| | - Crystal L. Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Isabel Leal
- William James Center for Research, ISPA—Instituto Universitário, 1149-041 Lisbon, Portugal
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Fouad FM, Hashoush M, Diab JL, Nabulsi D, Bahr S, Ibrahim S, Farhat T, Kobeissi L. Perceived facilitators and barriers to the provision of sexual and reproductive health services in response to the Syrian refugee crisis in Lebanon. Womens Health (Lond) 2023; 19:17455057231171486. [PMID: 37209110 PMCID: PMC10201148 DOI: 10.1177/17455057231171486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Syrian crisis has resulted in one of the worst humanitarian disasters in modern history. Inadequate access to and use of sexual and reproductive health services is a prevailing issue among adolescent girls and young refugee women in humanitarian settings. OBJECTIVES This article aimed to explore and describe the perceived extent of implementation of the different objectives and activities outlined within the minimum initial service package for reproductive health in crisis services in Lebanon, from the perspectives of a diverse set of stakeholders from leading organizations (public, private, primary health centers, nongovernmental organizations) that were directly engaged with the Syrian refugee crisis response. DESIGN This study is a cross-sectional survey conducted using a standardized and validated questionnaire. METHODS Centers that provided sexual and reproductive health services to Syrian refugees in Lebanon were mapped. The study was based on a purposive sampling approach, retrieving 52 eligible organizations to cover most areas in the country. A total of 43 centers accepted to take part in the study. The head of the center was then asked to identify one person in their center who holds adequate knowledge of the explained objectives of the survey. Accordingly, the identified person was asked to fill out the survey. RESULTS A considerable portion of the respondents had limited knowledge about the specific minimum initial service package objectives and related sexual and reproductive health services. The study found the presence of a leading reproductive health agency, the Lebanese MoPH, as an essential facilitating factor for sexual and reproductive health service provision in Lebanon and has helped in overseeing the overall sexual and reproductive health coordination response for Syrian refugees (76.74% of all respondents). The identified challenges impeding adequate sexual and reproductive health services provision for Syrian refugees included (1) insufficient supplies (46.51%); (2) insufficient funds (39.53%); and (3) shortage of staff (39.53%). CONCLUSION The recommendations for improved sexual and reproductive health service provision include the need for (1) enforcing the lead minimum initial service package agency for adequate and effective coordination, reporting, and accountability and (2) increasing funding for training staff and healthcare workers, as well as improving the overall quality of services available with the inclusion of family planning services, purchasing the necessary commodities, supplies and equipment, and covering fees associated with the different sexual and reproductive health services.
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Affiliation(s)
- Fouad M Fouad
- Refugee Health Program, Global Health
Institute, American University of Beirut, Beirut, Lebanon
- Faculty of Health Sciences, American
University of Beirut, Beirut, Lebanon
| | - Mahmoud Hashoush
- Refugee Health Program, Global Health
Institute, American University of Beirut, Beirut, Lebanon
| | - Jasmin Lilian Diab
- Refugee Health Program, Global Health
Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- Refugee Health Program, Global Health
Institute, American University of Beirut, Beirut, Lebanon
| | - Sarah Bahr
- Refugee Health Program, Global Health
Institute, American University of Beirut, Beirut, Lebanon
| | - Sarah Ibrahim
- Refugee Health Program, Global Health
Institute, American University of Beirut, Beirut, Lebanon
| | - Theresa Farhat
- Refugee Health Program, Global Health
Institute, American University of Beirut, Beirut, Lebanon
| | - Loulou Kobeissi
- Department of Sexual and Reproductive
Health and Research (SRH), World Health Organization (WHO), Geneva,
Switzerland
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Atag E, Gokcay S, Tanrikulu Simsek E, Aslan F, Yetisir AE, Sari M. Syrian Refugee and Turkish Women with Breast Cancer: A Comparison on Clinicopathological Features and Survival. Arch Iran Med 2023; 26:29-35. [PMID: 37543919 PMCID: PMC10685813 DOI: 10.34172/aim.2023.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 02/27/2022] [Indexed: 08/08/2023]
Abstract
BACKGROUND Cancer is a significant health problem for refugees and host countries. Breast cancer is the most common cancer among refugees. The subject of our study is to examine the clinical and pathological features of Syrian refugees with breast cancer and compare them with Turkish patients with breast cancer. METHODS Data of patients with breast cancer between January 2018 and December 2020 were retrospectively reviewed. The clinical and histological features, treatment modalities and overall survival were collected and analyzed. RESULTS A total number of 338 women with breast cancer were included in this study. Ninety-nine of the 338 (29.3%) patients were Syrian refugees and 239 patients (70.7%) were Turkish. The median follow-up time was significantly lower in Syrian patients (P<0.001). Median OS was 146 months in Turkish and 116 months in Syrian group (P=0.022). Independent risk factors associated with long survival were receiving adjuvant chemotherapy (HR 0.465; 95% CI 0.234-0.926; P=0.029), adjuvant radiotherapy (HR 0.372 95% CI 0.182-0.758; P=0.007), and adjuvant hormonotherapy (HR 0.367; 95% CI 0.201-0.669; P=0.001). The rates of receiving adjuvant chemotherapy, adjuvant radiotherapy, and adjuvant hormonal therapy were significantly lower in the Syrian group (P=0.023, P=0.005, P=0.002, respectively). CONCLUSION Syrian refugees with breast cancer are more likely to receive suboptimal treatments. They have inferior survival compared to local patients. Our findings highlight the need for the provision of cancer therapy in such vulnerable populations. We suggest that more attention should be paid to breast cancer, as it is the most common cancer among refugees.
