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Tang HY, Elhindi J, Blumenthal C, Pasupathy D, Melov SJ. Are migrants during the periconception period less likely to be supplementing with folic acid: An Australian cohort study. Midwifery 2024; 132:103984. [PMID: 38554606 DOI: 10.1016/j.midw.2024.103984] [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: 08/25/2023] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Folic acid (FA) supplementation before and in early pregnancy is known to improve outcomes such as reducing neural tube defects; however, little is known about groups in Australia at risk of low FA use. AIM To determine whether differences exist in FA supplementation rates between Australian-born women and migrant women, with a secondary aim of examining the sociodemographic characteristics of women who are not supplementing with FA in early pregnancy. METHODS A retrospective cohort study from January 2018-July 2022 in a high-migrant population in Western Sydney, Australia. Multivariate logistic regression analysis was conducted adjusting for confounders including place of birth, age, ethnicity, parity, history of diabetes, and type of conception. FINDINGS There were 48,045 women who met inclusion criteria; 65% of whom were migrants. We identified that 39.4% of the study population did not report FA supplementation by early pregnancy. Women who were migrants were more likely to report FA usage than those born in Australia (aOR 1.24; 95%CI 1.17-1.31). Women least likely to report use of FA were women < 20 years of age (aOR 0.54; 95%CI 0.44-0.67) and multiparous women (aOR 0.84; 95%CI 0.82-0.86). Women with type 1 or type 2 diabetes were more likely to report FA use (aOR 1.66; 95%CI 1.11-2.48, aOR 1.30; 95%CI 1.05-1.61). CONCLUSION A significant proportion of the population did not report FA supplementation before or during early pregnancy. To increase uptake of FA supplementation, clinicians and public health messaging should target at-risk groups.
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Affiliation(s)
- Hei Yee Tang
- Women's and Newborn Health, Westmead Hospital, New South Wales, Australia
| | - James Elhindi
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, New South Wales, Australia
| | - Caron Blumenthal
- Women's and Newborn Health, Westmead Hospital, New South Wales, Australia
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, New South Wales, Australia
| | - Sarah J Melov
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, New South Wales, Australia.
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2
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Xie L, Liang Z, Wang X, Luo X. The prevalence of preterm and low birth weight infants among migrant women in the Pearl River Delta region, China: a population-based birth cohort study. BMC Public Health 2024; 24:1179. [PMID: 38671398 DOI: 10.1186/s12889-024-18667-8] [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] [Received: 11/29/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The existing literature evaluating the association between neonatal morbidity and migrant status presents contradictory results. The purpose of this study was to compare the risk of preterm birth (PTB) and low birth weight (LBW) among newborns from local and migrant women in China's Pearl River Delta (PRD) region. METHODS In this observational population-based study, we included all live singleton deliveries from PRD region local women and migrant women. Data were sourced from the Guangdong Medical Birth Registry Information System between Jan 1, 2014, and Dec 31, 2020. Women were categorized into three groups by maternal migrant status: local women from PRD region, migrant women from Guangdong province or from other provinces. The outcome variables that were examined included two adverse birth outcomes: PTB and LBW. The association between the risk of PTB and LBW and maternal migrant status was assessed using logistic regression. RESULTS During 2014-2020, 5,219,133 single live deliveries were recorded, corresponding 13.22% to local women and the rest to migrant women coming from Guangdong (53.51%) and other provinces (33.26%). PTB prevalence was highest among local women (5.79%), followed by migrant women from Guangdong (5.29%), and the lowest among migrants from other provinces (4.95%). This association did not change after including maternal age, infant sex, delivery mode, and birth season in the models. Compared to local women, migrant women from other provinces had a lower risk of LBW (4.00% vs. 4.98%, P < 0.001). The prevalence of PTB and LBW was higher among local women than migrants. The odds of delivery PTB and LBW were higher for women who were age ≥ 35. Among the three maternal migration groups, the age-LBW association displayed a typical U-shaped pattern, with those in the youngest (16-24 years) and oldest (≥ 35) age categories exhibiting the higher odds of delivering a LBW neonate. With respect to infant sex, the prevalence of PTB was significantly higher in males than females among the three maternal migration groups. An opposite trend was found for LBW, and the prevalence of LBW was higher in females among the three maternal migration groups. CONCLUSION The findings of this study contribute to the understanding of the epidemiology of PTB and LBW among migrant women. Our study suggests that it is the health and robust nature of migrant mothers that predisposes them to better birth outcomes. It is important to recognize that the results of this study, while supportive of the healthy migrant effect, cannot be considered definitive without some exploration of motivation for moving and changes in lifestyle postmigration.
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Affiliation(s)
- Lulu Xie
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Zhijiang Liang
- Department of Public Health, Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Xionghu Wang
- Department of Health Care, Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Xianqiong Luo
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, 511442, China.
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3
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Petrie G, Angus K, O'Donnell R. A scoping review of academic and grey literature on migrant health research conducted in Scotland. BMC Public Health 2024; 24:1156. [PMID: 38658855 PMCID: PMC11044410 DOI: 10.1186/s12889-024-18628-1] [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: 09/04/2023] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Migration to Scotland has increased since 2002 with an increase in European residents and participation in the Asylum dispersal scheme. Scotland has become more ethnically diverse, and 10% of the current population were born abroad. Migration and ethnicity are determinants of health, and information on the health status of migrants to Scotland and their access to and barriers to care facilitates the planning and delivery of equitable health services. This study aimed to scope existing peer-reviewed research and grey literature to identify gaps in evidence regarding the health of migrants in Scotland. METHODS A scoping review on the health of migrants in Scotland was carried out for dates January 2002 to March 2023, inclusive of peer-reviewed journals and grey literature. CINAHL/ Web of Science/SocIndex and Medline databases were systematically searched along with government and third-sector websites. The searches identified 2166 journal articles and 170 grey literature documents for screening. Included articles were categorised according to the World Health Organisation's 2016 Strategy and Action Plan for Refugee and Migrant Health in the European region. This approach builds on a previously published literature review on Migrant Health in the Republic of Ireland. RESULTS Seventy-one peer reviewed journal articles and 29 grey literature documents were included in the review. 66% were carried out from 2013 onwards and the majority focused on asylum seekers or unspecified migrant groups. Most research identified was on the World Health Organisation's strategic areas of right to health of refugees, social determinants of health and public health planning and strengthening health systems. There were fewer studies on the strategic areas of frameworks for collaborative action, preventing communicable disease, preventing non-communicable disease, health screening and assessment and improving health information and communication. CONCLUSION While research on migrant health in Scotland has increased in recent years significant gaps remain. Future priorities should include studies of undocumented migrants, migrant workers, and additional research is required on the issue of improving health information and communication.
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Affiliation(s)
- G Petrie
- Caledonia House, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - K Angus
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - R O'Donnell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
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4
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Sornlorm K, Thi WM. Health literacy and high blood pressure among Myanmar migrant workers in Northeastern Thailand. PLoS One 2024; 19:e0302057. [PMID: 38662714 PMCID: PMC11045064 DOI: 10.1371/journal.pone.0302057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Hypertension, related to serious consequences unless diagnosed and treated, is a global concern, also affecting migrant workers. Due to the high prevalence of hypertension among migrant workers in Thailand, the influences of health literacy and other factors on blood pressure were needed to explore among Myanmar migrant workers in Northeastern Thailand. Hence, this study aimed to identify the prevalence of high blood pressure (HBP), its association with health literacy and other factors among Myanmar migrant workers in Northeastern Thailand. A cross-sectional analytical study was conducted in Northeastern Thailand. A multistage sampling procedure was applied. Data was gathered through interviews utilizing validated and reliable structured questionnaire. Descriptive statistics and inferential statistics with multiple logistic regression were used. Among 406 participants, about 60% were male and about 70% of them were married. The prevalence of overall HBP was 63.3% (95% CI: 58.49-67.86), 52% in females and 71.86% in males. Participants with limited health literacy were 79% more likely to have HBP than those with excellent and adequate health literacy (AOR = 1.79, 95% CI: 1.13-2.84). Other factors substantially linked with having HBP were being male gender (AOR = 4.68, 95% CI: 2.81-7.78), being overweight (AOR = 2.23, 95% CI: 1.18-4.23), being obese (AOR = 5.69, 95% CI: 2.96-10.96), not having health insurance (AOR = 2.01, 95% CI: 1.11-3.66), staying in Thailand for more than 48 months (AOR = 2.4, 95% CI: 1.48-3.9), and having family history of hypertension (AOR = 2.07, 95% CI: 1.28-3.35). In conclusion, more than half of Myanmar migrant workers had HBP. Factors associated with HBP were limited health literacy, male gender, overnutrition, lack of health insurance, longer duration of stay in Thailand and having family history of hypertension. Therefore, there is a need for a multifaceted strategy to prevent hypertension and its consequences by promoting health literacy as well as by enhancing good behavioural practice among this community.
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Affiliation(s)
- Kittipong Sornlorm
- Faculty of Public Health, Khon Kaen University, Nai Mueang, Mueang Khon Kaen, Khon Kaen, Thailand
| | - Wor Mi Thi
- Faculty of Public Health, Khon Kaen University, Nai Mueang, Mueang Khon Kaen, Khon Kaen, Thailand
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5
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Wang H, Gao X, Liu G, Wang F, Rosenberg MW. Environmental health, economy, and amenities interactively drive migration patterns among China's older people. Front Public Health 2024; 12:1354071. [PMID: 38660354 PMCID: PMC11040073 DOI: 10.3389/fpubh.2024.1354071] [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: 01/04/2024] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
The increasing number of older adult migrants is rapidly changing regional demographic and social structures in China. There is an urgent need to understand the spatial patterns and factors that influence older adults to migrate, especially the role of environmental health. However, this issue has been under-studied. This study focused on intra-provincial and inter-provincial older adult migrants as research subjects, estimated their spatial concentration index based on the iterative proportional fitting approach, and explored the factors influencing their migration using the GeoDetector Model. The results showed the following: (1) In 2015, more than 76% of inter-provincial older adult migrants were distributed in Eastern China, and most intra-provincial older adult migrants were scattered in sub-provincial cities. (2) Compared to factors relating to economy and amenities, environmental health by itself played a relatively weak role in the migration of older adults, but the interaction among environmental health, economy, and amenities was a key driving force of older adult migration. (3) There were significant differences in the dominant environmental health factors between inter-provincial migration and intra-provincial migration, which were temperature and altitude, respectively. Our findings can help policymakers focus on the composition of older adult migrants based on urban environmental health characteristics and rationally optimize older adult care facilities to promote supply-demand matching.
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Affiliation(s)
- Hongjie Wang
- College of Applied Arts and Science, Beijing Union University, Beijing, China
| | - Xiaolu Gao
- School of Architecture and Urban Planning, Beijing University of Civil Engineering and Architecture, Beijing, China
| | - Guili Liu
- College of Applied Arts and Science, Beijing Union University, Beijing, China
| | - Fuyuan Wang
- Institute of Geographic Sciences and Natural Resource Research, Chinese Academy of Sciences, Beijing, China
| | - Mark W. Rosenberg
- Department of Geography and Planning, Queen's University, Kingston, ON, Canada
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Dohál M, Dvořáková V, Šperková M, Pinková M, Ghodousi A, Omrani M, Porvazník I, Rasmussen EM, Škereňová M, Krivošová M, Wallenfels J, Konstantynovska O, Walker TM, Nikolayevskyy V, Cirillo DM, Solovič I, Mokrý J. Tuberculosis in Ukrainian War Refugees and Migrants in the Czech Republic and Slovakia: A Molecular Epidemiological Study. J Epidemiol Glob Health 2024; 14:35-44. [PMID: 38048026 PMCID: PMC11043285 DOI: 10.1007/s44197-023-00166-5] [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: 10/12/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The war in Ukraine has led to significant migration to neighboring countries, raising public health concerns. Notable tuberculosis (TB) incidence rates in Ukraine emphasize the immediate requirement to prioritize approaches that interrupt the spread and prevent new infections. METHODS We conducted a prospective genomic surveillance study to assess migration's impact on TB epidemiology in the Czech Republic and Slovakia. Mycobacterium tuberculosis isolates from Ukrainian war refugees and migrants, collected from September 2021 to December 2022 were analyzed alongside 1574 isolates obtained from Ukraine, the Czech Republic, and Slovakia. RESULTS Our study revealed alarming results, with historically the highest number of Ukrainian tuberculosis patients detected in the host countries. The increasing number of cases of multidrug-resistant TB, significantly linked with Beijing lineage 2.2.1 (p < 0.0001), also presents substantial obstacles to control endeavors. The genomic analysis identified the three highly related genomic clusters, indicating the recent TB transmission among migrant populations. The largest clusters comprised war refugees diagnosed in the Czech Republic, TB patients from various regions of Ukraine, and incarcerated individuals diagnosed with pulmonary TB specialized facility in the Kharkiv region, Ukraine, pointing to a national transmission sequence that has persisted for over 14 years. CONCLUSIONS The data showed that most infections were likely the result of reactivation of latent disease or exposure to TB before migration rather than recent transmission occurring within the host country. However, close monitoring, appropriate treatment, careful surveillance, and social support are crucial in mitigating future risks, though there is currently no evidence of local transmission in EU countries.
