Abstract
BackgroundHealth monitoring in Germany falls short on generating timely, reliable and representative data among migrants, especially transient and marginalized groups such as asylum seekers and refugees (ASR). We aim to advance current health monitoring approaches and obtain reliable estimates on health status and access to essential healthcare services among ASR in Germany’s third largest federal state, Baden-Württemberg.MethodsWe conducted a state-wide, cross-sectional, population-based health monitoring survey in nine languages among ASR and their children in collective accommodation centres in 44 districts. Questionnaire items capturing health status, access to care, and sociodemographic variables were taken from established surveys and translated using a team approach. Random sampling on the level of 1938 accommodation centres with 70,634 ASR was employed to draw a balanced sample of 65 centres with a net sample of 1% of the state’s ASR population. Multilingual field teams recruited eligible participants using a “door-to-door” approach. Parents completed an additional questionnaire on behalf of their children.ResultsThe final sample comprised 58 centres with 1843 ASR. Of the total sample expected eligible (N = 987), 41.7% (n = 412) participated in the survey. Overall, 157 households had children and received a children’s questionnaire; 61% (n = 95) of these were returned. Age, sex, and nationality of the included sample were comparable to the total population of asylum applicants in Germany. Adults reported longstanding limitations (16%), bad/very bad general health (19%), pain (25%), chronic illness (40%), depression (46%), and anxiety (45%). 52% utilised primary and 37% specialist care services in the previous 12 months, while reporting unmet needs for primary (31%) and specialist care (32%). Younger and male participants had above-average health status and below-average utilisation compared to older and female ASR.ConclusionsOur health monitoring survey yielded reliable estimates on health status and health care access among ASR, revealing relevant morbidities and patterns of care. Applying rigorous epidemiological methods in linguistically diverse, transient and marginalized populations is challenging, but feasible. Integration of this approach into state- and nation-wide health monitoring strategies is needed in order to sustain this approach as a health planning tool.
Highlights
Health monitoring in Germany falls short on generating timely, reliable and representative data among migrants, especially transient and marginalized groups such as asylum seekers and refugees (ASR)
Health care quality was examined by assessing the prevalence of ambulatory-care sensitive (ACSC), and as such avoidable hospitalisations [27], health system responsiveness (World Health Survey, WHS) [28], as well as by questions on medication overuse taken from the Structured Clinical Interview for DSM-5 (SCID; substance abuse) [29]
Response rates and patterns A total of 65 accommodation centres were randomly selected according to the balancing algorithm (Fig. 1), including 2346 individuals at the time the sample was drawn
Summary
Health monitoring in Germany falls short on generating timely, reliable and representative data among migrants, especially transient and marginalized groups such as asylum seekers and refugees (ASR). Due to the increased intensity, diversity, and duration of forced migration from conflict areas in the Middle East and Africa, governments of high-income countries in Europe and beyond are faced with the challenge of responding to the humanitarian needs of this population. One of these challenges is providing good access to needs-based, high-quality health care services to those whose residence status is not yet assured. Managing chronic illnesses is becoming an increasing concern for this highly mobile population [6, 8]
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