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Affiliation(s)
- Elif Atag
- Department of Medical Oncology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Serkan Gokcay
- Deparment of Medical Oncology, Private Silivri Anadolu Hospital, Istanbul, Turkey
| | - Eda Tanrikulu Simsek
- Department of Medical Oncology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Fatih Aslan
- Department of General Surgery, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Abdullah Evren Yetisir
- Department of Medical Oncology, Adana City Training and Research Hospital, Adana, Turkey
| | - Murat Sari
- Department of Medical Oncology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Abi Chahine M, Kienzler H. Ageism, an invisible social determinant of health for older Syrian refugees in Lebanon: a service providers' perspective. Confl Health 2022; 16:62. [PMID: 36434728 PMCID: PMC9694515 DOI: 10.1186/s13031-022-00491-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/31/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Older refugees face particular challenges because their health and social needs are largely overlooked in humanitarian programmes, policies and research. The few studies available have shown that older refugees suffer from a high prevalence of non-communicable diseases, including mental health problems, increased social isolation and poverty, and difficulty accessing health and social services. This article aims to provide further in-depth understanding of how service providers perceive health and social challenges of older Syrian refugees living in Lebanon by focusing on (1) their health and social challenges; (2) the available and lacking services; (3) participation; and (4) policy recommendations to improve services. METHODS This study is based on a qualitative research approach. Fifteen semi-structured interviews were conducted with health and social workers providing services to older Syrian refugees living in Lebanon. All interviews were digitally recorded, transcribed, coded and analysed using thematic analysis. RESULTS Study results clearly show that older refugees face increased marginalisation and neglect, mainly because of ageism. Ageism experienced at aid agency, family and individual levels, impacts negatively on older refugees. They have a sense of social isolation, neglect and feel they are a burden, consequently their social participation decreases, impacting negatively on their physical and mental health as well as their access to social and health care. Linked to experiences of ageism, study participants noted: (1) high prevalence rates of non-communicable diseases and mental health problems; (2) difficulties accessing care, with inadequate services to support the needs of older refugees; and (3) policy recommendations calling for an holistic approach to aid which takes into consideration the specific needs of older refugees as well as their capabilities. CONCLUDING REMARKS Ageism is a key determinant of health which negatively impacts the physical, mental and social health, and wellbeing of older Syrian refugees. It pushes them to the margins of society where they are left behind by the humanitarian response, policy makers and researchers, as well as their communities and families. To mitigate this situation, this article calls for directly addressing ageism on social, service and policy levels.
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Affiliation(s)
- Maya Abi Chahine
- grid.22903.3a0000 0004 1936 9801Faculty of Health Sciences, American University of Beirut, Bliss Street, Beirut, Lebanon
| | - Hanna Kienzler
- grid.13097.3c0000 0001 2322 6764Department of Global Health and Social Medicine, ESRC Centre for Society and Mental Health, King’s College London, Bush House (NE) 3.15, 40 Aldwych, London, WC2B 4BG UK
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Abou-Rizk J, Jeremias T, Cocuz G, Nasreddine L, Jomaa L, Hwalla N, Frank J, Scherbaum V. Food insecurity, low dietary diversity and poor mental health among Syrian refugee mothers living in vulnerable areas of Greater Beirut, Lebanon. Br J Nutr 2022; 128:1832-47. [PMID: 34842129 DOI: 10.1017/S0007114521004724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Syrian refugees in Lebanon are facing vulnerabilities that are affecting their food insecurity (FI) levels. The objectives of this study were to measure dietary diversity, FI and mental health status of Syrian refugee mothers in Lebanon and to explore its associations with their anaemia and nutritional status. A cross-sectional study was conducted among mothers with children under 5 years (n 433) in Greater Beirut, Lebanon. Dietary diversity was measured using the Minimum Dietary Diversity for Women (MDD-W) of reproductive age and FI using the global Food Insecurity Experience Scale at the individual level. Depression and post-traumatic stress disorder (PTSD) were measured to assess the maternal mental health status. Data on socio-economic characteristics, anthropometric measurements and Hb concentrations were collected. Overall, 63·3 % of the mothers had a low dietary diversity (LDD) and 34·4 % were moderately to severely food insecure, with 12·5 % being severely food insecure. The prevalence of PTSD, moderate depression and severe depression was 13·2, 11·1 and 9·9 %, respectively. A significant correlation was found between LDD and FI (P < 0·001). Low income was significantly associated with LDD and FI. Poor mental health was significantly associated with FI. LDD and FI were not associated with anaemia and nutritional status of mothers. Low-income households had significantly higher intakes of grains and refined starchy staples, whereas high-income households consumed more nutritious foods and sweets. Evidence of inadequate diet quality, FI and poor mental health among Syrian refugee mothers in Lebanon is presented. Multifaceted actions are needed to reduce FI and improve dietary diversity.
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Viazminsky A, Borho A, Morawa E, Schmitt GM, Erim Y. Perceived discrimination among Syrian refugees in Germany and its associations with mental health. Glob Public Health 2022; 17:2854-2867. [PMID: 35042431 DOI: 10.1080/17441692.2022.2026449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Discrimination is a crucial post migratory stressor but there is little research on perceived discrimination by Syrian refugees. This study aims to assess self-reported discrimination by Syrian refugees with a residence permit in Germany, determine its forms, places, and predictors, and explore its possible relation with mental health. Sociodemographics, migration-specific characteristics, traumatic life events, quality of life, perceived discrimination, depression, generalised anxiety disorder, post-traumatic symptoms, and somatic distress were assessed among 116 participants. More than one-third of the participants perceived discrimination in low frequency, and in general, perceived discrimination was confined to treatment with less courtesy or respect. Unfair treatment was perceived mostly while searching for accommodation and in the neighbourhood. Refugees attributed their experiences to their lack of language skills prior to national, religious, and racial causes. Lower age, higher number of completed years of education, and symptoms of posttraumatic stress disorder were significantly and substantially associated with perceived discrimination. Anxiety symptoms, number of traumatic experiences and gender may also be regarded as relevant predictors of perceived discrimination. Health care professionals must be aware of the links between discrimination and symptoms of mental disorders. Policymakers should address discrimination as a key refugee issue and risk to mental health.
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Affiliation(s)
- Andre Viazminsky
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Abou-Rizk J, Jeremias T, Nasreddine L, Jomaa L, Hwalla N, Frank J, Scherbaum V. Infant Feeding Practices, Nutrition, and Associated Health Factors during the First Six Months of Life among Syrian Refugees in Greater Beirut, Lebanon: A Mixed Methods Study. Nutrients 2022; 14:nu14214459. [PMID: 36364722 PMCID: PMC9654662 DOI: 10.3390/nu14214459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023] Open
Abstract
The objective was to describe infant feeding practices, nutrition and related health aspects of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with infants under six months in July-October 2018 (N = 114). Additionally, eleven focus group discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding was low (31%), and exclusive breastfeeding very low (24.6%). One-fifth of the infants were anemic (20.5%) and 9.6% were wasted. A significantly higher proportion of non-exclusively breastfed infants had a fever and took medicines than those who were exclusively breastfed. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and exclusive breastfeeding, along with receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes' distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees, awareness on proper breastfeeding practices, maternal nutrition, and psychosocial support should be provided to mothers and family members alike.