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Affiliation(s)
- Matúš Dohál
- Comenius University Bratislava, Malá Hora 4A, 036 01, Martin, Slovak Republic.
| | - Věra Dvořáková
- National Institute of Public Health, Prague, Czech Republic
| | | | | | - Arash Ghodousi
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- San Raffaele University, Milan, Italy
- University of Milan, Milan, Italy
| | - Maryam Omrani
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Igor Porvazník
- National Institute of Tuberculosis, Lung Diseases and Thoracic Surgery, Vyšné Hágy, Slovak Republic
- Catholic University, Ružomberok, Slovak Republic
| | | | - Mária Škereňová
- Comenius University Bratislava, Malá Hora 4A, 036 01, Martin, Slovak Republic
| | - Michaela Krivošová
- Comenius University Bratislava, Malá Hora 4A, 036 01, Martin, Slovak Republic
| | | | | | - Timothy M Walker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- University of Oxford, Oxford, UK
| | | | | | - Ivan Solovič
- National Institute of Tuberculosis, Lung Diseases and Thoracic Surgery, Vyšné Hágy, Slovak Republic
- Catholic University, Ružomberok, Slovak Republic
| | - Juraj Mokrý
- Comenius University Bratislava, Malá Hora 4A, 036 01, Martin, Slovak Republic
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Lan Z, Wu X, Huang J, Pan C, Lai J, Liang X. Obstetric service demand is the main health need of the Vietnamese population in Guangxi, China: A cross-sectional study. Medicine (Baltimore) 2024; 103:e37234. [PMID: 38335402 PMCID: PMC10860929 DOI: 10.1097/md.0000000000037234] [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: 09/18/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
China has become an emerging destination for international migration, especially in some Association of South East Asian Nations countries, but the situation of migrants seeking medical care in China remains unclear. A retrospective cross-sectional study was conducted in a hospital in Chongzuo, which provides medical services for foreigners, to investigate the situation of Vietnamese people seeking health care in Guangxi, China. Vietnamese patients who visited the hospital between 2018 and 2020 were included in the study. Demographic characteristics, clinical characteristics, characteristics of payment for medical costs, and characteristics of hospitalization were compared between outpatients and inpatients. In total, 778 Vietnamese outpatients and 173 inpatients were included in this study. The percentages of female outpatients and inpatients were 93.44% and 88.44% (χ2 = 5.133, P = .023), respectively. Approximately 30% of outpatients and 47% of inpatients visited the hospital due to obstetric needs. The proportions of outpatients with basic medical insurance for urban residents, basic medical insurance for urban employees, and new cooperative medical schemes were 28.02%, 3.21%, and 2.31%, respectively. In comparison, the proportion of inpatients with the above 3 types of medical insurance was 16.76%, 1.73%, and 2.31%, respectively. The proportion of different payments for medical costs between outpatients and inpatients were significantly different (χ2 = 24.404, P < .01). Middle-aged Vietnamese females in Guangxi, China, may have much greater healthcare needs. Their main medical demand is for obstetric services. Measurements should be taken to improve the health services targeting Vietnamese female, but the legitimacy of Vietnamese in Guangxi is a major prerequisite for them to access more and better healthcare services.
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Affiliation(s)
- Zhini Lan
- Office of International Exchange and Cooperation, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Xiaoqiu Wu
- Administration Office, The People’s Hospital of Chongzuo, Chongzuo, Guangxi, China
| | - Jiefang Huang
- Liaison Office, The People’s Hospital of Chongzuo, Chongzuo, Guangxi, China
| | - Cuizhu Pan
- Office of International Exchange and Cooperation, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Jingzhen Lai
- Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Xia Liang
- Headmaster’s Office, Guangxi Medical University, Nanning, Guangxi, China
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8
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Vega Potler NJ, Zhang J, Hackley B, Choi J, Xie X, Punsky B, Pineda L, Shapiro A. Persistence of Emotional Distress in Unaccompanied Migrant Children and Adolescents Primarily From the Northern Triangle of Central America. JAMA Netw Open 2023; 6:e2318977. [PMID: 37338902 PMCID: PMC10282890 DOI: 10.1001/jamanetworkopen.2023.18977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/03/2023] [Indexed: 06/21/2023] Open
Abstract
Importance In the US, unaccompanied migrant children and adolescents (hereinafter referred to as children) are predominantly from Central America's Northern Triangle. While unaccompanied migrant children are at high risk for psychiatric sequelae due to complex traumatic exposures, longitudinal investigations of psychiatric distress after resettlement are lacking. Objective To identify factors associated with emotional distress and longitudinal changes in emotional distress among unaccompanied migrant children in the US. Design, Setting, and Participants For this retrospective cohort study, the 15-item Refugee Health Screener (RHS-15) was administered between January 1, 2015, and December 31, 2019, to unaccompanied migrant children as part of their medical care to detect emotional distress. Follow-up RHS-15 results were included if they were completed before February 29, 2020. Median follow-up interval was 203 days (IQR, 113-375 days). The study was conducted in a federally qualified health center that provides medical, mental health, and legal services. Unaccompanied migrant children who completed the initial RHS-15 were eligible for analysis. Data were analyzed from April 18, 2022, to April 23, 2023. Exposures Traumatic events before migration, during migration, during detention, and after resettlement in the US. Main Outcomes and Measures Emotional distress, including symptoms of posttraumatic stress disorder, anxiety, and depressive symptoms, as indicated by the RHS-15 (ie, score ≥12 on items 1-14 or ≥5 on item 15). Results In total, 176 unaccompanied migrant children completed an initial RHS-15. They were primarily from Central America's Northern Triangle (153 [86.9%]), were mostly male (126 [71.6%]), and had a mean (SD) age of 16.9 (2.1) years. Of the 176 unaccompanied migrant children, 101 (57.4%) had screen results above the positive cutoff. Girls were more likely to have positive screen results than boys (odds ratio, 2.48 [95% CI, 1.15-5.34]; P = .02). Follow-up scores were available for 68 unaccompanied migrant children (38.6%). On the follow-up RHS-15, most scored above the positive cutoff (44 [64.7%]). Three-quarters of unaccompanied migrant children who scored above the positive cutoff initially continued to have positive scores at follow-up (30 of 40), and half of those with negative screen scores initially had positive scores at follow-up (14 of 28). Female vs male unaccompanied migrant children (unstandardized β = 5.14 [95% CI, 0.23-10.06]; P = .04) and initial total score (unstandardized β = 0.41 [95% CI, 0.18-0.64]; P = .001) were independently associated with increased follow-up RHS-15 total score. Conclusions and Relevance The findings suggest that unaccompanied migrant children are at high risk for emotional distress, including symptoms of depression, anxiety, and posttraumatic stress. The persistence of emotional distress suggests that unaccompanied migrant children would benefit from ongoing psychosocial and material support after resettlement.
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Affiliation(s)
- Natan J. Vega Potler
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Jessica Zhang
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Barbara Hackley
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Xianhong Xie
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Brenda Punsky
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Lisa Pineda
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
| | - Alan Shapiro
- Bronx Health Collective, Montefiore Medical Center, Bronx, New York
- Department of Pediatrics, Montefiore Medical Center, Bronx, New York
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9
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Wang Q, Liu X. Child Abuse and Non-Suicidal Self-Injury among Chinese Migrant Adolescents: The Moderating Roles of Beliefs About Adversity and Family Socioeconomic Status. J Interpers Violence 2023; 38:3165-3190. [PMID: 35616091 DOI: 10.1177/08862605221104537] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 06/15/2023]
Abstract
Although research has indicated the association between child abuse and non-suicidal self-injury (NSSI), few studies have examined their relationship in a particular sample of Chinese rural-to-urban migrant adolescents who tend to experience parental abuse and engage in NSSI. More importantly, factors moderating the relationship between child abuse and migrant adolescents' NSSI have been understudied. To address this issue, this study aimed to examine whether beliefs about adversity and family socioeconomic status (SES) moderated the longitudinal relationship between child abuse and NSSI in a sample of Chinese migrant adolescents. 308 Chinese rural-to-urban migrant adolescents (aged 10-14; 138 boys) completed the two-wave survey. Self-reported questionnaires regarding child abuse, NSSI, beliefs about adversity, and family SES were used. Results showed that child abuse was significantly positively related to NSSI a year later. Moreover, the interaction of child abuse, beliefs about adversity, and family SES was significant. Specifically, for migrant adolescents with low SES, positive beliefs about adversity played a protective role in the association between child abuse and NSSI; while for those with high SES, such beliefs showed vulnerability. Findings underscore the importance of considering multiple resilient factors simultaneously by examining beliefs about adversity and SES as the moderating mechanisms in the association between child abuse and NSSI. Findings also emphasize the significance of developing differential interventions targeting NSSI in abused Chinese migrant adolescents. Positive beliefs about adversity are important in buffering the negative effect of child abuse for migrant adolescents with low SES. For those with high SES, special attention should be given to the interactive impact of child abuse, beliefs about adversity, and family SES.
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Affiliation(s)
- Quanquan Wang
- Collaborative Innovation Centre of Assessment for Basic Education Quality, Institute of Developmental Psychology, Beijing Normal University, China
| | - Xia Liu
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, China
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10
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Acosta F, Martínez-Lirola M, Sola-Campoy PJ, Sicilia J, Guerra-Galán T, Maus SR, Muñoz P, Pérez-Lago L, García de Viedma D. Insights into the Complexity of a Dormant Mycobacterium tuberculosis Cluster Once Transmission Is Resumed. Microbiol Spectr 2022; 10:e0138121. [PMID: 35044196 PMCID: PMC8768656 DOI: 10.1128/spectrum.01381-21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
Genotyping tools help identify the complexity in Mycobacterium tuberculosis transmission clusters. We carried out a thorough analysis of the epidemiological and bacteriological complexity of a cluster in Almería, Spain. The cluster, initially associated with Moroccan migrants and with no secondary cases identified in 4 years, then reappeared in Spanish-born individuals. In one case, two Mycobacterium tuberculosis clonal variants were identified. We reanalyzed the cluster, supported by the characterization of multiple cultured isolates and respiratory specimens, whole-genome sequencing, and epidemiological case interviews. Our findings showed that the cluster, which was initially thought to have restarted activity with just a single case harboring a small degree of within-host diversity, was in fact currently growing due to coincidental reactivation of past exposures, with clonal diversity transmitted throughout the cluster. In one case, within-host diversity was amplified, probably due to prolonged diagnostic delay. IMPORTANCE The precise study of the dynamics of tuberculosis transmission in socio-epidemiologically complex scenarios may require more thorough analysis than the standard molecular epidemiology strategies. Our study illustrates the epidemiological and bacteriological complexity present in a transmission cluster in a challenging epidemiological setting with a high proportion of migrant cases. The combination of whole-genome sequencing, refined and refocused epidemiological interviews, and in-depth analysis of the bacterial composition of sputa and cultured isolates was crucial in order to correctly reinterpret the true nature of this cluster. Our global approach allowed us to reinterpret correctly the unnoticed epidemiological and bacteriological complexity involved in the Mycobacterium tuberculosis transmission event under study, which had been overlooked by the usual molecular epidemiology approaches.
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Affiliation(s)
- Fermin Acosta
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Pedro J. Sola-Campoy
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jon Sicilia
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Teresa Guerra-Galán
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Sandra R. Maus
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - Laura Pérez-Lago
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Darío García de Viedma
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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11
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Agarwal S, Sarkar S. Topical analysis of migration coverage during lockdown in India by mainstream print media. PLoS One 2022; 17:e0263787. [PMID: 35176059 PMCID: PMC8853493 DOI: 10.1371/journal.pone.0263787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Implementing countrywide lockdown measures in India, from March 2020 to May 2020 was a major step to deal with the COVID -19 pandemic crisis. The decision of country lockdown adversely affected the urban migrant population, and a large section of them was compelled to move out of the urban areas to their native places. The reverse migration garnered widespread media attention and coverage in electronic as well as print media. The present study focuses on the coverage of the issue by print media using descriptive natural language text mining. The study uses topic modelling, clustering, and sentiment analysis to examine the articles on migration issues during the lockdown period published in two leading English newspapers in India- The Times of India and The Hindu. The sentiment analysis results indicate that the majority of articles have neutral sentiment while very few articles show high negative or positive polarity. Descriptive topic modelling results show that transport, food security, special services, and employment with migration and migrants are the majorly covered topics after employing Bag of Words and TF-IDF models. Clustering is performed to group the article titles based on similar traits using agglomerative hierarchical clustering.
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Affiliation(s)
- Swati Agarwal
- Department of Computer Science and Information System, BITS Pilani Goa Campus, Pilani, Goa, India
- * E-mail: (SA); (SS)
| | - Sayantani Sarkar
- Department of Humanities and Social Sciences, BITS Pilani Goa Campus, Pilani, Goa, India
- * E-mail: (SA); (SS)
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12
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Schröder CC, Breckenkamp J, du Prel JB. Medical rehabilitation of older employees with migrant background in Germany: Does the utilization meet the needs? PLoS One 2022; 17:e0263643. [PMID: 35130330 PMCID: PMC8820604 DOI: 10.1371/journal.pone.0263643] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/25/2022] [Indexed: 11/19/2022] Open
Abstract
Due to demographic change with an ageing workforce, the proportion of employees with poor health and a need for medical rehabilitation is increasing. The aim was to investigate if older employees with migrant background have a different need for and utilization of medical rehabilitation than employees without migrant background. To investigate this, self-reported data from older German employees born in 1959 or 1965 of the first and second study wave of the lidA cohort study were exploratory analyzed (n = 3897). Subgroups of employees with migrant background were separated as first-generation, which had either German or foreign nationality, and second-generation vs. the rest as non-migrants. All subgroups were examined for their need for and utilization of medical rehabilitation with descriptive and bivariate statistics (chi-square, F- and post-hoc tests). Furthermore, multiple logistic regressions and average marginal effects were calculated for each migrant group separately to assess the effect of need for utilization of rehabilitation. According to our operationalizations, the foreign and German first-generation migrants had the highest need for medical rehabilitation while the German first- and second-generation migrants had the highest utilization in the bivariate analysis. However, the multiple logistic model showed significant positive associations between their needs and utilization of rehabilitation for all subgroups. Further in-depth analysis of the need showed that something like under- and oversupply co-exist in migrant groups, while the foreign first-generation migrants with lower need were the only ones without rehabilitation usage. However, undersupply exists in all groups independent of migrant status. Concluding, all subgroups showed suitable use of rehabilitation according to their needs at first sight. Nevertheless, the utilization does not appear to have met all needs, and therefore, the need-oriented utilization of rehabilitation should be increased among all employees, e.g. by providing more information, removing barriers or identifying official need with uniform standards.
