Non-communicable diseases and use of medication among Syrian refugees: a prospective cohort study

Abstract

Abstract Background Conflict-driven disruption in continuity of care for non-communicable diseases (NCDs) is likely to have adverse public health impact. Yet, data on the prevalence and treatment coverage of NCDs among refugees is scarce. In this study we aim to assess the changes in prevalence of NCDs and use of relevant medication among Syrian refugees from a near-conflict phase in Lebanon to a resettlement phase in Norway. Methods This is a prospective cohort study. Survey data were collected during 2017-2018 among adult Syrian refugees in Lebanon selected for quota resettlement and at follow-up approximately one year after resettlement in Norway. Our primary outcomes were changes in NCDs as defined by the WHO and use of relevant medication. We calculated prevalence proportions with confidence intervals and assessed changes in prevalence over time using generalized estimating equations. Results Altogether 353 Syrians participated. The median age was 34 years and 51 percent were women. The overall prevalence of NCDs was 12 (9-16) percent at baseline and 9 (6-12) percent at follow-up. The odds ratio for reporting any NCD at follow-up compared to baseline was 0.68 (0.46, 1.00). Among those reporting NCDs, the prevalence of using either antithrombotic or cholesterol lowering medication, antihypertensives, antidiabetics, or drugs for asthma or chronic obstructive pulmonary disease was 55 (39-70) percent at baseline and 63 (44-80) percent at follow-up. The odds ratio for using relevant medication at follow-up compared to baseline was 1.01 (0.63, 2.05). Conclusions In our study around one tenth of the refugees reported at least one NCD. Nearly half of those reporting NCDs in a conflict-near setting did not seem to receive relevant medication, while the same was true for more than one third of respondents after resettlement. We call for innovative public health approaches and interventions to protect continuity of care for NCDs in settings of conflict-driven exodus. Key messages A high share of Syrian refugees reporting NCDs do not seem to receive relevant medication. The management of NCDs among refugees needs attention in order to avoid negative health effects.