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Affiliation(s)
- Joana Abou-Rizk
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
- Correspondence: or
| | - Theresa Jeremias
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Lamis Jomaa
- Department of Human Sciences, College of Health and Sciences, North Carolina Central University, Durham, NC 27707, USA or
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Jan Frank
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, Faculty of Natural Sciences, University of Hohenheim, 70599 Stuttgart, Germany
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Alnuaimi K, Alshraifeen A, Aljaraedah H. Factors influencing quality of life among syrian refugees pregnant women in Jordan: A cross-sectional study. Heliyon 2022; 8:e10685. [PMID: 36193516 PMCID: PMC9526160 DOI: 10.1016/j.heliyon.2022.e10685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/26/2022] [Accepted: 09/13/2022] [Indexed: 10/25/2022] Open
Abstract
Background Pregnancy is a critical period of transition incorporating important normal physical, emotional, hormonal, and physiological status changes. These changes might affect the quality of life (QOL) of pregnant woman. This study aimed to examine the levels of quality of life and perceived social support of Syrian refugees' pregnant women in Al-Zaatari Refugee Camp in Jordan. Methods A cross-sectional survey design was used. A sample of 319 pregnant women was recruited from two maternal health clinics at Al-Zaatari Refugee Camp. Data were collected from June to August 2020 using the Arabic version of World Health Organization Quality of Life (WHOQOL-BREF), the Multidimensional Perceived Social Support (MSPSS) questionnaires, and two sheets were used to assess sociodemographic and obstetric variables. Results The study reveals that Syrian refugees' pregnant women had good satisfaction with their overall QOL and health status and social support. A significant relationship was found between the socioeconomic index and QOL. Also, age, being in the third trimester, and parity correlated negatively with QOL. In contrast, those who stayed in Jordan as a refugee for a longer period reported better QOL. Conclusion Syrian women in Jordan, in general, have a good QOL and high level of social support. However, women were least satisfied with their physical health domain. Several factors affected QOL including income, employment status, age, number of children, and pregnancy trimester. Social support is an important factor in improving the QOL among Syrian refugees' pregnant women.
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Affiliation(s)
- Karimeh Alnuaimi
- Maternal and Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology Jordan
| | - Ali Alshraifeen
- Adult Health Nursing Department, Faculty of Nursing, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Hala Aljaraedah
- Faculty of Nursing, Jordan University of Science and Technology, P.O. Box (3030), Irbid, 22110 Jordan
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Ramadan M, Kheirallah K, Saleh T, Bellizzi S, Shorman E. The Relationship Between Spirituality and Post-Traumatic Stress Symptoms in Syrian Adolescents in Jordan. J Child Adolesc Trauma 2022; 15:585-593. [PMID: 35958726 PMCID: PMC9360348 DOI: 10.1007/s40653-021-00401-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 05/07/2023]
Abstract
The civil war in Syria began in 2011 and escalated over years resulting in one of the largest humanitarian crises since the Second World War. Injury, loss, poverty, and immigration trapped the Syrian population in a diversity of psychological disorders, including post-traumatic stress disorder (PTSD). Spirituality has, on the other hand, been consistently reported as a resilient factor against developing mental disorders. Hence, spirituality or religiosity have been incorporated in clinical and psychotherapeutic practice for several mental disorders. We explored the association between spirituality and the development of PTSD symptoms among Syrian refugee adolescents in Jordanian schools. A sample of 418 Syrian adolescent students (age range between 12-16 years) from Jordanian schools in the northern part of the country were enrolled in the study after informing on study context and objectives. The study questionnaire included sample demographics, smoking status, PTSD checklist - Civilian Version (PCL-C), two spirituality-targeting questions, and trauma and loss history. `Almost half of participants (N = 196) showed moderate PTSD symptoms while around 30% (N = 124) had a severe level of PTSD symptoms. On the other hand, 3 out of four students perceived themselves as highly spiritual. The study resulted in a positive correlation between belief in God and God's thankfulness. Furthermore, increased spirituality level did not appear to lower the risk of developing PTSD symptoms. Spiritual self-perception of Syrian refugee adolescents showed neither protective nor aggravating effect of on the occurrence of post-traumatic stress symptoms. Additional research and more accurate tools are needed to assess the potential impact of spiritual/religious values towards PTSD symptoms among adolescents.
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Affiliation(s)
| | - Khalid Kheirallah
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq Saleh
- Department of Basic Medical Sciences, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Saverio Bellizzi
- Medical Epidemiologist, Independent Consultant, Geneva, Switzerland
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Hammad AM, Al-Qerem W, Alasmari F, Ling J, Qarqaz R, Alaqabani H. Identifying Drug-Therapy Problems among Syrian Refugees in Zaatari Refugee Camp. Int J Environ Res Public Health 2022; 19:7199. [PMID: 35742447 DOI: 10.3390/ijerph19127199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
Background: Due to a lack of proper pharmaceutical care, Syrian refugees in the Zaatari refugee camp are more likely to have drug-related issues, such as prescription errors and adverse drug occurrences. Aim: The current study aims to identify drug-therapy problems among Syrian refugees in the Zaatari refugee camp. Method: This is a retrospective cross-sectional study. Patients’ files were collected from the Zaatari camp database. Patients who were 18 years or older and were previously diagnosed with a chronic disease were included. A classification of drug therapy problems (DTPs) was adapted. Results: The data of 1530 adult patients (896 females) were collected. The mean age of the sample was 53.7 years and the mean Body mass Index (BMI) was 27.20. The mean of all taken medications was 4.01 (±2.33) medications, with a maximum number of 13. A total of 3572 DTPs was identified, with a mean of 2.33 (±1.26) DTPs per patient. Based on the above-mentioned classification, 70.32% of the DTPs were related to indication, 26.65% were related to effectiveness, and 3.03% were related to safety. Conclusion: This study found that refugees in the Zaatari refugee camp have numerous DTPs among their medications. Greater focus should be placed on their medical care, in order to prevent any future complications due to DTPs.