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Affiliation(s)
| | - Jürgen Breckenkamp
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jean-Baptist du Prel
- Department of Occupational Health Science, University of Wuppertal, Wuppertal, Germany
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13
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Kujawska M, Schmeda-Hirschmann G. The use of medicinal plants by Paraguayan migrants in the Atlantic Forest of Misiones, Argentina, is based on Guaraní tradition, colonial and current plant knowledge. J Ethnopharmacol 2022; 283:114702. [PMID: 34627987 DOI: 10.1016/j.jep.2021.114702] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Information on the use of medicinal plants in the daily life by Paraguayan people is scarce in mainstream scientific literature. The study on the Paraguayan diaspora in the Provincia de Misiones, Argentina, gives an insight into Guaraní traditions, colonial legacy and current search for new medicinal plants to address new health challenges. AIM OF THE STUDY To document the use of medicinal plants by Paraguayan mestizo migrants who moved into a new country, yet within the same ecological region. The present and past uses of medicinal plants were compared to understand the continuity and change in the Paraguayan herbal pharmacopoeia. MATERIALS AND METHODS Fieldwork based on ethnographic and ethnobotanical techniques was carried out in the Provincia de Misiones, Argentina, in 2014, 2015, and 2019. Eighty-five Paraguayan migrants and their descendants from eastern Paraguay took part in the study. The list of recorded plants was compared with the information in historical sources from Paraguay, to examine the continuity and changes in Paraguayan herbal medicine, and with the present-day ethnobotanical studies from Paraguay. Ethnopharmacological and phytochemical studies on the medicinal plants with the highest consensus of uses were reviewed. RESULTS Altogether, 204 medicinal plant species were recorded. The most frequently mentioned species represented a combination of plants native to the New and Old World. Nearly 40% of the present-day Paraguayan pharmacopoeia shows continuity from colonial and post-colonial periods. Plants were used for 19 medical categories, of which digestive, circulatory and those belonging to humoral medicine were the most prevalent. The ongoing search of plants to treat new health problems is illustrated by reports of 40 species used for hypertension, 26 for diabetes and 18 to lower cholesterol. There is still little evidence for the effectiveness of these plants in the pharmacological literature. Paraguayan migrants were able to continue their traditional plant medicine in Misiones, Argentina, in a substantial way. CONCLUSION This study was carried out in a geographic area with a long-standing tradition of Guaraní medicine. Paraguayan migrants in Misiones integrate pre-Hispanic Guaraní names and uses of plants and old humoral concepts with current adaptation of plants to meet new health challenges. Several of the uses described in early colonial times are still practiced, giving a solid background for in-depth studies of the local pharmacopoeia.
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Affiliation(s)
- Monika Kujawska
- University of Lodz, Institute of Ethnology and Cultural Anthropology, Lindleya 3/5, 90-131, Lodz, Poland.
| | - Guillermo Schmeda-Hirschmann
- Universidad de Talca, Campus Lircay, Instituto de Química de Recursos Naturales, Laboratorio de Química de Productos Naturales, 3460000, Talca, Chile.
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14
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Dale KD, Abayawardana MJ, McBryde ES, Trauer JM, Carvalho N. Modeling the Cost-Effectiveness of Latent Tuberculosis Screening and Treatment Strategies in Recent Migrants to a Low-Incidence Setting. Am J Epidemiol 2022; 191:255-270. [PMID: 34017976 DOI: 10.1093/aje/kwab150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/02/2021] [Accepted: 05/13/2021] [Indexed: 11/12/2022] Open
Abstract
Many tuberculosis (TB) cases in low-incidence settings are attributed to reactivation of latent TB infection (LTBI) acquired overseas. We assessed the cost-effectiveness of community-based LTBI screening and treatment strategies in recent migrants to a low-incidence setting (Australia). A decision-analytical Markov model was developed that cycled 1 migrant cohort (≥11-year-olds) annually over a lifetime from 2020. Postmigration/onshore and offshore (screening during visa application) strategies were compared with existing policy (chest x-ray during visa application). Outcomes included TB cases averted and discounted cost per quality-adjusted life-year (QALY) gained from a health-sector perspective. Most recent migrants are young adults and cost-effectiveness is limited by their relatively low LTBI prevalence, low TB mortality risks, and high emigration probability. Onshore strategies cost at least $203,188 (Australian) per QALY gained, preventing approximately 2.3%-7.0% of TB cases in the cohort. Offshore strategies (screening costs incurred by migrants) cost at least $13,907 per QALY gained, preventing 5.5%-16.9% of cases. Findings were most sensitive to the LTBI treatment quality-of-life decrement (further to severe adverse events); with a minimal decrement, all strategies caused more ill health than they prevented. Additional LTBI strategies in recent migrants could only marginally contribute to TB elimination and are unlikely to be cost-effective unless screening costs are borne by migrants and potential LTBI treatment quality-of-life decrements are ignored.
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Zhou W, Deng W, Luo J, Bai Y, He Z, Wang H. Predictors for HIV testing among Chinese workers in infrastructure construction enterprises in Kenya. BMC Public Health 2021; 21:2213. [PMID: 34863140 PMCID: PMC8642875 DOI: 10.1186/s12889-021-12234-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are increasing Chinese migrants in sub-Saharan Africa currently. Most of them are engaged in infrastructure construction. Research has shown that they stay at particular risk of HIV and are recommended for HIV testing. However, their HIV testing behavior, and its relevant factors, have not been researched among them by now. This study describes the recent HIV testing behavior and relevant factors among Chinese migrant workers in Kenya. METHODS A cross-sectional survey was conducted among 110 male Chinese workers from six different Chinese infrastructure construction enterprises in Kenya. Furthermore, a two-stage cluster random sampling method was used to select participants. We used a questionnaire that included HIV testing history, demographic characteristics, and putative multilevel facilitators of HIV testing. Logistic regression was used to explore the predictors of recent HIV testing behavior among Chinese migrant workers in Kenya. RESULT Of the 110 participants, 30 (27.27%) were tested for HIV in the recent year. All participants were male, and the majority were married (73.2%). The mean age was 37.49 years (SD = 9.73; range: 23 to 63), and a considerable proportion refused to answer questions about transactional sexual behaviors in the last year. Most were able to obtain HIV-related information (91.8%) and were exposed to HIV-related information in the last year (68.2%), but only 47.6% had sufficient HIV knowledge. Nearly one-fifth of them believed that selling sex and paying for sex is acceptable. Multiple logistic regression analysis indicated that participants who could accept the 'pay for sex' (OR: 2.74; 95% CI: 1.02, 7.36) and exposed to HIV related information (OR: 4.75; 95% CI: 1.29, 17.44) were more likely to test for HIV in the recent 1 year. CONCLUSION Higher current HIV test rates were associated with a more open sexual attitude towards paying for sex and being exposed to HIV-related information in the last year among Chinese workers in Kenya. More specific attention to HIV should be attached to this population to increase the rate of HIV testing among them.
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Affiliation(s)
- Wenjuan Zhou
- School of literature and journalism, Central South University, Changsha, Hunan Province, China
| | - Wenyu Deng
- Xiang Ya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Junfei Luo
- School of literature and journalism, Central South University, Changsha, Hunan Province, China
| | - Yin Bai
- School of literature and journalism, Central South University, Changsha, Hunan Province, China
| | - Zeyi He
- School of literature and journalism, Central South University, Changsha, Hunan Province, China
| | - Honghong Wang
- Xiang Ya Nursing School, Central South University, Changsha, Hunan Province, China.
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16
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Pradeepa R, Subashini R, Venkatesan U, Ningombam S, Purty A, John M, Reang T, Luaia R, Tripathy SK, Modi S, Mokta JK, Desai A, Dash K, Deepa M, Nirmal E, Unnikrishnan R, Anjana RM, Kaur T, Dhaliwal RS, Mohan V. Effect of internal migration on diabetes and metabolic abnormalities in India - The ICMR-INDIAB study. J Diabetes Complications 2021; 35:108051. [PMID: 34607777 DOI: 10.1016/j.jdiacomp.2021.108051] [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: 08/09/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
AIMS To assess the effect of migration (rural-to-urban and vice versa) on prevalence of diabetes and metabolic disorders in Asian Indians participating in the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. MATERIALS AND METHODS The ICMR-INDIAB study is a national study on diabetes and associated cardiometabolic disorders in individuals aged ≥20 years from 28 states and 2 union territories of India. Individuals who moved to a different place from their place of birth and had resided in the new location for at least one year were considered as migrants. Anthropometric measurements, blood pressure estimation and a capillary oral glucose tolerance test were performed. RESULTS Of the 113,043 participants, 66.4% were non-migrant rural dwellers, 19.4% non-migrant urban dwellers, 8.4% rural-urban migrants, 3.8% multiple migrants and 2.0% urban-rural migrants. Weighted prevalence of diabetes was highest in rural-urban migrants followed by urban dwellers, urban-rural migrants and rural dwellers [14.7%, 13.2%, 12.7% and 7.7% respectively (p < 0.001)]. Rural-urban migrants had highest prevalence of abdominal obesity (50.5%) compared to the other three groups. The risk for diabetes was 1.9 times higher in rural-urban migrants than among rural dwellers. Five risk factors [hypertension, abdominal and generalized obesity, physical inactivity and low fruit and vegetable intake] together explained 69.8% (partial population attributable risk) of diabetes among rural-urban migrants and 66.4% among non-migrant urban dwellers. CONCLUSIONS Rural-to-urban migration is associated with increased risk of developing diabetes and other cardiometabolic abnormalities. Adoption of healthier lifestyle patterns among migrants could help prevent/delay onset of these abnormalities in this population.
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Affiliation(s)
- Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India.
| | - Radhakrishnan Subashini
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Ulagamathesan Venkatesan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | | | - Anil Purty
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Mary John
- Christian Medical College & Hospital, Ludhiana, India
| | | | | | | | - Sagar Modi
- Himalayan Institute of Medical Sciences, Dehradun, India
| | | | | | | | - Mohan Deepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Elangovan Nirmal
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Ranjit Unnikrishnan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
| | - Tanvir Kaur
- Non-Communicable Disease Division, Indian Council of Medical Research, New Delhi, India
| | | | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, ICMR Centre for Advanced Research on Diabetes, Chennai, India
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Osei TB, van Dijk AM, Dingerink S, Chilunga FP, Beune E, Meeks KAC, Bahendeka S, Schulze MB, Agyemang C, Nicolaou M, Holleboom AG, Danquah I. Reduced Rank Regression-Derived Dietary Patterns Related to the Fatty Liver Index and Associations with Type 2 Diabetes Mellitus among Ghanaian Populations under Transition: The RODAM Study. Nutrients 2021; 13:nu13113679. [PMID: 34835937 PMCID: PMC8620643 DOI: 10.3390/nu13113679] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/08/2021] [Accepted: 10/16/2021] [Indexed: 12/05/2022] Open
Abstract
The Fatty Liver Index (FLI) is a proxy for the steatotic component of non-alcoholic fatty liver disease (NAFLD). For sub-Saharan African populations, the contribution of dietary factors to the development of NAFLD in the etiology of type 2 diabetes mellitus (T2DM) remains to be clarified. We identified sex-specific dietary patterns (DPs) related to the FLI using reduced ranked regression (RRR) and evaluated the associations of these DPs with T2DM. This analysis used data from the RODAM, a multi-center cross-sectional study of Ghanaian populations living in Ghana and Europe. The daily intake frequencies of 30 food groups served as the predictor variables, while the FLI was the response variable. The odds ratios and 95% confidence intervals for T2DM were calculated per one standard deviation increase in the DP score using logistic regression. In males, the DP score explained 9.9% of the variation in their food intake and 16.0% of the variation in the FLI. This DP was characterized by high intakes of poultry, whole-grain cereals, coffee and tea, condiments, and potatoes, and the chance of T2DM was 45% higher per 1 DP score-SD (Model 2). Our results indicate that the intake of modernized foods was associated with proxies of NAFLD, possibly underlying the metabolic pathways to developing T2DM.
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Affiliation(s)
- Tracy Bonsu Osei
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany;
| | - Anne-Marieke van Dijk
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (A.-M.v.D.); (S.D.); (A.G.H.)
| | - Sjoerd Dingerink
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (A.-M.v.D.); (S.D.); (A.G.H.)
| | - Felix Patience Chilunga
- Department of Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (F.P.C.); (E.B.); (K.A.C.M.); (C.A.); (M.N.)
| | - Erik Beune
- Department of Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (F.P.C.); (E.B.); (K.A.C.M.); (C.A.); (M.N.)
| | - Karlijn Anna Catharina Meeks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (F.P.C.); (E.B.); (K.A.C.M.); (C.A.); (M.N.)
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD 20892-2152, USA
| | - Silver Bahendeka
- Department of Internal Medicine, St. Francis Hospital Nsambya, MKPGMS-Uganda Martyrs University, Kampala 5498, Uganda;
| | - Matthias Bernd Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany;
- Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (F.P.C.); (E.B.); (K.A.C.M.); (C.A.); (M.N.)
| | - Mary Nicolaou
- Department of Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (F.P.C.); (E.B.); (K.A.C.M.); (C.A.); (M.N.)
| | - Adriaan Georgius Holleboom
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (A.-M.v.D.); (S.D.); (A.G.H.)
| | - Ina Danquah
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany;
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany;
- Correspondence: ; Tel.: +49-622156-5086
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Pantazis N, Rosinska M, van Sighem A, Quinten C, Noori T, Burns F, Cortes Martins H, Kirwan PD, O'Donnell K, Paraskevis D, Sommen C, Zenner D, Pharris A. Discriminating Between Premigration and Postmigration HIV Acquisition Using Surveillance Data. J Acquir Immune Defic Syndr 2021; 88:117-124. [PMID: 34138772 DOI: 10.1097/qai.0000000000002745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Migrant populations are overrepresented among persons diagnosed with HIV in the European Union and the European Economic Area. Understanding the timing of HIV acquisition (premigration or postmigration) is crucial for developing public health interventions and for producing reliable estimates of HIV incidence and the number of people living with undiagnosed HIV infection. We summarize a recently proposed method for determining the timing of HIV acquisition and apply it to both real and simulated data. METHODS The considered method combines estimates from a mixed model, applied to data from a large seroconverters' cohort, with biomarker measurements and individual characteristics to derive probabilities of premigration HIV acquisition within a Bayesian framework. The method is applied to a subset of data from the European Surveillance System (TESSy) and simulated data. FINDINGS Simulation study results showed good performance with the probabilities of correctly classifying a premigration case or a postmigration case being 87.4% and 80.4%, respectively. Applying the method to TESSy data, we estimated the proportions of migrants who acquired HIV in the destination country were 31.9%, 37.1%, 45.3%, and 45.2% for those originating from Africa, Europe, Asia, and other regions, respectively. CONCLUSIONS Although the considered method was initially developed for cases with multiple biomarkers' measurements, its performance, when applied to data where only one CD4 count per individual is available, remains satisfactory. Application of the method to TESSy data, estimated that a substantial proportion of HIV acquisition among migrants occurs in destination countries, having important implications for public health policy and programs.
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Affiliation(s)
- Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Magdalena Rosinska
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | | | - Chantal Quinten
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Fiona Burns
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Peter D Kirwan
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, Public Health England, London, United Kingdom
| | - Kate O'Donnell
- HSE-Health Protection Surveillance Centre, Dublin, Ireland
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Dominik Zenner
- Centre for Global Public Health, Institute for Population Health Sciences, Queen Mary University London, London, United Kingdom
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Ramos-Sesma V, Navarro M, Llenas-García J, Gil-Anguita C, Torrus-Tendero D, Wikman-Jorgensen P, García-López M, Amador-Prous C, Ventero-Martín MP, Guevara-Hernández P, Garijo-Saiz A, Sanchez-Sanchez A, Bernal-Alcaraz C, Pujades-Tarraga AI, Muñoz-Perez R, Flores-Chávez M, Ramos-Rincón JM. Community-based screening of Chagas disease among Latin American migrants in a non-endemic country: an observational study. Infect Dis Poverty 2021; 10:117. [PMID: 34526137 PMCID: PMC8441044 DOI: 10.1186/s40249-021-00897-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chagas disease is a parasitic disease endemic to Latin America, but it has become a disease of global concern due to migration flows. Asymptomatic carriers may host the parasite for years, without knowing they are infected. The aim of this study is to assess prevalence of Chagas disease and evaluate the participants' level of knowledge between Latin American migrants attending a community-based screening campaign. METHODS Three community-based campaigns were performed in Alicante (Spain) in 2016, 2017 and 2018, including educational chats and blood tests for Trypanosoma cruzi serology. Participants completed a questionnaire assessing knowledge about the mechanisms of transmission, disease presentation, diagnosis, and treatment. People seropositive for T. cruzi underwent diagnostic confirmation by two different tests. Results were analyzed by multivariable logistic regression and expressed as adjusted odds ratios (aORs), adjusting for age, sex, and time in Spain. RESULTS A total of 596 participants were included in the study; 17% were aged under 18 years. Prevalence in adults was 11% [54/496; 95% confidence interval (CI): 8.3-14.5%] versus 0% among children. All but one case were in Bolivians. Diagnosis was independently associated with having been born in Bolivia (aOR: 102, 95% CI: 13-781) and a primary school-level education (aOR: 2.40, 95% CI: 1.14-5.06). Of 54 people diagnosed with Chagas disease (most of whom were asymptomatic), 42 (77.7%) returned to the clinic at least once, and 24 (44.4%) received treatment. Multivariable analysis showed that coming from Argentina (aOR: 13, 95% CI: 1.61-1188) or Bolivia (aOR: 1.90, 95% CI: 1.19-3.39) and having received information about Chagas disease in Spain (aOR: 4.63, 95% CI: 2.54-8.97) were associated with a good level of knowledge on the disease. Having primary level studies (aOR: 0.59, 95% CI: 0.34-0.98) and coming from Ecuador (aOR: 4.63, 95% CI: 2.52-847) were independently associated with a lower level of knowledge. CONCLUSIONS Community-based interventions are a good strategy for diagnosing neglected diseases such as Chagas disease in non-endemic countries and for identifying and treating infected, asymptomatic individuals.
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Affiliation(s)
| | - Miriam Navarro
- Public Health, Science History and Gynecology Department, Universidad Miguel Hernández de Elche, Alicante, Spain
- Epidemiology Unit Public Health Center of Elche, Alicante, Spain
| | - Jara Llenas-García
- Internal Medicine Department, Hospital Vega Baja de Orihuela (Alicante, Spain)-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Alicante, Spain
- Clinical Medicine Department, University Miguel Hernández of Elche, Sant Joan d'Alacant, Spain
| | - Concepción Gil-Anguita
- Internal Medicine Department, Hospital Marina BaixaLa Vila Joiosa (Alicante, Spain)-FISABIO, Alicante, Spain
| | - Diego Torrus-Tendero
- Internal Medicine Department, General University Hospital of Alicante-Biomedical and Health Research Institute of Alicante (ISABIAL), Alicante, Spain
- Parasitology Area, University Miguel Hernández of Elche, Sant Joan d'Alacant, Spain
| | - Philip Wikman-Jorgensen
- Internal Medicine Department, University Hospital of Sant Joan, (Sant Joan d'Alacant, Spain)- FISABIO, Alicante, Spain
| | - María García-López
- Internal Medicine Department, Hospital Vega Baja de Orihuela (Alicante, Spain)-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Alicante, Spain
| | - Concepción Amador-Prous
- Internal Medicine Department, Hospital Marina BaixaLa Vila Joiosa (Alicante, Spain)-FISABIO, Alicante, Spain
| | | | - Pedro Guevara-Hernández
- Internal Medicine Department, Hospital Vega Baja de Orihuela (Alicante, Spain)-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Alicante, Spain
| | - Ana Garijo-Saiz
- Internal Medicine Department, Hospital Marina BaixaLa Vila Joiosa (Alicante, Spain)-FISABIO, Alicante, Spain
| | - Ares Sanchez-Sanchez
- Pediatric Department, General University Hospital of Alicante-ISABIAL, Alicante, Spain
| | - Cristina Bernal-Alcaraz
- Internal Medicine Department, Hospital Vega Baja de Orihuela (Alicante, Spain)-Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), Alicante, Spain
| | - Ana-Isabel Pujades-Tarraga
- Internal Medicine Department, Hospital Marina BaixaLa Vila Joiosa (Alicante, Spain)-FISABIO, Alicante, Spain
| | - Roser Muñoz-Perez
- Digestive Service, General University Hospital of Alicante-ISABIAL, Alicante, Spain
| | - María Flores-Chávez
- Reference and Research Laboratory in Parasitology, National Center of Microbiology/Mundo Sano Foundation, Madrid, Spain
| | - José-Manuel Ramos-Rincón
- Clinical Medicine Department, University Miguel Hernández of Elche, Sant Joan d'Alacant, Spain.
- Internal Medicine Department, General University Hospital of Alicante-Biomedical and Health Research Institute of Alicante (ISABIAL), Alicante, Spain.
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Abstract
New-generation migrant workers in Chinese cities are struggling with a lack of urban resources, such as capital, skills, and relationships. To cope with the pressure of these resource constraints, new-generation migrant workers obtain urban development opportunities through resource bricolage. Based on a questionnaire survey of 365 new-generation migrant workers, we used a multiple regression analysis to study the mechanism underlying the effects of resource bricolage on the city integration of new-generation migrant workers. There were four findings: (1) resource bricolage had a significant positive effect on career growth and city integration; (2) career growth had a mediation effect on the relationship between resource bricolage and city integration; (3) environmental dynamism had a positive moderating effect on the relationship between resource bricolage and city integration for new-generation migrant workers; and (4) resource bricolage and environmental dynamism had a moderating effect on city integration through the mediation effect of career growth. The results suggest that resource bricolage promotes the career growth of new-generation migrant workers and further promotes their city integration, and that the environmental dynamism faced by workers is the external condition for promoting integration through resource bricolage. The study emphasizes the importance of resource bricolage in new-generation migrant workers' city integration.
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Affiliation(s)
- Ai-xiang Zheng
- School of Government, Nanjing University, Nanjing, Jiangsu, China
- School of Management, Wuxi Institute of Technology, Wuxi, Jiangsu, China
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22
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Flouris AD, Babar Z, Ioannou LG, Onarheim KH, Phua KH, Hargreaves S. Improving the evidence on health inequities in migrant construction workers preparing for big sporting events. BMJ 2021; 374:n1615. [PMID: 34353788 PMCID: PMC8340916 DOI: 10.1136/bmj.n1615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Andreas D Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Thessaly, Greece
| | - Zahra Babar
- Center for International and Regional Studies, Georgetown University, Doha, Qatar
| | - Leonidas G Ioannou
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Thessaly, Greece
| | - Kristine H Onarheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen Norway
| | - Kai H Phua
- Graduate School of Public Policy, Nazarbayev University, Nur-Sultan, Kazakhstan
- Institute of Policy Studies, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK
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Affiliation(s)
| | - Kai Hong Phua
- Graduate School of Public Policy, Nazarbayev University, Kazakhstan and Institute of Policy Studies, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | | | - Andreas D Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Greece
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
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Meredith HR, Wesolowski A, Menya D, Esimit D, Lokoel G, Kipkoech J, Freedman B, Lokemer S, Maragia J, Ambani G, Taylor SM, Prudhomme-O’Meara W, Obala AA. Epidemiology of Plasmodium falciparum Infections in a Semi-Arid Rural African Setting: Evidence from Reactive Case Detection in Northwestern Kenya. Am J Trop Med Hyg 2021; 105:1076-1084. [PMID: 34339387 PMCID: PMC8592151 DOI: 10.4269/ajtmh.21-0256] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/24/2021] [Indexed: 11/07/2022] Open
Abstract
In northwestern Kenya, Turkana County has been historically considered unsuitable for stable malaria transmission because of its unfavorable climate and predominantly semi-nomadic population; consequently, it is overlooked during malaria control planning. However, the area is changing, with substantial development, an upsurge in travel associated with resource extraction, and more populated settlements forming. Recently, numerous malaria outbreaks have highlighted the need to characterize malaria transmission and its associated risk factors in the region to inform control strategies. Reactive case detection of confirmed malaria cases at six health facilities across central Turkana was conducted from 2018 to 2019. Infections in household members of index cases were detected by malaria rapid diagnostic tests (RDTs) and PCR tests, and they were grouped according household and individual characteristics. The relationships between putative risk factors and infection were quantified by multilevel logistic regression models. Of the 3,189 household members analyzed, 33.6% had positive RDT results and/or PCR test results. RDT-detected infections were more prevalent in children; however, PCR-detected infections were similarly prevalent across age groups. Recent travel was rarely reported and not significantly associated with infection. Bed net coverage was low and net crowding was associated with increased risks of household infections. Infections were present year-round, and fluctuations in prevalence were not associated with rainfall. These findings indicate year-round, endemic transmission with moderate population immunity. This is in stark contrast to recent estimates in this area. Therefore, further investigations to design effective intervention approaches to address malaria in this rapidly changing region and other similar settings across the Horn of Africa are warranted.
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Affiliation(s)
- Hannah R. Meredith
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Diana Menya
- Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Daniel Esimit
- Department of Health Services and Sanitation, Turkana County, Kenya
| | - Gilchrist Lokoel
- Department of Health Services and Sanitation, Turkana County, Kenya
| | - Joseph Kipkoech
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Betsy Freedman
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina
| | - Samuel Lokemer
- Department of Health Services and Sanitation, Turkana County, Kenya
| | - James Maragia
- Lodwar County Referral Hospital, Turkana County, Kenya
| | - George Ambani
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Steve M. Taylor
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Wendy Prudhomme-O’Meara
- Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Andrew A. Obala
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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Rostila M, Cederström A, Wallace M, Brandén M, Malmberg B, Andersson G. Disparities in Coronavirus Disease 2019 Mortality by Country of Birth in Stockholm, Sweden: A Total-Population-Based Cohort Study. Am J Epidemiol 2021; 190:1510-1518. [PMID: 33710317 PMCID: PMC7989658 DOI: 10.1093/aje/kwab057] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 12/20/2022] Open
Abstract
Preliminary evidence points to higher morbidity and mortality from coronavirus disease 2019 (COVID-19) in certain racial and ethnic groups, but population-based studies using microlevel data are lacking so far. We used register-based cohort data including all adults living in Stockholm, Sweden, between January 31, 2020 (the date of the first confirmed case of COVID-19) and May 4, 2020 (n = 1,778,670) to conduct Poisson regression analyses with region/country of birth as the exposure and underlying cause of COVID-19 death as the outcome, estimating relative risks and 95% confidence intervals. Migrants from Middle Eastern countries (relative risk (RR) = 3.2, 95% confidence interval (CI): 2.6, 3.8), Africa (RR = 3.0, 95% CI: 2.2, 4.3), and non-Sweden Nordic countries (RR = 1.5, 95% CI: 1.2, 1.8) had higher mortality from COVID-19 than persons born in Sweden. Especially high mortality risks from COVID-19 were found among persons born in Somalia, Lebanon, Syria, Turkey, Iran, and Iraq. Socioeconomic status, number of working-age household members, and neighborhood population density attenuated up to half of the increased COVID-19 mortality risks among the foreign-born. Disadvantaged socioeconomic and living conditions may increase infection rates in migrants and contribute to their higher risk of COVID-19 mortality.
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Affiliation(s)
- Mikael Rostila
- Correspondence to Dr. Mikael Rostila, Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Sveavägen 160, SE-106 91 Stockholm, Sweden (e-mail: )
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Madge S, Barber TJ, Hunter A, Bhagani S, Lipman M, Burns F. Descriptive account of 18 adults with known HIV infection hospitalised with SARS-CoV-2 infection. Sex Transm Infect 2021; 97:392-393. [PMID: 32879027 PMCID: PMC7474897 DOI: 10.1136/sextrans-2020-054660] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To report on the clinical characteristics and outcome of 18 people living with HIV (PLWH) hospitalised with SARS-CoV-2 infection in a London teaching hospital. METHODS The hospital notes of 18 PLWH hospitalised with SARS-CoV-2 infection were retrospectively reviewed alongside data concerning their HIV demographics from an established HIV Database. RESULTS The majority (16/18) had positive PCR swabs for SARS-CoV-2, and two had negative swabs but typical COVID-19 imaging and history. Most were male (14/18, 78%), median age 63 years (range 47-77 years). Two-thirds were migrants, nine (50%) of Black, Asian and minority ethnicity (BAME). All were diagnosed with HIV for many years (range 8-31 years), and all had an undetectable HIV viral load (<40 copies/mL). The median CD4 prior to admission was 439 (IQR 239-651), and 10/16 (63%) had a CD4 nadir below 200 cells/mm3. Almost all (17/18) had been diagnosed with at least one comorbidity associated with SARS-CoV-2 prior to admission. 3/18 patients died. None received mechanical ventilation. Hospital stay and clinical course did not appear prolonged (median 9 days). CONCLUSIONS Our data suggest that PLWH may not necessarily have prolonged or complex admissions to hospital when compared with the general hospital and national population admitted with COVID-19. Many had low nadir CD4 counts and potentially impaired functional immune restoration. The PLWH group was younger than generally reported for COVID-19, and the majority were male with multiple complex comorbidities. These patients had frequent contact with hospital settings increasing potential for nosocomial acquisition and increased risk of severe COVID-19.