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Yıldırım M, Aziz IA, Vostanis P, Hassan MN. Associations among resilience, hope, social support, feeling belongingness, satisfaction with life, and flourishing among Syrian minority refugees. J Ethn Subst Abuse 2022; 23:166-181. [PMID: 35635441 DOI: 10.1080/15332640.2022.2078918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To date, research on refugee mental health has mainly focused on understanding the absence of psychopathology rather than on their well-being and associated positive aspects. The aim of this study was to examine the role of resilience, hope, belongingness, and social support in predicting satisfaction with life and flourishing among 361 minority Syrian refugees living in Iraq (age range = 18-60 years, mean = 32.57, SD = 10.05). Participants completed the Brief Resilience Scale, Adult Hope Scale, Multidimensional Scale of Perceived Social Support Scale, General Belongingness Scale, Satisfaction With Life Scale, and Flourishing Scale. Males reported significantly higher levels of resilience, belongingness, and flourishing compared to females. Demographic variables (age, gender, and economic level), resilience, hope, belongingness, and social support were correlated with life satisfaction and flourishing scores. While controlling for sociodemographic characteristics, resilience and hope were associated with life satisfaction and flourishing scores. However, belongingness and social support were only associated with flourishing scores. The findings suggest that equipping refugees with positive psychological resources could promote increased levels of life satisfaction and flourishing and thus enhance preventive psychosocial programs.
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Affiliation(s)
- Murat Yıldırım
- Ağrı İbrahim Çeçen University, Ağrı, Turkey
- University of Leicester, Leicester, UK
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Lupieri S. 'Vulnerable' but not 'Valuable': Older refugees and perceptions of deservingness in medical humanitarianism. Soc Sci Med 2022; 301:114903. [PMID: 35339944 DOI: 10.1016/j.socscimed.2022.114903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
In a crisis, there is widespread recognition and acceptance that not all lives can be saved. But whose lives can legitimately be saved and who decides? Recent scholarship has begun to examine how refugees perceived as 'vulnerable', such as women and children, are frequently prioritized over other groups in humanitarian responses. Such analyses, however, fail to adequately explain why some groups - such as older persons - are considered vulnerable and yet are largely neglected. Based on the case of older Syrian refugees in Jordan, this article critically examines the ways in which humanitarian health actors make sense of the humanitarian principle of 'impartiality' in the face of limited resources. Based on 61 interviews and observational data collected in Jordan between 2017 and 2019, my results show that humanitarians routinely classify older refugees as 'vulnerable' and in need of medical assistance. Yet I find that three neoliberal considerations - including perceptions of the reduced lifespan, disproportionate disease burden, and limited contributions to the economy of older refugees - make this demographic low 'value for money'. This article expands our understanding of how medical humanitarian understandings of 'deservingness' are increasingly shaped by market-driven logics, and how these (re)create ageist, gendered and racialized hierarchies within refugee health.
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Affiliation(s)
- Sigrid Lupieri
- Stanford University, Center for International Security and Cooperation, USA.
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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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Elnakib S, El Khoury G, Salameh P, Sacre H, Abirafeh L, Robinson WC, Metzler J. Investigating Incidence, Correlates, and Consequences of Child Marriage Among Syrian Refugees Residing in the South of Lebanon: A Cross-Sectional Study. J Adolesc Health 2022; 70:S64-S71. [PMID: 35184834 DOI: 10.1016/j.jadohealth.2021.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/01/2021] [Accepted: 08/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Research on child marriage has increased in volume but remains scarce in humanitarian settings. This study aimed to investigate rates, correlates, and consequences of child marriage among Syrian refugees in South Lebanon. METHODS A sample of 1,593 female adolescents and 893 adults was selected using a multistage stratified cluster survey design. We quantified the cumulative incidence of child marriage among age cohorts of female refugees and identified risk factors associated with child marriage using survival methods. We also presented sexual and reproductive health measures among child brides. RESULTS We found evidence that child marriage was widely practiced among adolescent girls, with Kaplan-Meier curves showing that 32.56% of girls aged 10-19 transitioned to marriage by age 17. Although high, this was lower than rates among women aged 25-29 (p < .005), indicating that child marriage was already widely practiced in prewar Syria. Our Cox models indicated that several factors, which mirror drivers of child marriage in stable settings, are associated with hazard of child marriage in this context. We additionally found important sexual and reproductive health gaps among child brides, such as low levels of knowledge of the dangers of early childbearing and closely spaced births as well as high rates of early and multiple births. CONCLUSIONS Child marriage is a pervasive practice among Syrian refugees residing in this setting. Our results suggest that a confluence of factors at different levels of the social ecology increase refugee girls' vulnerability to child marriage. They also demonstrate the pressing need for interventions that target refugee child brides.
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Affiliation(s)
- Shatha Elnakib
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland.
| | - Ghada El Khoury
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Pascale Salameh
- Department of Public Health, INSPECT-LB (Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon; Department of Research, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Hala Sacre
- Department of Public Health, INSPECT-LB (Institut National de Santé Publique d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Lina Abirafeh
- Department of Research, The Arab Institute for Women, Lebanese American University, Beirut, Lebanon
| | - W Courtland Robinson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Maryland
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Atrooz F, Chen TA, Biekman B, Alrousan G, Bick J, Salim S. Displacement and Isolation: Insights from a Mental Stress Survey of Syrian Refugees in Houston, Texas, USA. Int J Environ Res Public Health 2022; 19:2547. [PMID: 35270240 DOI: 10.3390/ijerph19052547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022]
Abstract
(1) Background: Syrians are the largest forcibly displaced population in the world. Approximately 20,000 Syrian refugees have resettled in the United States (US) since the civil war in Syria began in 2011, with an estimated 130 families resettling in Houston, Texas. We conducted a pilot study with the objective of examining the physical and mental well-being of the Houston Syrian refugee population. (2) Methods: Online surveys were conducted using psychometrically valid instruments including Afghan Symptom Checklist (ASC), Refugee Post-Migration Stress Scale (RPMSS), Perceived Stress Scale (PSS), and Self-Report Questionnaire (SRQ) (3) Results: According to independent t-tests, Syrian refugee females scored higher than males on ASC (37.78 vs. 31.64, p = 0.0446), particularly in the subscales of sadness with social withdrawal (28.89 vs. 24.31, p = 0.0495), and stress-induced reactivity (6.56 vs. 4.86, p = 0.0004). Similarly, females scored higher than males in RPMSS (60.54 vs. 45.15, p = 0.0022), including the social strain domain (8.08 vs. 5.18, p = 0.0204). In PSS and SRQ, Syrian refugee females reported comparable stress and distress scores as males. (4) Conclusions: Syrian refugee females reported higher stress and distress than males. Displacement from their home country and social strain were the major sources of stress in Syrian refugee females, as indicated in RPMSS.
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Salim NA, Sawair FA, Meyad FH, Satterthwaite JD, Abukaraky A, Sartawi S. Pattern, frequency and causes of dental extraction among children/adolescents Syrian refugees: an observational study. BMC Pediatr 2022; 22:100. [PMID: 35189847 DOI: 10.1186/s12887-022-03162-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/16/2022] [Indexed: 11/15/2022] Open
Abstract
Background The Syrian conflict has had a massive impact on the dental health of refugees. Dental extraction is a good indicator of socioeconomic position and degree of oral hygiene, however there is a scarcity of evidence in the scientific literature that characterizes the reasons for extraction in refugees. Aims and methods The current study looked at the extraction causes and related sociodemographic variables of 322 Syrian refugees (46.3% females, 53.7% males) who were treated in a dental clinic in Zaatari camp (Jordan), from September to December 2019. All child Syrian refugees (aged 4–16) visiting the facility were eligible to participate. A validated semi-structured survey was used to collect clinical and sociodemographic data from the research sample. Chi-square test, Independent sample t-test, and ANOVA test were used to examine associations between the different variables. The significance level was set at P < 0.05. Results The total number of teeth extracted was 397: 25 (6.3%) permanent teeth, 371 (93.5%) primary teeth, and one mesiodens (0.2%). Overall, lower teeth were most commonly extracted (56.9%). The most common teeth that required extraction were the lower primary molars, with lower left primary second molars being the most commonly extracted (15.9%). As the level of parental education increased, the mean number of extracted teeth decreased (P = 0.035), additionally, as the frequency of toothbrushing increased extractions due to caries decreased significantly (P = 0.027). Conclusions Dental caries and pulpal diseases were discovered to be the most prevalent causes for primary and permanent tooth extraction, with no difference between males and females. The lower left primary molar was the most commonly afflicted tooth.
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Balat A, Kilic BD, Aksu B, Kara MA, Buyukcelik M, Agbas A, Eroglu FK, Gungor T, Alaygut D, Yildiz N, Bastug F, Atmis B, Melek E, Elmaci M, Tulpar S, Pehlivanoglu C, Doven SS, Comak E, Tabel Y, Gemici A, Uysal B, Ozzorlar GS, Kuçuk N, Delibas A, Ozcelik G, Goknar N, Dursun I, Ertan P, Ozunan IA, Sonmez F. Kidney disease profile and encountered problems during follow-up in Syrian refugee children: a multicenter retrospective study. Pediatr Nephrol 2022; 37:393-402. [PMID: 34331573 DOI: 10.1007/s00467-021-05046-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children are one of the most vulnerable groups in conflict zones, especially those with chronic diseases. This study aimed to investigate kidney disease profiles and problems during follow-up in a population of Syrian refugee children residing in Turkey. METHODS Syrian refugee children aged between 0 and 18 years were included in the study. Demographic data, diagnosis, particular interventions due to nephrological problems, and problems encountered during follow-up were obtained from all participating pediatric nephrology centers. RESULTS Data from 633 children from 22 pediatric nephrology centers were included. Mean age of the children was 94.8 ± 61.7 months and 375 were male (59%). 57.7% had parental consanguinity and 23.3% had a close relative(s) with kidney disease. The most common kidney diseases were congenital anomalies of the kidney and urinary tract (CAKUT) (31.0%), glomerular disease (19.9%), chronic kidney disease (CKD) (14.8%), and urolithiasis (10.7%). Frequent reasons for CAKUT were nonobstructive hydronephrosis (23.0%), vesico-ureteral reflux (18.4%), and neurogenic bladder (15.8%). The most common etiology of glomerular diseases was nephrotic syndrome (69%). Ninety-four children had CKD, and 58 children were on chronic dialysis. Six children had kidney transplantation. Surgical intervention was performed on 111 patients. The language barrier, lack of medical records, and frequent disruptions in periodic follow-ups were the main problems noted. CONCLUSIONS CAKUT, glomerular disease, and CKD were highly prevalent in Syrian refugee children. Knowing the frequency of chronic diseases and the problems encountered in refugees would facilitate better treatment options and preventive measures.
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Kutluk T, Koç M, Öner İ, Babalıoğlu İ, Kirazlı M, Aydın S, Ahmed F, Köksal Y, Tokgöz H, Duran M, Sullivan R. Cancer among syrian refugees living in Konya Province, Turkey. Confl Health 2022; 16:3. [PMID: 35101060 PMCID: PMC8805424 DOI: 10.1186/s13031-022-00434-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/06/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND With more than 3.6 million Syrian refugees Turkey hosts the world's largest number of Syrians. Considering the morbidity, mortality, and healthcare spending, cancer is one of the leading health and economic burden for patients and healthcare systems. However, very limited information available in the scientific literature to understand the burden and characteristics of cancer in countries hosting Syrian refugees. The aim of the present study is to evaluate the demographic and clinical characteristics, treatment outcome of Syrian cancer patients living in Konya, Turkey. METHODS We retrospectively reviewed medical records of Syrian cancer patients at three major institutions from 2005 to 2020. The information regarding demographic and clinical characteristics of patients were identified. The number of days between the first symptom and diagnosis was considered as the "diagnostic interval". Patients who failed to attend clinics within four weeks of appointment were assumed abandoned treatment. Survival curves were estimated using the Kaplan-Meier method. RESULTS We identified 230 adult and 38 children refugee diagnosed with cancer during the study period. With regards to adult patients, there were 114 (49.6%) male and 116 (50.4%) female. The median age at diagnosis was 52.4, 47.3 years for male, female respectively. The five most common cancer by site among all were; breast (24.8%), colorectal (10.9%), lung (7.4%), central nervous system (CNS) (7.0%), and stomach (5.2%). 93 (40.4%) had metastatic disease at diagnosis. The overall survival probability was 37.5% at five years for the adult population. Data were extracted for 20 boys and 18 girls with childhood cancer. Their median age at diagnosis was 5.8 and 6.0 years respectively. The three most common childhood cancer were; leukemias (21.1%), lymphomas (21.1%), and CNS (13.2%). Excluding leukemia, 13 (43.3%) of childhood cancer cases had the advanced disease at diagnosis. Three year survival probality was 69.5%. The median diagnostic interval for adult and childhood cancer was 96.5 (IQR = 53-165) and 23 (IQR = 13.5-59) days respectively. Twenty-one adults and four children had treatment abandonment. CONCLUSION This study contributes to understanding the burden of cancer among Syrian refugees living in Konya, growing health issue for refugees. Larger and prospective studies will help to measure the real burden and compare the difference in cancer risk factors, care, and outcomes among the refugee and host populations.