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Affiliation(s)
- Sara Madge
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Tristan J Barber
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Alan Hunter
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Sanjay Bhagani
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Marc Lipman
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Fiona Burns
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
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Selten JP, Termorshuizen F, van Sonsbeek M, Bogers J, Schmand B. Migration and dementia: a meta-analysis of epidemiological studies in Europe. Psychol Med 2021; 51:1838-1845. [PMID: 32264980 PMCID: PMC8381287 DOI: 10.1017/s0033291720000586] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND To provide an overview of epidemiological studies of dementia among migrant groups in Europe and to estimate their pooled odds ratio (OR) v. the reference population. METHODS Search for articles reporting on incidence or prevalence of dementia among ethnic minorities and migrants in Europe, published before 21 December 2018. We performed several meta-analyses, using a random-effects model, and, when there was no evidence of heterogeneity, a fixed-effects model. We distinguished between all migrants, African-Europeans and Asian-Europeans. RESULTS We retrieved five population-based surveys and two health care record studies. The latter included one incidence study, the remainder were prevalence studies. The meta-analysis of all studies yielded a pooled OR, adjusted for age and sex, of 1.73 (95% CI 1.42-2.11) for dementia in all migrant groups. However, the pooled OR of population surveys (3.10; 95% CI 2.12-4.51) was significantly higher than that for the health care record studies (OR 0.94; 95% CI 0.80-1.11). The pooled ORs for African-Europeans and Asian-Europeans, based on population surveys, were 2.54 (95% CI 1.70-3.80) and 5.36 (95% CI 2.78-10.31), respectively. CONCLUSIONS The discrepancy between health care record studies and population surveys suggests that many migrants remain undiagnosed. Migrants from Asia and Africa seem to be at significantly increased risk of dementia in Europe. Since the prevalence rates in their countries of origin are generally not higher than those for natives in Europe, there may be a parallel with the epidemiology of schizophrenia.
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Affiliation(s)
- Jean-Paul Selten
- Rivierduinen, Institute for Mental Health Care, Leiden, The Netherlands
- School for Mental Health and Neuroscience, University of Maastricht, Maastricht, The Netherlands
| | - Fabian Termorshuizen
- Rivierduinen, Institute for Mental Health Care, Leiden, The Netherlands
- School for Mental Health and Neuroscience, University of Maastricht, Maastricht, The Netherlands
| | | | - Jan Bogers
- Rivierduinen, Institute for Mental Health Care, Leiden, The Netherlands
| | - Ben Schmand
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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28
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Abstract
Nearly one-quarter of all children under age 2 in China are left behind in the countryside as parents migrate to urban areas for work. We use a four-wave longitudinal survey following young children from 6 to 30 months of age to provide first evidence on the effects of parental migration on development, health, and nutritional outcomes in the critical first stages of life. We find that maternal migration has a negative effect on cognitive development: migration before children reach 12 months of age reduces cognitive development by 0.3 standard deviations at age 2. Possible mechanisms include reduced dietary diversity and engagement in stimulating activities, both known to be causally associated with skill development in early life. We find no effects on other dimensions of physical and social-emotional health.
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Affiliation(s)
- Ai Yue
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, No. 620 West Chang'an Avenue, Chang'an District, Xi'an, 710119, Shaanxi, China
| | - Yu Bai
- School of Economics, Minzu University of China, 27 Zhongguancun South Avenue, Beijing, China.
| | - Yaojiang Shi
- Center for Experimental Economics in Education (CEEE), Shaanxi Normal University, No. 620 West Chang'an Avenue, Chang'an District, Xi'an, 710119, Shaanxi, China
| | - Renfu Luo
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing, China
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Alexis Medina
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Fellmeth G, Plugge E, Fazel M, Nosten S, Oo MM, Pimanpanarak M, Phichitpadungtham Y, Fitzpatrick R, McGready R. Perinatal depression in migrant and refugee women on the Thai-Myanmar border: does social support matter? Philos Trans R Soc Lond B Biol Sci 2021; 376:20200030. [PMID: 33938275 PMCID: PMC8090811 DOI: 10.1098/rstb.2020.0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/22/2022] Open
Abstract
Migrant and refugee women are at risk of perinatal depression due to stressors experienced before, during and after migration. This study assesses the associations between social support and perinatal depression among migrant and refugee women on the Thai-Myanmar border. We conducted a cohort study of pregnant and post-partum women. Depression status was assessed using a structured clinical interview. Received support, perceived support and partner support were measured in the third trimester. Logistic regression was used to calculate associations between social support measures and perinatal depression controlling for demographic, socio-economic, migration, obstetric and psychosocial factors. Four hundred and fifty-one women (233 migrants; 218 refugees) were included. The prevalence of perinatal depression was 38.6% in migrants and 47.3% in refugees. Migrants had higher levels of received, perceived and partner support than refugees. After controlling for all other variables, higher levels of received support remained significantly associated with a lower likelihood of perinatal depression in migrants (adjusted odds ratio 0.82; 95% CI 0.68-0.99). In both groups, depression history and trauma were strongly associated with perinatal depression. Our study highlights the importance of received social support to perinatal depression in migrant women on the Thailand-Myanmar border. The perinatal period offers a valuable opportunity to ask women about their support and offer community-level or public policy interventions to nurture support networks in current locations and resettlement destinations. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
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Affiliation(s)
- Gracia Fellmeth
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LT, UK
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - Emma Plugge
- Health and Justice Team, Health Improvement Directorate, Public Health England, 60 Caversham Road, Reading RG1 7EB, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - May May Oo
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - Mupawjay Pimanpanarak
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - Yuwapha Phichitpadungtham
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
| | - Raymond Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LT, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, 68/30 Bantung Road, PO Box 46, Mae Sot, Tak 63110, Thailand
- Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok 10400, Thailand
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Ibarra JT, Caviedes J, Altamirano TA, Urra R, Barreau A, Santana F. Social-ecological filters drive the functional diversity of beetles in homegardens of campesinos and migrants in the southern Andes. Sci Rep 2021; 11:12462. [PMID: 34127685 PMCID: PMC8203784 DOI: 10.1038/s41598-021-91185-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/24/2021] [Indexed: 11/08/2022] Open
Abstract
Homegardens are coupled social-ecological systems that act as biodiversity reservoirs while contributing to local food sovereignty. These systems are characterized by their structural complexity, while involving management practices according to gardener's cultural origin. Social-ecological processes in homegardens may act as filters of species' functional traits, and thus influence the species richness-functional diversity relationship of critical agroecosystem components like beetles (Coleoptera). We tested the species richness-functional diversity relationship of beetle communities and examined whether habitat structure across different levels, sociodemographic profiles, and management practices act as filters in homegardens in a Global Biodiversity Hotspot, Chile. For 100 homegardens (50 campesino and 50 migrant), we sampled beetles and habitat attributes, and surveyed gardeners' sociodemographic profiles and management practices. We recorded 85 beetle species and found a positive relationship between species richness and functional richness that saturated when functionally similar species co-occur more often than expected by chance, indicating functional redundancy in species-rich homegardens. Gardener origin (campesino/migrant), homegarden area (m2), structural complexity (index), and pest control strategy (natural, chemical, or none) were the most influential social-ecological filters that selectively remove beetle species according to their functional traits. We discuss opportunities in homegarden management for strengthening local functional diversity and resilience under social-environmental changes.
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Affiliation(s)
- José Tomás Ibarra
- ECOS (Ecosystem-Complexity-Society) Co-Laboratory, Center for Local Development (CEDEL) & Center for Intercultural and Indigenous Research (CIIR), Villarrica Campus, Pontificia Universidad Católica de Chile, Bernardo O'Higgins 501, Villarrica, La Araucanía Region, Chile.
- Department of Ecosystems and Environment, Faculty of Agriculture and Forest Sciences & Center of Applied Ecology and Sustainability (CAPES), Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul, Santiago, Chile.
| | - Julián Caviedes
- ECOS (Ecosystem-Complexity-Society) Co-Laboratory, Center for Local Development (CEDEL) & Center for Intercultural and Indigenous Research (CIIR), Villarrica Campus, Pontificia Universidad Católica de Chile, Bernardo O'Higgins 501, Villarrica, La Araucanía Region, Chile
| | - Tomás A Altamirano
- ECOS (Ecosystem-Complexity-Society) Co-Laboratory, Center for Local Development (CEDEL) & Center for Intercultural and Indigenous Research (CIIR), Villarrica Campus, Pontificia Universidad Católica de Chile, Bernardo O'Higgins 501, Villarrica, La Araucanía Region, Chile
| | - Romina Urra
- ECOS (Ecosystem-Complexity-Society) Co-Laboratory, Center for Local Development (CEDEL) & Center for Intercultural and Indigenous Research (CIIR), Villarrica Campus, Pontificia Universidad Católica de Chile, Bernardo O'Higgins 501, Villarrica, La Araucanía Region, Chile
| | - Antonia Barreau
- ECOS (Ecosystem-Complexity-Society) Co-Laboratory, Center for Local Development (CEDEL) & Center for Intercultural and Indigenous Research (CIIR), Villarrica Campus, Pontificia Universidad Católica de Chile, Bernardo O'Higgins 501, Villarrica, La Araucanía Region, Chile
| | - Francisca Santana
- ECOS (Ecosystem-Complexity-Society) Co-Laboratory, Center for Local Development (CEDEL) & Center for Intercultural and Indigenous Research (CIIR), Villarrica Campus, Pontificia Universidad Católica de Chile, Bernardo O'Higgins 501, Villarrica, La Araucanía Region, Chile
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Pega F, Govindaraj S, Tran NT. Health service use and health outcomes among international migrant workers compared with non-migrant workers: A systematic review and meta-analysis. PLoS One 2021; 16:e0252651. [PMID: 34106987 PMCID: PMC8189512 DOI: 10.1371/journal.pone.0252651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives The review aimed to synthesise recent evidence on health service use and health outcomes among international migrant workers, compared with non-migrant workers. Methods A search was carried out in MEDLINE, PubMed, Embase, and CINAHL for studies published between Jan 1, 2010, and Feb 29, 2020. Included outcomes were: occupational health service use, fatal occupational injury, HIV, and depression. Two authors independently screened records, extracted data, assessed risk of bias and judged quality of evidence. We meta-analysed estimates and conducted subgroup analyses by sex, geographical origin, geographical destination, and regularity of migration. Results Twenty-one studies were included comprising >17 million participants in 16 countries. Most studies investigated regular migrant workers in high-income destination countries. Compared with non-migrant workers, migrant workers were less likely to use health services (relative risk 0·55, 95% confidence interval 0·41 to 0·73, 4 studies, 3,804,131 participants, I2 100%, low quality of evidence). They more commonly had occupational injuries (1·27, 95% confidence interval 1·11 to 1·45, 7 studies, 17,100,626 participants, I2 96%, low quality of evidence). Relative risks differed by geographical origin and/or destination. There is uncertainty (very low quality of evidence) about occupational health service use (0 studies), fatal occupational injuries (5 studies, N = 14,210,820), HIV (3 studies, N = 13,775), and depression (2 studies, N = 7,512). Conclusions Migrant workers may be less likely than non-migrant workers to use health services and more likely to have occupational injuries. More research is required on migrant workers from and in low- and middle-income countries, across migration stages, migrating irregularly, and in the informal economy.
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Affiliation(s)
- Frank Pega
- Environment, Climate Change and Health Department, World Health Organization, Geneva, Switzerland
- * E-mail:
| | - Srinivasan Govindaraj
- Environment, Climate Change and Health Department, World Health Organization, Geneva, Switzerland
| | - Nguyen Toan Tran
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, Sydney, NSW, Australia
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Arcêncio RA, Berra TZ, Terena NDFM, Rocha MP, Ferraz de Araújo Alecrim T, de Souza Kihara FM, Mascarello KC, Martins Sales CM, Maciel ELN. Spatial clustering and temporal trend analysis of international migrants diagnosed with tuberculosis in Brazil. PLoS One 2021; 16:e0252712. [PMID: 34106968 PMCID: PMC8189475 DOI: 10.1371/journal.pone.0252712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Tuberculosis (TB) in migrants is of concern to health authorities worldwide and is even more critical in Brazil, considering the country´s size and long land borders. The aim of the study was to identify critical areas in Brazil for migrants diagnosed with TB and to describe the temporal trend in this phenomenon in recent years. Methods This is an ecological study that used spatial analysis and time series analysis. As the study population, all cases of migrants diagnosed with TB from 2014 to 2019 were included, and Brazilian municipalities were considered as the unit of ecological analysis. The Getis-Ord Gi* technique was applied to identify critical areas, and based on the identified clusters, seasonal-trend decomposition based on loess (STL) and Prais-Winsten autoregression were used, respectively, to trace and classify temporal trend in the analyzed series. In addition, several municipal socioeconomic indicators were selected to verify the association between the identified clusters and social vulnerability. Results 2,471 TB cases were reported in migrants. Gi* analysis showed that areas with spatial association with TB in immigrants coincide with critical areas for TB in the general population (coast of the Southeast and North regions). Four TB clusters were identified in immigrants in the states of Amazonas, Roraima, São Paulo, and Rio de Janeiro, with an upward trend in most of these clusters. The temporal trend in TB in immigrants was classified as increasing in Brazil (+ 60.66% per year [95% CI: 27.21–91.85]) and in the clusters in the states of Amazonas, Roraima, and Rio de Janeiro (+1.01, +2.15, and + 2.90% per year, respectively). The cluster in the state of São Paulo was the only one classified as stationary. The descriptive data on the municipalities belonging to the clusters showed evidence of the association between TB incidence and conditions of social vulnerability. Conclusions The study revealed the critical situation of TB among migrants in the country. Based on the findings, health authorities might focus on actions in regions identified, stablishing an intensive monitoring and following up, ensuring that these cases concluded their treatment and avoiding that they could spread the disease to the other regions or scenarios. The population of migrants are very dynamic, therefore strategies for following up them across Brazil are really urgent to manage the tuberculosis among international migrants in an efficient and proper way.
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Affiliation(s)
- Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto School of Nursing, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Thaís Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto School of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | - Matheus Piumbini Rocha
- Epidemiology Laboratory, Health Sciences Center, Universidade Federal do Espírito Santo, Vitoria, Brazil
| | | | | | - Keila Cristina Mascarello
- Department of Health Sciences, Centro Universitário Norte do Espírito Santo, Universidade Federal do Espírito Santo, Vitoria, Brazil
| | | | - Ethel Leonor Noia Maciel
- Epidemiology Laboratory, Health Sciences Center, Universidade Federal do Espírito Santo, Vitoria, Brazil
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Kuehne A, van Boetzelaer E, Alfani P, Fotso A, Elhammali H, Khamala T, Thorson T, Angelova I, Benvenuti B, Pop-Stefanija B, Verdecchia M, Kremer R. Health of migrants, refugees and asylum seekers in detention in Tripoli, Libya, 2018-2019: Retrospective analysis of routine medical programme data. PLoS One 2021; 16:e0252460. [PMID: 34086778 PMCID: PMC8177456 DOI: 10.1371/journal.pone.0252460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/14/2021] [Indexed: 11/24/2022] Open
Abstract
Libya is a major transit and destination country for international migration. UN agencies estimates 571,464 migrants, refugees and asylum seekers in Libya in 2021; among these, 3,934 people are held in detention. We aimed to describe morbidities and water, hygiene, and sanitation (WHS) conditions in detention in Tripoli, Libya. We conducted a retrospective analysis of data collected between July 2018 and December 2019, as part of routine monitoring within an Médecins Sans Frontières (MSF) project providing healthcare and WHS support for migrants, refugees and asylum seekers in some of the official detention centres (DC) in Tripoli. MSF had access to 1,630 detainees in eight different DCs on average per month. Only one DC was accessible to MSF every single month. The size of wall openings permitting cell ventilation failed to meet minimum standards in all DCs. Minimum standards for floor space, availability of water, toilets and showers were frequently not met. The most frequent diseases were acute respiratory tract infections (26.9%; 6,775/25,135), musculoskeletal diseases (24.1%; 6,058/25,135), skin diseases (14.1%; 3,538/25,135) and heartburn and reflux (10.0%; 2,502/25,135). Additionally, MSF recorded 190 cases of violence-induced wounds and 55 cases of sexual and gender-based violence. During an exhaustive nutrition screening in one DC, linear regression showed a reduction in mid-upper arm circumference (MUAC) of 2.5mm per month in detention (95%-CI 1.3–3.7, p<0.001). Detention of men, women and children continues to take place in Tripoli. Living conditions failed to meet minimum requirements. Health problems diagnosed at MSF consultations reflect the living conditions and consist largely of diseases related to overcrowding, lack of water and ventilation, and poor diet. Furthermore, every month that people stay in detention increases their risk of malnutrition. The documented living conditions and health problems call for an end of detention and better protection of migrants, refugees and asylum seekers in Libya.
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Affiliation(s)
- Anna Kuehne
- Médecins Sans Frontières, Berlin, Germany
- Médecins Sans Frontières, London, United Kingdom
- * E-mail:
| | | | - Prince Alfani
- Médecins Sans Frontières, Berlin, Germany
- Médecins Sans Frontières, Tripoli, Libya
| | | | | | | | | | | | | | | | | | - Ronald Kremer
- Médecins Sans Frontières, Amsterdam, The Netherlands
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Abstract
Farmers and farm workers are critical to the secure supply of food, yet this population is potentially at high risk to acquire COVID-19. This study estimates the prevalence of COVID-19 among farmers and farmworkers in the United States by coupling county-level data on the number of farm workers relative to the general population with data on confirmed COVID-19 cases and deaths. In the 13 month period since the start of the pandemic (from March 1, 2020 to March 31, 2021), the estimated cumulative number of COVID-19 cases (deaths) was 329,031 (6,166) among agricultural producers, 170,137 (2,969) among hired agricultural workers, 202,902 (3,812) among unpaid agricultural workers, and 27,223 (459) among migrant agricultural workers. The cases amount to 9.55%, 9.31%, 9.39%, and 9.01% of all U.S. agricultural producers, hired workers, unpaid workers, and migrant workers, respectively. The COVID-19 incidence rate is significantly higher in counties with more agricultural workers; a 1% increase in the number of hired agricultural workers in a county is associated with a 0.04% increase in the number of COVID-19 cases per person and 0.07% increase in deaths per person. Although estimated new cases among farm workers exhibit similar trends to that of the general population, the correlation between the two is sometimes negative, highlighting the need to monitor this particular population that tends to live in more rural areas. Reduction in labor availability from COVID-19 is estimated to reduce U.S. agricultural output by about $309 million.
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Affiliation(s)
- Jayson L. Lusk
- Department of Agricultural Economics, Purdue University, West Lafayette, Indiana, United States of America
- * E-mail:
| | - Ranveer Chandra
- Microsoft Azure Global, Redmond, WA, United States of America
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Ngo TD, Canavati SE, Dung DV, Vo TH, Tran DT, Tran LK, Whedbee RJ, Milgotina EI, Kelly GC, Edgel KA, Martin NJ. Results from a malaria indicator survey highlight the importance of routine data capture in high-risk forest and farm transmission sites in Vietnam to tailor location-specific malaria elimination interventions. PLoS One 2021; 16:e0250045. [PMID: 33861798 PMCID: PMC8051764 DOI: 10.1371/journal.pone.0250045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
In-line with the World Health Organization's (WHO) Global Technical Strategy for Malaria (2016-2030), Vietnam is striving to eliminate malaria by 2030. Targeting appropriate interventions in high-risk populations such as forest and forest-fringe communities is a critical component of malaria elimination efforts in Vietnam. In 2016, a household-level malaria indicator survey was conducted in Phu Yen Province, Vietnam with the aim of assessing the knowledge, behaviors and associated risks of malaria infection among priority mobile and migrant populations (MMPs) working and sleeping in forests and on farms. A total of 4211 people were included in the survey, comprised of 1074 heads of households and 3137 associated household members. Of the 1074 head-of-household respondents, 472 slept in a forest, 92 slept on a farm, 132 slept in both forests and farms, and 378 slept at their villages within the last 12 months. Age, literacy, and occupation were significantly different among those who slept in a forest versus on a farm. Of 301 respondents who answered questions about malaria risk factors at sleeping sites, 35% were somewhat aware of malaria prevention practices, but only 4% could recall at least four malaria prevention messages. Among the same group of 301 respondents, only 29% used nets and only 11% used treated nets. Ownership and use of nets among forest-goers was significantly lower than those who slept on a farm or in their village. Huts without walls were significantly prominent forest sleeping site locations (POR = 10.3; 95% CI 4.67-22.7). All respondents who slept in a forest requested standby malaria drugs and one-third of them self-treated without blood testing. Results from this study highlight the importance of capturing relevant location-specific data among priority populations such as remote forest and farm going mobile and migrant populations in Vietnam. Data regarding behavioral practices, knowledge, preventative measures, and intervention coverage at remote-area transmission sites must be routinely captured to effectively monitor progress and refine targeted intervention strategies accordingly.
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Affiliation(s)
- Thang Duc Ngo
- Department of Epidemiology, National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Sara E. Canavati
- Vysnova Partners, Inc., Landover, Maryland, United States of America
- Burnet Institute, Melbourne, Victoria, Australia
| | - Dang Viet Dung
- Department of Epidemiology, National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Thuan Huu Vo
- Vysnova Partners, Inc., Landover, Maryland, United States of America
| | - Duong Thanh Tran
- Department of Epidemiology, National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Long Khanh Tran
- Vysnova Partners, Inc., Landover, Maryland, United States of America
| | - Rosalie J. Whedbee
- Global Scientific Solutions for Health, Baltimore, Maryland, United States of America
| | | | - Gerard C. Kelly
- Vysnova Partners, Inc., Landover, Maryland, United States of America
- * E-mail:
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Tu TM, Seet CYH, Koh JS, Tham CH, Chiew HJ, De Leon JA, Chua CYK, Hui ACF, Tan SSY, Vasoo SS, Tan BYQ, Umapathi NT, Tambyah PA, Yeo LLL. Acute Ischemic Stroke During the Convalescent Phase of Asymptomatic COVID-2019 Infection in Men. JAMA Netw Open 2021; 4:e217498. [PMID: 33885771 PMCID: PMC8063067 DOI: 10.1001/jamanetworkopen.2021.7498] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Acute ischemic stroke (AIS) is a known neurological complication in patients with respiratory symptoms of COVID-19 infection. However, AIS has not been described as a late sequelae in patients without respiratory symptoms of COVID-19. OBJECTIVE To assess AIS experienced by adults 50 years or younger in the convalescent phase of asymptomatic COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS This case series prospectively identified consecutive male patients who received care for AIS from public health hospitals in Singapore between May 21, 2020, and October 14, 2020. All of these patients had laboratory-confirmed asymptomatic COVID-19 infection based on a positive SARS-CoV-2 serological (antibodies) test result. These patients were individuals from South Asian countries (India and Bangladesh) who were working in Singapore and living in dormitories. The total number of COVID-19 cases (54 485) in the worker dormitory population was the population at risk. Patients with ongoing respiratory symptoms or positive SARS-CoV-2 serological test results confirmed through reverse transcriptase-polymerase chain reaction nasopharyngeal swabs were excluded. MAIN OUTCOMES AND MEASURES Clinical course, imaging, and laboratory findings were retrieved from the electronic medical records of each participating hospital. The incidence rate of AIS in the case series was compared with that of a historical age-, sex-, and ethnicity-matched national cohort. RESULTS A total of 18 male patients, with a median (range) age of 41 (35-50) years and South Asian ethnicity, were included. The median (range) time from a positive serological test result to AIS was 54.5 (0-130) days. The median (range) National Institutes of Health Stroke Scale score was 5 (1-25). Ten patients (56%) presented with a large vessel occlusion, of whom 6 patients underwent intravenous thrombolysis and/or endovascular therapy. Only 3 patients (17%) had a possible cardiac source of embolus. The estimated annual incidence rate of AIS was 82.6 cases per 100 000 people in this study compared with 38.2 cases per 100 000 people in the historical age-, sex-, and ethnicity-matched cohort (rate ratio, 2.16; 95% CI, 1.36-3.48; P < .001). CONCLUSIONS AND RELEVANCE This case series suggests that the risk for AIS is higher in adults 50 years or younger during the convalescent period of a COVID-19 infection without respiratory symptoms. Acute ischemic stroke could be part of the next wave of complications of COVID-19, and stroke units should be on alert and use serological testing, especially in younger patients or in the absence of traditional risk factors.
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Affiliation(s)
- Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | | | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | - Andrew Che-Fai Hui
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Shaun Shi Yan Tan
- Department of Laboratory Medicine, National University Health System, Singapore
| | - Shawn Sushilan Vasoo
- Department of Infectious Diseases, Tan Tock Seng Hospital and National Centre for Infectious Diseases, Singapore
| | | | | | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore
| | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
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Schaffner F, Bansal D, Al-Thani MHJ, Al-Romaihi H, Farag EABA. Preventing vector-borne diseases at major sport events: Addressing the challenges for FIFA 22 in Qatar. PLoS Negl Trop Dis 2021; 15:e0009135. [PMID: 33705399 PMCID: PMC7951900 DOI: 10.1371/journal.pntd.0009135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Dorkenoo MA, Tchankoni MK, Yehadji D, Yakpa K, Tchalim M, Sossou E, Bronzan R, Ekouevi DK. Monitoring migrant groups as a post-validation surveillance approach to contain the potential reemergence of lymphatic filariasis in Togo. Parasit Vectors 2021; 14:134. [PMID: 33653393 PMCID: PMC7923304 DOI: 10.1186/s13071-021-04644-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In March 2017, Togo was declared the first country in sub-Saharan Africa to eliminate lymphatic filariasis as a public health problem, but post-validation surveillance has been lacking. In some areas of the country, migrant groups from neighboring countries that are still endemic for LF pose a risk of reintroduction of LF to Togo. The objective of this study was to identify the risk posed by migrant groups by measuring their prevalence of LF infection and investigating any positive case using Togo's case investigation algorithm to prevent resurgence of LF and sustain Togo's elimination success. METHOD A cross-sectional study was conducted in 2018 in the northernmost region of the country. Three migrant populations were identified: (i) nomadic Peuhls, (ii) Togolese members of local communities who migrate annually to neighboring countries for seasonal labor, and (iii) refugees from Ghana who came to Togo because of a communal conflict in Ghana. A questionnaire was designed to collect data on demographics and history of LF and MDA; all participants were tested for circulating filariasis antigen (CFA) using the filariasis test strip (FTS). Any CFA-positive case was confirmed with nocturnal microfilaremia. RESULTS Refugees, seasonal economic migrants and nomadic Peuhls represented 42.1%, 31.4% and 26.5% of the study participants, respectively. The overall prevalence of CFA was 4.2% (58/1391) with the highest prevalence in the nomadic Peuhl group (11.9%), but only one of them (0.07%) was confirmed positive with nocturnal microfilaremia. Using the case investigation algorithm, no other positive case was identified in the positive case's surroundings. CONCLUSION This study demonstrates that nomadic Peuhls, with a CFA prevalence of 11.9%, pose a potential risk for reintroduction of LF into Togo while Ghanaian refugees and seasonal economic migrants do not appear to pose a significant risk. Periodic monitoring of migrants, especially the nomadic Peuhl population, is a potential post-validation surveillance approach that could be used to promptly detect any LF cluster that may arise.