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Affiliation(s)
- Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100, Ankara, Turkey.
| | - Mehmet Koç
- Provincial Directorate of Health Konya, Konya, Turkey
| | - İrem Öner
- Medical Oncology Unit, Ministry of Health City Hospital, Konya, Turkey
| | - İbrahim Babalıoğlu
- Radiation Oncology Unit, Ministry of Health City Hospital, Konya, Turkey
| | - Meral Kirazlı
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100, Ankara, Turkey
| | - Sinem Aydın
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100, Ankara, Turkey
| | - Fahad Ahmed
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100, Ankara, Turkey
| | - Yavuz Köksal
- Department of Pediatric Oncology, Selçuk University Meram Faculty of Medicine, Konya, Turkey
| | - Hüseyin Tokgöz
- Department of Pediatric Hematology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Mustafa Duran
- Hematology Unit, Ministry of Health City Hospital, Konya, Turkey
| | - Richard Sullivan
- Institute of Cancer Policy, Conflict and Health Research Group, King's College London, London, UK
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Yildiz MS, Cimsir MT. Comparison of obstetric and neonatal outcomes between Syrian adolescent refugees and local Turkish adolescent citizens. J OBSTET GYNAECOL 2022; 42:1092-1096. [PMID: 35023800 DOI: 10.1080/01443615.2021.2003308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The provision of antenatal care in adolescents in refugee populations presents particular difficulties because of conflict, nutritional deficiencies, language barriers and lack of access to health care facilities. Due to the absence of prenatal care, associated medical complications can occur. A total of 525 adolescent women who gave birth to singletons agreed to participate in this study. Data about maternal demographic and obstetric characteristics, as well as neonatal outcomes were analysed. In conclusion, adolescent pregnancy continues to be an important social problem due to health support needs. However, the results of our present study are important in terms of showing that perinatal care is quietly improving in Turkey.Impact StatementWhat is already known on this subject? Adolescent pregnancies are at much higher risk than adult pregnancies in terms of complications. These complications include preterm delivery, intrauterine growth retardation, maternal morbidity and mortality, neonatal morbidity and mortality. According to various beliefs and traditions, marriages in early ages are observed in some societies and as a result, adolescents become pregnant. Additionally, the present study includes early adolescent aged pregnancies as 14,15 and 16. As far as we search in the literature, there is no reported about early adolescent pregnancies.What do the results of this study add? Often, such pregnancies occur more frequently in societies with low socioeconomic levels. For this reason routine pregnancy screening, support during pregnancy, prenatal care is not adequately provided. Some of the complications develop on them. Primarily, the adolescent pregnancies should be gotten under control, if not, some complications can be prevented by routine pregnancy follow-up and adequate provision of prenatal care and support.What are the implications of these findings for clinical practice and/or further research? As a guide on clinical practices and further studies; an effective method of contraception should be applied to sexually active women at early maternal age. If not, pregnancies should be kept under close follow-up and with adequate support to avoid complications.
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Affiliation(s)
- Muhammet Serhat Yildiz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Alanya Education and Research Hospital, Alaaddin Keykubat University, Alanya, Turkey
| | - Meral Tugba Cimsir
- Faculty of Medicine, Department of Obstetrics and Gynecology, Alaaddin Keykubat University, Alanya, Turkey
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Nguyen TP, Guajardo MGU, Sahle BW, Renzaho AMN, Slewa-Younan S. Prevalence of common mental disorders in adult Syrian refugees resettled in high income Western countries: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:15. [PMID: 34986827 PMCID: PMC8729124 DOI: 10.1186/s12888-021-03664-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/16/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The immense social upheaval and ongoing humanitarian crisis created by the 2011 war in Syria has forced millions of civilians to flee their homeland, many of whom seek refugee status in Western nations. Whilst it is known that the prevalence of mental illness is higher within refugee populations, this systematic review and meta-analysis aims to pool the prevalence rates of common mental disorders (namely posttraumatic stress disorder, depression and generalized anxiety disorder) in adult Syrian refugees resettled in high income Western countries. METHODS Seven electronic databases (Medline, PsychInfo, CINAHL, PTSDpubs, SCOPUS, PubMed and Embase) were searched up to the 31st of December 2020. Using pre-determined inclusion and exclusion criteria, relevant articles were screened by title and abstract, and later by full text. A meta-analysis was used to estimate the prevalence rates for each mental illness. RESULTS Eleven studies met the eligibility criteria for the systematic review. Nine of these studies had a low-moderate risk of bias and were included in the meta-analysis. Of the 4873 refugees included in the meta-analysis, the total pooled prevalence rate of having any of the three mental disorders was 33% (CI 95%, 27-40%), 40% for anxiety (CI 95%, 31-50%), 31% for depression (CI 95%, 20-44%) and 31% for PTSD (CI 95%, 22-41%). A meta-regression revealed that the total pooled prevalence rate for having any of the three mental disorders was not influenced by age, host country, duration in host country, educational or marital status. CONCLUSIONS Despite significant study heterogeneity, the prevalence rates of common mental disorders in adult Syrian refugees resettled in high-income Western countries are significantly higher than reported rates in the general population.