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Affiliation(s)
- Monique Ameyo Dorkenoo
- Université de Lomé, Faculté des Sciences de la Santé, BP 1515 Lomé, Togo
- Programme National d’Elimination de la Filariose Lymphatique, Ministère de la Santé et de l’Hygiène Publique, BP 336 Lomé, Togo
- Division des Laboratoires, Ministère de la Santé et de l’Hygiène Publique, 374 avenue Georges Pompidou, BP 1161 Lomé, Togo
| | | | - Degninou Yehadji
- Division des Laboratoires, Ministère de la Santé et de l’Hygiène Publique, 374 avenue Georges Pompidou, BP 1161 Lomé, Togo
| | - Kossi Yakpa
- Laboratoire de Parasitologie, Programme National de Lutte contre le Paludisme, Ministère de la Santé et de l’Hygiène Publique, Rue Adamé, Quartier administratif BP 518, Lomé, Togo
| | - Mawèké Tchalim
- Programme National d’Elimination de la Filariose Lymphatique, Ministère de la Santé et de l’Hygiène Publique, BP 336 Lomé, Togo
| | - Efoe Sossou
- Division des Laboratoires, Ministère de la Santé et de l’Hygiène Publique, 374 avenue Georges Pompidou, BP 1161 Lomé, Togo
| | - Rachel Bronzan
- Health and Development International (HDI), Newburyport, MA USA
| | - Didier Koumavi Ekouevi
- Université de Lomé, Faculté des Sciences de la Santé, BP 1515 Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
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Khatiwada J, Muzembo BA, Wada K, Ikeda S. The effect of perceived social support on psychological distress and life satisfaction among Nepalese migrants in Japan. PLoS One 2021; 16:e0246271. [PMID: 33635865 PMCID: PMC7909674 DOI: 10.1371/journal.pone.0246271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 01/18/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The world is becoming individualized due to modernization. International migration is one of the factors that lead to family dissociation and a lack of social support. Social support is viewed as a crucial factor that contributes to psychological well-being and satisfaction with life among migrants. However, very little is known about the impacts of social support on psychological distress and satisfaction with life among migrants. Therefore, we conducted this study to assess the association of perceived social support with psychological distress and satisfaction with life among Nepalese migrants, and we evaluated the factors associated with receiving social support. METHODS This was a cross-sectional study conducted with a convenience sample of Nepalese migrants (N = 249) living in Tokyo. Self-administered online questionnaires were distributed using social networks and chain referral methods. The measures included the Multidimensional Scale of Perceived Social Support, the General Health Questionnaire, and Satisfaction with Life Scale. Descriptive analysis, Pearson's correlation analysis, and multiple linear regression analyses were performed using SPSS ver. 25. RESULTS The mean (SD) age of the respondents was 31.8 years old (7.3). The family, friends, and significant others subscales of the multidimensional scale of perceived social support were negatively correlated with psychological distress (p<0.01). The family subscale was positively correlated with satisfaction with life (p<0.05), and the friend and significant others subscales were positively correlated with satisfaction with life (p<0.01). Social support from the family was significantly and negatively associated with the type of visa (Beta = -0.160, p = 0.049), and marital status was negatively associated with support from significant others (Beta = -0.175, p = 0.024). CONCLUSION Social support from family, friends, and significant others was found to be influential in decreasing psychological distress and increasing satisfaction with life among Nepalese migrants in Tokyo. Strengthing social support system through the expansion of interpersonal network may help minimize the psychological distress.
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Affiliation(s)
- Januka Khatiwada
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Basilua Andre Muzembo
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Koji Wada
- Graduate School of Public Health, International University of Health and Welfare, Otawara, Japan
| | - Shunya Ikeda
- Graduate School of Public Health, International University of Health and Welfare, Otawara, Japan
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Argaw MD, Woldegiorgis AG, Workineh HA, Akelom BA, Abebe ME, Abate DT, Ashenafi EG. Access to malaria prevention and control interventions among seasonal migrant workers: A multi-region formative assessment in Ethiopia. PLoS One 2021; 16:e0246251. [PMID: 33621245 PMCID: PMC7901780 DOI: 10.1371/journal.pone.0246251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mobile or seasonal migrant workers are at increased risk for acquiring malaria infections and can be the primary source of malaria reintroduction into receptive areas. The aim of this formative assessment was to describe access to malaria prevention and control interventions among seasonal migrant or mobile workers in seven regional states of Ethiopia. METHODS A cross-sectional formative assessment was conducted using a qualitative and quantitative mixed-method design, between October 2015 and October 2016. Quantitative data were collected from organizations that employ seasonal migrant workers and were analyzed using Microsoft Excel and ArcGIS 10.8 (Geo-spatial data). Qualitative data were collected using in-depth interview from 23 key informants (7 seasonal migrant workers, and 16 experts and managers of development projects who had hired seasonal migrant workers), which were recorded, transcribed, translated, coded, and thematically analyzed. RESULTS There were 1,017,888 seasonal migrant workers employed in different developmental organizations including large-scale crop cultivating farms, sugar cane plantations, horticulture, road and house construction work, and gold mining and panning. Seasonal migrant workers' housing facilities were poorly structured and overcrowded (30 people living per 64 square meter room) limiting the use of indoor residual spraying (IRS), and forcing seasonal migrant workers not to use long lasting insecticidal treated nets (LLINs). Seasonal migrant workers are engaged in nighttime activities when employment includes watering farmlands, harvesting sesame, and transporting sugar cane from the field to factories. Despite such high-risk living conditions, access and utilization of preventive and curative services by the seasonal workers were limited. Informal migrant worker employment systems by development organizations and inadequate technical and financial support coupled with poor supply chain management limited the planning and delivery of malaria prevention and treatment strategies targeting seasonal migrant workers. CONCLUSIONS Seasonal migrant workers in seven regions of Ethiopia were at substantial risk of acquiring malaria. Existing malaria prevention, control and management interventions were inadequate. This will contribute to the resurgence of outbreaks of malaria in areas where transmission has been lowered. A coordinated action is needed among all stakeholders to identify the size of seasonal migrant workers and develop and implement a comprehensive strategy to address their healthcare needs.
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Affiliation(s)
- Mesele Damte Argaw
- USAID Private Health Sector Project, Abt Associates Inc., Addis Ababa, Ethiopia
| | | | | | | | - Mesfin Eshetu Abebe
- USAID Private Health Sector Project, Abt Associates Inc., Addis Ababa, Ethiopia
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Lim JT, Dickens BL, Ong J, Aik J, Lee VJ, Cook AR, Ng LC. Decreased dengue transmission in migrant worker populations in Singapore attributable to SARS-CoV-2 quarantine measures. J Travel Med 2021; 28:taaa228. [PMID: 33274384 PMCID: PMC7798931 DOI: 10.1093/jtm/taaa228] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND We examined the impact of SARS-CoV-2 social distancing and quarantine policies on dengue transmission in the general and migrant worker populations in Singapore. METHODS We utilized all nationally reported dengue cases in the general and migrant worker populations from 1 January 2013 to 31 May 2020. A difference-in-difference identification strategy was used to determine the effects of social distancing and quarantine policies on reported dengue case counts over time, whilst controlling for weather patterns, seasonality, age and population size. RESULTS A reduction of 4.8 dengue cases per age band among migrant workers was attributable to quarantine policies, corresponding to a total reduction of around 432 reported dengue cases over 10 weeks. In the general working population, an increase of 14.5 dengue cases per age band was observed, which corresponds to a total increase of around 1450 reported dengue cases in the same time period. There is an expected relative risk reduction in dengue transmission for the migrant worker population at 0.635 due to quarantine policy and a relative risk increase for the general working population due to social distancing policies at 0.685. CONCLUSIONS Migrant workers experienced a reduced risk of dengue when they were confined to their dormitories as part of the COVID-19 social distancing measures. Our study highlights the vulnerability of migrant workers under normal working conditions.
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Affiliation(s)
- Jue Tao Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Borame Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Janet Ong
- Environmental Health Institute, National Environmental Agency, Singapore
| | - Joel Aik
- Environmental Health Institute, National Environmental Agency, Singapore
| | - Vernon J Lee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Ministry of Health, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Lee Ching Ng
- Environmental Health Institute, National Environmental Agency, Singapore
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Bwambale MF, Bukuluki P, Moyer CA, van den Borne BHW. Demographic and behavioural drivers of intra-urban mobility of migrant street children and youth in Kampala, Uganda. PLoS One 2021; 16:e0247156. [PMID: 33600461 PMCID: PMC7891785 DOI: 10.1371/journal.pone.0247156] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 02/02/2021] [Indexed: 01/05/2023] Open
Abstract
While research on the nexus of migration and wellbeing of individuals has gained recognition in recent years, far less attention has been devoted to intra-urban mobility especially among the urban poor young populations. We assess the drivers of intra-urban mobility using a random sample of 412 migrant street children and youth in Kampala city, Uganda. This paper draws from a larger cross-sectional survey of circular migration and sexual and reproductive health choices among street children in Kampala, Uganda. We define 'migrants' as street children and youth with a rural-urban migration experience and 'intra-urban mobility' as the number of places stayed in or moved since migrating to the city, measured on a continuous scale. More than half (54.37%) of the migrant street children and youth had lived in two or more places since migrating to the city. Multivariate negative binomial regression analysis reveals migrant street children and youth's intra-urban mobility to be associated with gender (aIRR = 0.71, 95%CI 0.53-0.96), sex work (aIRR = 1.38, 95%CI 1.01-1.88), a daily income of one USD or more (aIRR = 1.57, 95%CI 1.16-2.13) and duration of stay in the city (aIRR = 1.54, 95%CI 1.17-2.01). Other drivers of intra-urban mobility included availability of causal work, personal safety and affordability of rental costs. Our findings suggest the need for urban housing and health policies to take into account street children and youth's intra-urban mobility and its drivers. Future research on all drivers of street children and youth's intra-urban mobility and its linkage with their health outcomes is recommended.
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Affiliation(s)
- Mulekya Francis Bwambale
- Department of Health Education & Promotion, University of Maastricht Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, College of Humanities and Social Sciences, Kampala, Uganda
| | - Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, College of Humanities and Social Sciences, Kampala, Uganda
| | - Cheryl A. Moyer
- Departments of Learning Health Sciences and Obstetrics and Gynaecology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Bart H. W. van den Borne
- Department of Health Education & Promotion, University of Maastricht Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands
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Dugassa S, Murphy M, Chibsa S, Tadesse Y, Yohannes G, Lorenz LM, Solomon H, Yewhalaw D, Irish SR. Malaria in migrant agricultural workers in western Ethiopia: entomological assessment of malaria transmission risk. Malar J 2021; 20:95. [PMID: 33593385 PMCID: PMC7885338 DOI: 10.1186/s12936-021-03633-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ethiopia has made great strides in malaria control over the last two decades. However, this progress has not been uniform and one concern has been reported high rates of malaria transmission in large agricultural development areas in western Ethiopia. Improved vector control is one way this transmission might be addressed, but little is known about malaria vectors in this part of the country. METHODS To better understand the vector species involved in malaria transmission and their behaviour, human landing collections were conducted in Dangur woreda, Benishangul-Gumuz, between July and December 2017. This period encompasses the months with the highest rain and the peak mosquito population. Mosquitoes were identified to species and tested for the presence of Plasmodium sporozoites. RESULTS The predominant species of the Anopheles collected was Anopheles arabiensis (1,733; i.e. 61.3 % of the entire Anopheles), which was also the only species identified with sporozoites (Plasmodium falciparum and Plasmodium vivax). Anopheles arabiensis was collected as early in the evening as 18:00 h-19:00 h, and host-seeking continued until 5:00 h-6:00 h. Nearly equal numbers were collected indoors and outdoors. The calculated entomological inoculation rate for An. arabiensis for the study period was 1.41 infectious bites per month. More An. arabiensis were collected inside and outside worker's shelters than in fields where workers were working at night. CONCLUSIONS Anopheles arabiensis is likely to be the primary vector of malaria in the agricultural development areas studied. High rates of human biting took place inside and outdoor near workers' residential housing. Improved and targeted vector control in this area might considerably reduce malaria transmission.
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Affiliation(s)
- Sisay Dugassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Mathew Murphy
- Centers for Disease Control and Prevention, 1600 Clifton Road, 30329-4027, Atlanta, GA, USA
- The US President's Malaria Initiative, Bureau for Global Health, United States Agency for International Development, 1300 Pennsylvania Ave NW, 20523, Washington, DC, USA
| | - Sheleme Chibsa
- The US President's Malaria Initiative, Bureau for Global Health, United States Agency for International Development, 1300 Pennsylvania Ave NW, 20523, Washington, DC, USA
- U.S. Agency for International Development (USAID), Entoto Street, Addis Ababa, Ethiopia
| | - Yehualashet Tadesse
- The President's Malaria Initiative Private Health Sector Project, Abt Associates Inc, Haile Gebreselassie road, Rebecca Building, 5th Floor, Addis Ababa, Ethiopia
| | - Gedeon Yohannes
- The President's Malaria Initiative Africa Indoor Residual Spraying Project, Abt Associates, Gerji Road, Sami Building, 1st Floor, Addis Ababa, Ethiopia
| | - Lena M Lorenz
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
- College of Medicine & Veterinary Medicine, University of Edinburgh, University of Edinburgh, UK
| | - Hiwot Solomon
- Disease prevention and control directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Delenasaw Yewhalaw
- Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia
- Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Seth R Irish
- Centers for Disease Control and Prevention, 1600 Clifton Road, 30329-4027, Atlanta, GA, USA
- The US President's Malaria Initiative, Bureau for Global Health, United States Agency for International Development, 1300 Pennsylvania Ave NW, 20523, Washington, DC, USA
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Abstract
This study examines the prevalence and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among migrant workers in Singapore.