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Affiliation(s)
- Thomas P. Nguyen
- grid.1029.a0000 0000 9939 5719Mental Health, School of Medicine, Western Sydney University, Sydney, Australia
| | | | - Berhe W. Sahle
- grid.1021.20000 0001 0526 7079School of Nursing and Midwifery, Deakin University, Geelong, Victoria Australia ,grid.267362.40000 0004 0432 5259Centre for Quality and Patient Safety Research (QPS), Alfred Health Partnership, Melbourne, Victoria Australia ,grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
| | - Andre M. N. Renzaho
- grid.1029.a0000 0000 9939 5719Mental Health, School of Medicine, Western Sydney University, Sydney, Australia ,grid.1029.a0000 0000 9939 5719Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia ,grid.1056.20000 0001 2224 8486Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria Australia
| | - Shameran Slewa-Younan
- Mental Health, School of Medicine, Western Sydney University, Sydney, Australia. .,School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia. .,Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
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Zamil J, Atrooz F, Majd Z, Zeidat S, Alrousan G, Abughosh S, Salim S. Perception Regarding Knowledge of COVID-19 Prevention in a Sample of a Middle Eastern and North African (MENA) Community in Houston, Texas, USA. Int J Environ Res Public Health 2022; 19:524. [PMID: 35010783 DOI: 10.3390/ijerph19010524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 02/01/2023]
Abstract
(1) Background: Knowledge of COVID-19 prevention among communities is the first step towards protective behaviors. The objective of this study was to assess COVID-19 prevention knowledge among a Middle Eastern and North African community in Houston, Texas. (2) Methods: A cross-sectional study was conducted using a validated quantitative survey; survey questions consisted of three parts: COVID-19 specific questions, general health questions, and sociodemographic questions. A multivariable logistic regression model was used to determine predictors of perception of knowledge on preventing COVID-19 spread. The outcome of interest comprised of "good/excellent" versus "average and below" knowledge. (3) Results: A total of 366 participants (66.39% males) completed the survey. A univariate analysis demonstrated significant differences in self-reported COVID-19 prevention knowledge among those with and without health insurance, different ages, level of knowledge, and perceived severity of COVID-19 infection. In the multivariate logistic regression, two predictors were identified: those in the 18-25-year-old group were more likely to have "excellent/good" knowledge on COVID-19 spread compared to the ≥40-year-old group (OR: 6.36; 95% CI: 1.38, 29.34). Those who somewhat agree with knowing how to protect themselves from COVID-19 were more likely to have "excellent/good" knowledge of preventing COVID-19 spread compared to those that neither agree nor disagree or disagree (OR: 7.74; 95% CI: 2.58, 23.26). (4) Conclusions: Younger adults reported higher knowledge of COVID-19 prevention.
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McEwen FS, Popham C, Moghames P, Smeeth D, de Villiers B, Saab D, Karam G, Fayyad J, Karam E, Pluess M. Cohort profile: biological pathways of risk and resilience in Syrian refugee children (BIOPATH). Soc Psychiatry Psychiatr Epidemiol 2022; 57:873-883. [PMID: 35041012 PMCID: PMC8960581 DOI: 10.1007/s00127-022-02228-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023]
Abstract
The BIOPATH cohort was established to explore the interplay of psychosocial and biological factors in the development of resilience and mental health problems in Syrian refugee children. Based in Lebanon, a middle-income country significantly impacted by the refugee crisis, it is the first such cohort of refugees in the Middle East. Families were recruited from informal tented settlements in the Beqaa region using purposive cluster sampling. At baseline (October 2017-January 2018), N = 3188 individuals participated [n = 1594 child-caregiver dyads; child gender, 52.6% female; mean (SD) age = 11.44 (2.44) years, range = 6-19]. Re-participation rate at 1-year follow-up was 62.8%. Individual interviews were conducted with children and primary caregivers and biological samples collected from children. Measures include: (1) children's well-being and mental health problems (using tools validated against clinical interviews in a subsample of the cohort); (2) psychosocial risk and protective factors at the level of the individual (e.g. coping strategies), family (e.g. parent-child relationship), community (e.g. collective efficacy), and wider context (e.g. services); (3) saliva samples for genetic and epigenetic (methylation) analyses; (4) hair samples to measure cortisol, dehydroepiandrosterone (DHEA) and testosterone. This cohort profile provides details about sampling and recruitment, data collection and measures, demographic data, attrition and potential bias, key findings on resilience and mental health problems in children and strengths and limitations of the cohort. Researchers interested in accessing data should contact Professor Michael Pluess at Queen Mary University of London, UK (e-mail: m.pluess@qmul.ac.uk).
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Affiliation(s)
- Fiona S McEwen
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Cassandra Popham
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | | | - Demelza Smeeth
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Bernadette de Villiers
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Dahlia Saab
- Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
| | - Georges Karam
- Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
- Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine, Balamand University, El-Koura, Lebanon
| | - John Fayyad
- Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
- Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine, Balamand University, El-Koura, Lebanon
| | - Elie Karam
- Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
- Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine, Balamand University, El-Koura, Lebanon
| | - Michael Pluess
- Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK.
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Abstract
Early marriage remains a central concern among reproductive and sexual rights advocates worldwide. Mainstream researchers have often focused on the negative effects of early marriage on young women, presenting them as powerless victims of social and cultural traditions. Yet the voices and perceptions of young women remain strongly absent in many studies on early marriage. Our study addresses this knowledge gap by utilising participatory and ethnographic methodologies to better understand what early marriage means to those who have experienced it and how these emic perspectives may diverge from humanitarian paradigms. Since the war began in 2011, Syrians have become one of the largest groups of refugees worldwide, with over 5.5 million individuals seeking asylum abroad. Humanitarian organisations have called attention to high rates of early marriage within this population and its unique drivers in the specific context of displacement. We draw upon data collected between 2018 and 2020 during 90 individual interviews and 14 participatory action research meetings to explore how Syrian refugee women conceptualise the practice of early marriage and its drivers after displacement. Our findings reveal that early marriage is perceived as a practice that benefits young women and is justified in terms of its beneficial effects. Participants described early marriage as a rational solution to present-day problems, many of which they associate with the unique context of displacement. Our findings echo prior qualitative studies that illustrate the complexity of attitudes towards early marriage and the importance of understanding the specific contexts in which it is practised.
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Affiliation(s)
- Ruba Al Akash
- Assistant Professor, Faculty of Archaeology and Anthropology, Anthropology Department, Yarmouk University, Irbid, Jordan
| | - Morgen A Chalmiers
- PhD Student, Medical Scientist Training Program, Anthropology Department, University of California San Diego, La Jolla, CA, USA. Correspondence:
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Elçi E, Kirisçioglu E, Üstübici A. How Covid-19 financially hit urban refugees: evidence from mixed-method research with citizens and Syrian refugees in Turkey. Disasters 2021; 45 Suppl 1:S240-S263. [PMID: 34196968 PMCID: PMC8444662 DOI: 10.1111/disa.12498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Peering through a lens of disasters and inequalities, this article measures the financial impacts of Covid-19 on citizens and refugee communities in Turkey during a relatively early phase of the global pandemic. Our data comes from an online survey (N = 1749) conducted simultaneously with Turkish citizens and Syrian refugees living in Turkey, followed by in-depth online interviews with Syrian refugees. Our findings indicate that the initial Covid-19 measures had a higher financial impact on Syrians than on citizens when controlled for employment, wealth, and education, among other variables. In line with the literature, our research confirms that disasters' socio-economic effects disproportionally burden minority communities. We additionally discuss how Covid-19 measures have significantly accelerated effects on refugees compared to the local population, mainly due to the structural and policy context within which forcibly displaced Syrians have been received in Turkey.
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Al Masri F, Müller M, Nebl J, Greupner T, Hahn A, Straka D. Quality of life among Syrian refugees in Germany: a cross-sectional pilot study. Arch Public Health 2021; 79:213. [PMID: 34839832 PMCID: PMC8628448 DOI: 10.1186/s13690-021-00745-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background More than 10 million Syrians have left their homes and sought refuge in neighboring countries, including Europe, since the beginning of the Syrian conflict in March 2011, and immigration continues to this day. This cross-sectional study included Syrian refugees residing in and around Hannover, Germany. We investigated whether general socioeconomic factors (e.g. age, sex, housing, asylum duration) were predictive factors for the quality of life (QOL) of Syrian refugees in Germany. Methods The QOL of Syrian refugees was assessed using the WHOQOL-BREF tool, a questionnaire assessing the QOL in four domains: Physical health, psychological, social relationships and environment. A total of 114 Syrian refugees, aged between 18 and 45 years, who obtained one of the following statuses, asylum, refugee protection or subsidiary protection, were included. The QOL domain and total scores of Syrian refugees in Germany were compared with a Western norm and Sub-Saharan population. Data were analyzed with the Spearman Rho correlation coefficient, Kruskal–Wallis and Mann–Whitney U test and multivariate linear regression. Results More than 65% of the participants (62.3% male, 37.7% female) were between 18 and 29 years old, and 45% had lived in Germany for less than four years. The lowest QOL score was reported in the social relationship’s domain (60.5%), while the psychological score was lowest in participants aged 40–45 years (P = 0.011). The age was significantly negatively associated with physical health (P = 0.010), psychological (P < 0.001) and the total QOL (P = 0.005). Asylum duration was associated with the environment domain (P = 0.040), the short-time refugees were less satisfied than the longtime refugees, and with aspects of the psychological domain in Enjoying life and Concentration ability (P < 0.001 and P = 0.033, respectively), yet was not associated with total QOL or total domain scores. There were significant associations between housing and the psychological domain (P = 0.032) and housing and the social relationship domain (P < 0.001). The refugees who living in camps registered a lower score in psychological than residents of apartments and houses, and the single refugees had a higher score than those married and divorced (P = 0.032 and P = 0.035, respectively). Conclusions The Syrian refugees participating in this study showed a low QOL score in the assessment of all domains compared to the normal population, especially regarding social relations and psychological; it was associated with socioeconomic factors, such as housing, asylum duration and marital status. This calls for urgent societal and political efforts to strengthen the social living conditions of Syrian refugees in Germany.
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Affiliation(s)
- Feras Al Masri
- Gottfried Wilhelm Leibniz University of Hannover, Institute of Food Science and Human Nutrition, Hannover, Germany.
| | - Mattea Müller
- Gottfried Wilhelm Leibniz University of Hannover, Institute of Food Science and Human Nutrition, Hannover, Germany
| | - Josefine Nebl
- Gottfried Wilhelm Leibniz University of Hannover, Institute of Food Science and Human Nutrition, Hannover, Germany
| | - Theresa Greupner
- Gottfried Wilhelm Leibniz University of Hannover, Institute of Food Science and Human Nutrition, Hannover, Germany
| | - Andreas Hahn
- Gottfried Wilhelm Leibniz University of Hannover, Institute of Food Science and Human Nutrition, Hannover, Germany
| | - Dorothee Straka
- Osnabrück University of Applied Sciences, Agricultural Sciences and Landscape Architecture, Osnabrück, Germany
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Abstract
BACKGROUND The Syrian conflict has created the worst humanitarian refugee crisis of our time, with the largest number of people displaced. Many have sought refuge in Egypt, where they are provided with the same access to healthcare services as Egyptian citizens. Nevertheless, in addition to the existing shortcomings of the Egyptian health system, many obstacles specifically limit refugees' access to healthcare. This study looks to assess equity across levels of care after observing services utilization among the Syrian refugees, and look at the humanitarian dilemma when facing resource allocation and the protection of the most vulnerable. METHODS A cross-sectional survey was used and collected information related to access and utilization of outpatient and inpatient health services by Syrian refugees living in Egypt. We used concentration index (CI), horizontal inequity (HI) and benefit incidence analysis (BIA) to measure the inequity in the use of healthcare services and distribution of funding. We decomposed inequalities in utilization, using a linear approximation of a probit model to measure the contribution of need, non-need and consumption influential factors. RESULTS We found pro-rich inequality and horizontal inequity in the probability of refugees' outpatient and inpatient health services utilization. Overall, poorer population groups have greater healthcare needs, while richer groups use the services more extensively. Decomposition analysis showed that the main contributor to inequality is socioeconomic status, with other elements such as large families, the presence of chronic disease and duration of asylum in Egypt further contributing to inequality. Benefit incidence analysis showed that the net benefit distribution of subsidies of UNHCR for outpatient and inpatient care is also pro-rich, after accounting for out-of-pocket expenditures. CONCLUSION Our results show that without equitable subsidies, poor refugees cannot afford healthcare services. To tackle health inequities, UNHCR and organisations will need to adapt programmes to address the social determinants of health, through interventions within many sectors. Our findings contribute to assessments of different levels of accessibility to healthcare services and uncover related sources of inequities that require further attention and advocacy by policymakers.
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Affiliation(s)
- Hani Fares
- United Nations High Commissioner for Refugees (UNHCR), 1202, Geneva, Switzerland.
- Universitat Pompeu Fabra-Barcelona School of Management (UPF-BSM), C. Balmes 132-134, 08007, Barcelona, Catalonia, Spain.
| | - Jaume Puig-Junoy
- Universitat Pompeu Fabra-Barcelona School of Management (UPF-BSM), C. Balmes 132-134, 08007, Barcelona, Catalonia, Spain
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