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Affiliation(s)
- Iain Beehuat Tan
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
- Ministry of Health, Singapore
| | - Clive Tan
- Headquarters Medical Corps, Singapore Armed Forces Headquarters, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Li Yang Hsu
- Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yock Young Dan
- Ministry of Health, Singapore
- Department of Medicine, National University Singapore, Singapore
| | - Andrew Aw
- Dental Services, Tan Tock Seng Hospital, Singapore
| | - Alex R. Cook
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Vernon J. Lee
- Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Abstract
This study uses US Immigration and Customs Enforcement (ICE) Health Service Corps data to describe incident cases and outbreaks of influenza, varicella, and mumps in 22 US ICE detention centers between 2017 and March 2020.
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Affiliation(s)
- Nathan C. Lo
- Department of Medicine, University of California, San Francisco
| | - Sindiso Nyathi
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | | | | | - Margot Kushel
- Center for Vulnerable Populations, University of California, San Francisco
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics and Medicine, University of California, San Francisco
| | - Joseph A. Lewnard
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley
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Casanova FO, Hamblett A, Brinkley-Rubinstein L, Nowotny KM. Epidemiology of Coronavirus Disease 2019 in US Immigration and Customs Enforcement Detention Facilities. JAMA Netw Open 2021; 4:e2034409. [PMID: 33464315 PMCID: PMC7816105 DOI: 10.1001/jamanetworkopen.2020.34409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Felicia O. Casanova
- Institute for Advanced Study of the Americas, Department of Sociology, University of Miami, Coral Gables, Florida
| | - Alice Hamblett
- Brown University School of Public Health, Providence, Rhode Island
| | - Lauren Brinkley-Rubinstein
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill
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Al-Awadhi M, Iqbal J, Ahmad S. An Update on the Epidemiological Features of Imported Schistosomiasis and Cystic Echinococcosis in Kuwait, 2010-2018. Med Princ Pract 2021; 30:138-145. [PMID: 33524982 PMCID: PMC8114046 DOI: 10.1159/000514873] [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: 10/26/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Kuwait is considered a non-endemic country for most parasitic infections. However, ∼70% of 4.7 million residents in Kuwait are expatriates from Asian and African countries, which are endemic for parasitic infections. Results of microbiological investigations for schistosomiasis and cystic echinococcosis (CE) performed in a reference national laboratory were retrospectively collected and analyzed to provide an insight on the epidemiology of these 2 neglected tropical diseases in Kuwait. SUBJECTS AND METHODS Schistosoma infection in fecal and urine specimens from suspected patients was detected by microscopy. Schistosoma and CE infections were also detected by indirect hemagglutination assays (IHAs) using blood specimens. Patients' epidemiological data were extracted from the laboratory records. RESULTS The overall prevalence rates of schistosomiasis and CE were 19.0 and 5.8%, respectively. Almost all schistosomiasis cases were seen among Egyptians, especially among males, and a significantly higher prevalence (p < 0.05) was seen for CE cases among the Syrian residents. A decreasing annual trend was observed for both the parasitic infections over time in Kuwait. CONCLUSIONS This study confirmed that schistosomiasis is not autochthonous in Kuwait, as all cases were detected among expatriates from Schistosoma-endemic countries. Our data also showed that CE remains endemic among humans and livestock in Kuwait as is also seen in other Middle Eastern countries.
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Affiliation(s)
- Mohammad Al-Awadhi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Jamshaid Iqbal
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
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Tang D, Wang J. Basic Public Health Service Utilization by Internal Older Adult Migrants in China. Int J Environ Res Public Health 2021; 18:ijerph18010270. [PMID: 33401371 PMCID: PMC7795646 DOI: 10.3390/ijerph18010270] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022]
Abstract
Since 2009, the Chinese government has launched a basic public health services (BPHS) equalization program to provide the same BPHS to all the citizens. However, utilization of BPHS among older migrants is still low. The purpose of this paper was to explore the determinant individual and contextual factors of older migrants’ utilization of BPHS, and to provide suggestion for the government to improve BPHS utilization. Based on Andersen’s model of health services use, data from the China’s Regional Economic Statistics Yearbook 2014 and National Health and Family Planning Dynamic Monitoring Survey on Migrant Population 2015 were analyzed using a hierarchical random intercept model for binary outcomes. Results showed that the percentage of migrant older adults receiving free physical examinations, which is an important item of BPHS, was 36.2%. Predisposing (education, hukou, living duration in the host city, and scope of migration), enabling (health insurance and social networks), and need (self-rated health and chronic conditions) factors of individuals’ characteristics had significant impact on the use of BPHS. The proportions of both migrant children enrolled in public schools and people with established health records had a positive impact on an individual’s chance of receiving free physical examinations. These findings suggest that economic development and improvement at the level of the city’s health resources cannot effectively improve access to BPHS by older adult migrants. Instead, the driving force appears to be supportive policies for the migrant population.
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Affiliation(s)
- Dan Tang
- Center for Population and Development Studies, Renmin University of China, Beijing 100872, China;
- Institute of Gerontology, Renmin University of China, Beijing 100872, China
| | - Jiwen Wang
- Center for Population and Development Studies, Renmin University of China, Beijing 100872, China;
- Population Studies and Training Center, Brown University, Providence, RI 02912, USA
- Correspondence:
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Cox A, Iedema R, Li S, Sabbe M, Salaets H, Dauby N. Adding barriers to barriers during the COVID-19 pandemic: a call for interdisciplinary research on communication with migrant patients in the emergency department. Eur J Emerg Med 2021; 28:5-6. [PMID: 33369953 DOI: 10.1097/mej.0000000000000777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Antoon Cox
- Research Group Interpreting Studies, Faculty of Arts, KU Leuven, Antwerpen
- Brussels Institute of Applied Linguistics and Linguistics and Literary Studies, Faculty of Arts and Philosophy, Vrije Universiteit Brussel
- Centre for Medical Education, Faculty of Life Sciences and Medicine, King's College London
| | - Rick Iedema
- Centre for Team-Based Practice & Learning in Health Care, Faculty of Life Sciences and Medicine, King's College London, London
| | - Shuangyu Li
- Centre for Medical Education, Faculty of Life Sciences and Medicine, King's College London
| | - Marc Sabbe
- Department of Public Health and Primary Care - Unit of Emergency Medicine, Emergency Department, UZ Leuven
| | - Heidi Salaets
- Research Group Interpreting Studies, Faculty of Arts, KU Leuven, Antwerpen
| | - Nicolas Dauby
- Department of Infectious Diseases, CHU Saint Pierre, Université Libre de Bruxelles (ULB)
- School of public health, ULB, Brussels, Belgium
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50
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Lopez WD, Kline N, LeBrón AMW, Novak NL, De Trinidad Young ME, Gonsalves G, Mishori R, Safi BA, Kysel IM. Preventing the Spread of COVID-19 in Immigration Detention Centers Requires the Release of Detainees. Am J Public Health 2021; 111:110-115. [PMID: 33211577 PMCID: PMC7750591 DOI: 10.2105/ajph.2020.305968] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 01/03/2023]
Abstract
Immigration detention centers are densely populated facilities in which restrictive conditions limit detainees' abilities to engage in social distancing or hygiene practices designed to prevent the spread of COVID-19. With tens of thousands of adults and children in more than 200 immigration detention centers across the United States, immigration detention centers are likely to experience COVID-19 outbreaks and add substantially to the population of those infected.Despite compelling evidence indicating a heightened risk of infection among detainees, state and federal governments have done little to protect the health of detained im-migrants. An evidence-based public health framework must guide the COVID-19 response in immigration detention centers.We draw on the hierarchy of controls framework to demonstrate how immigration detention centers are failing to implement even the least effective control strategies. Drawing on this framework and recent legal and medical advocacy efforts, we argue that safely releasing detainees from immigration detention centers into their communities is the most effective way to prevent COVID-19 outbreaks in immigration detention settings. Failure to do so will result in infection and death among those detained and deepen existing health and social inequities.
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Affiliation(s)
- William D Lopez
- William D. Lopez is with the University of Michigan School of Public Health, Ann Arbor. Nolan Kline is with the Department of Anthropology, Rollins College, Winter Park, FL. Alana M. W. LeBrón is with the Department of Health, Society, and Behavior and Department of Chicano/Latino Studies, University of California, Irvine. Nicole L. Novak is with the Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City. Maria-Elena De Trinidad Young is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Gregg Gonsalves is with Public Health Modeling Unit, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT. Ranit Mishori is with Physicians for Human Rights, Washington, DC. Basil A. Safi is with the Office of Engagement Initiatives, Cornell University, Ithaca, NY. Ian M. Kysel is with the Cornell Law School, Ithaca, NY
| | - Nolan Kline
- William D. Lopez is with the University of Michigan School of Public Health, Ann Arbor. Nolan Kline is with the Department of Anthropology, Rollins College, Winter Park, FL. Alana M. W. LeBrón is with the Department of Health, Society, and Behavior and Department of Chicano/Latino Studies, University of California, Irvine. Nicole L. Novak is with the Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City. Maria-Elena De Trinidad Young is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Gregg Gonsalves is with Public Health Modeling Unit, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT. Ranit Mishori is with Physicians for Human Rights, Washington, DC. Basil A. Safi is with the Office of Engagement Initiatives, Cornell University, Ithaca, NY. Ian M. Kysel is with the Cornell Law School, Ithaca, NY
| | - Alana M W LeBrón
- William D. Lopez is with the University of Michigan School of Public Health, Ann Arbor. Nolan Kline is with the Department of Anthropology, Rollins College, Winter Park, FL. Alana M. W. LeBrón is with the Department of Health, Society, and Behavior and Department of Chicano/Latino Studies, University of California, Irvine. Nicole L. Novak is with the Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City. Maria-Elena De Trinidad Young is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Gregg Gonsalves is with Public Health Modeling Unit, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT. Ranit Mishori is with Physicians for Human Rights, Washington, DC. Basil A. Safi is with the Office of Engagement Initiatives, Cornell University, Ithaca, NY. Ian M. Kysel is with the Cornell Law School, Ithaca, NY
| | - Nicole L Novak
- William D. Lopez is with the University of Michigan School of Public Health, Ann Arbor. Nolan Kline is with the Department of Anthropology, Rollins College, Winter Park, FL. Alana M. W. LeBrón is with the Department of Health, Society, and Behavior and Department of Chicano/Latino Studies, University of California, Irvine. Nicole L. Novak is with the Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City. Maria-Elena De Trinidad Young is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Gregg Gonsalves is with Public Health Modeling Unit, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT. Ranit Mishori is with Physicians for Human Rights, Washington, DC. Basil A. Safi is with the Office of Engagement Initiatives, Cornell University, Ithaca, NY. Ian M. Kysel is with the Cornell Law School, Ithaca, NY
| | - Maria-Elena De Trinidad Young
- William D. Lopez is with the University of Michigan School of Public Health, Ann Arbor. Nolan Kline is with the Department of Anthropology, Rollins College, Winter Park, FL. Alana M. W. LeBrón is with the Department of Health, Society, and Behavior and Department of Chicano/Latino Studies, University of California, Irvine. Nicole L. Novak is with the Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City. Maria-Elena De Trinidad Young is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Gregg Gonsalves is with Public Health Modeling Unit, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT. Ranit Mishori is with Physicians for Human Rights, Washington, DC. Basil A. Safi is with the Office of Engagement Initiatives, Cornell University, Ithaca, NY. Ian M. Kysel is with the Cornell Law School, Ithaca, NY
| | - Gregg Gonsalves
- William D. Lopez is with the University of Michigan School of Public Health, Ann Arbor. Nolan Kline is with the Department of Anthropology, Rollins College, Winter Park, FL. Alana M. W. LeBrón is with the Department of Health, Society, and Behavior and Department of Chicano/Latino Studies, University of California, Irvine. Nicole L. Novak is with the Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City. Maria-Elena De Trinidad Young is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Gregg Gonsalves is with Public Health Modeling Unit, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT. Ranit Mishori is with Physicians for Human Rights, Washington, DC. Basil A. Safi is with the Office of Engagement Initiatives, Cornell University, Ithaca, NY. Ian M. Kysel is with the Cornell Law School, Ithaca, NY
| | - Ranit Mishori
- William D. Lopez is with the University of Michigan School of Public Health, Ann Arbor. Nolan Kline is with the Department of Anthropology, Rollins College, Winter Park, FL. Alana M. W. LeBrón is with the Department of Health, Society, and Behavior and Department of Chicano/Latino Studies, University of California, Irvine. Nicole L. Novak is with the Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City. Maria-Elena De Trinidad Young is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Gregg Gonsalves is with Public Health Modeling Unit, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT. Ranit Mishori is with Physicians for Human Rights, Washington, DC. Basil A. Safi is with the Office of Engagement Initiatives, Cornell University, Ithaca, NY. Ian M. Kysel is with the Cornell Law School, Ithaca, NY
| | - Basil A Safi
- William D. Lopez is with the University of Michigan School of Public Health, Ann Arbor. Nolan Kline is with the Department of Anthropology, Rollins College, Winter Park, FL. Alana M. W. LeBrón is with the Department of Health, Society, and Behavior and Department of Chicano/Latino Studies, University of California, Irvine. Nicole L. Novak is with the Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City. Maria-Elena De Trinidad Young is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Gregg Gonsalves is with Public Health Modeling Unit, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT. Ranit Mishori is with Physicians for Human Rights, Washington, DC. Basil A. Safi is with the Office of Engagement Initiatives, Cornell University, Ithaca, NY. Ian M. Kysel is with the Cornell Law School, Ithaca, NY
| | - Ian M Kysel
- William D. Lopez is with the University of Michigan School of Public Health, Ann Arbor. Nolan Kline is with the Department of Anthropology, Rollins College, Winter Park, FL. Alana M. W. LeBrón is with the Department of Health, Society, and Behavior and Department of Chicano/Latino Studies, University of California, Irvine. Nicole L. Novak is with the Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City. Maria-Elena De Trinidad Young is with the Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced. Gregg Gonsalves is with Public Health Modeling Unit, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT. Ranit Mishori is with Physicians for Human Rights, Washington, DC. Basil A. Safi is with the Office of Engagement Initiatives, Cornell University, Ithaca, NY. Ian M. Kysel is with the Cornell Law School, Ithaca, NY
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