East African Refugees Research Articles

Transcultural Psychiatry in Medical Ethics: Assessing Decision-Making Capacity within the Lens of an East African Refugee.

AbstractA 29-year-old female East African refugee with no formal psychiatric history and a medical history significant for HIV was admitted for failure to thrive and concern for bizarre behavior in the context of abandonment by her husband and separation from her child. After psychiatric evaluation, it was determined that she did not have the capacity to care for herself independently; adult protective services then pursued and was awarded guardianship. While admitted, the patient repeatedly refused medical treatment, had a feeding tube placed for forced nutrition and medications (though she did at one point remove this tube herself), and received two electroconvulsive therapy (ECT) treatments. Soon thereafter, the patient's court-appointed guardian met with the primary medical, psychiatric, and ethics teams to discuss goals of care in the setting of complex social and cultural needs. It was collectively determined that the patient's choices to refuse care (including nutrition, lab work, medications, and ECT) and some repeated behaviors (e.g., denial of divorce, denial of HIV, denial of need for care) could be considered culturally appropriate in the context of the acute stressors leading up to hospitalizations. All teams concluded, therefore, that the patient had the capacity to refuse these interventions and that further forced intervention would pose a greater chance of exacerbating her already-significant trauma history than improving her outcomes. Ultimately, the patient was able to be discharged into the care of her guardian, who would assist her in receiving support from members of her community who share her language and culture.

NEREA AMORÓS ELORDUY - Architecture as a Way of Seeing and Learning. The built environment as an added educator in East African refugee camps

NEREA AMORÓS ELORDUY - Architecture as a Way of Seeing and Learning. The built environment as an added educator in East African refugee camps

The Effect of Tension and Trauma Releasing Exercises (TRE) on Trauma Symptoms in East African Refugees

The Effect of Tension and Trauma Releasing Exercises (TRE) on Trauma Symptoms in East African Refugees

(075) Transcultural Psychiatry in Medical Ethics: A Case of Assessing Decision Making Capacity (DMC) Within the Lens of an East African Refugee

(075) Transcultural Psychiatry in Medical Ethics: A Case of Assessing Decision Making Capacity (DMC) Within the Lens of an East African Refugee

CORR Insights®: What Proportion of East African Refugees Report Musculoskeletal Problems? A Cross-sectional Survey.

CORR Insights®: What Proportion of East African Refugees Report Musculoskeletal Problems? A Cross-sectional Survey.

What Proportion of East African Refugees Report Musculoskeletal Problems? A Cross-sectional Survey.

Musculoskeletal conditions are the leading cause of disability worldwide and disproportionally affect individuals in low-income and middle-income countries. There is a dearth of evidence on musculoskeletal problems among refugees, 74% of whom reside in low-income and middle-income countries. (1) What proportion of refugees in Nyarugusu Camp, Kigoma, western Tanzania, are affected by musculoskeletal problems and what are the characteristics of those individuals? (2) What are the characteristics of these musculoskeletal problems, including their causes, location, and duration? (3) What forms of healthcare do those with musculoskeletal problems seek, including those for both musculoskeletal and nonmusculoskeletal problems? We conducted a cross-sectional study among refugees in Nyarugusu Camp, using the Surgeons OverSeas Assessment of Surgical Need tool. The Surgeons OverSeas Assessment of Surgical Need tool is a validated population-based survey tool developed for use in limited-resource settings that is intended to determine the prevalence of surgical disease in a community. It uses a cluster random sampling methodology with house-to-house data collection in the form of a verbal head-to-toe examination that is performed by a trained community healthcare worker. A total of 99% responded, and 3574 records were analyzed. The mean age of respondents was 23 ± 18 years, with under 18 as the most-represented age group (44% [1563]). A total of 57% (2026) of respondents were women, 79% (2802 of 3536) were generally healthy, and 92% (3297 of 3570) had visited a camp medical facility. Only records endorsing musculoskeletal problems (extremity or back) were included in this analysis. Using all refugees surveyed as our denominator and refugees who endorsed a musculoskeletal problem (extremity or back) as the numerator, we calculated the proportion of refugees who endorsed a musculoskeletal problem. We then analyzed the characteristics of those endorsing musculoskeletal problems, including their healthcare-seeking behavior, and the characteristics of the musculoskeletal problems themselves. Among 3574 refugees interviewed, 22% (769) reported musculoskeletal problems, with 17% (609) reporting extremity problems and 7% (266) reporting back problems. Among all people surveyed, 8% (290) reported current extremity problems while 5% (188) reported current back problems. Among those reporting musculoskeletal problems, respondents younger than 18 years were the most-represented age group for extremity problems (28% [169 of 609]) whereas respondents between 30 and 44 years of age were the most-represented age group for back problems (29% [76 of 266]). Wounds from an injury or trauma (24% [133 of 557]) and acquired disability (24% [133 of 557]) were the most-common causes of extremity problems, whereas acquired disability (53% [97 of 184]) followed by a wound not from injury or trauma (25% [45 of 184]) were the most common causes of back problems. Fifty percent (303) of those with extremity problems characterized it as disabling, whereas 76% (203) of those with back problems did. Over one of five refugees endorsed musculoskeletal problems, which are most often caused by acquired disease and injury. These musculoskeletal problems are often characterized as disabling, yet only slightly more than half have sought treatment for problems. This warrants further research on care-seeking behavior in this setting, and emphasizes that investing in the spectrum of musculoskeletal health systems, including medical management and rehabilitation services, is critical to decreasing disability caused by musculoskeletal problems. Level IV, prognostic study.

Prevalence of suicidality and associated factors of suicide risk in a representative community sample of families in three East African refugee camps

PurposeTo assess the prevalence of suicidality and associated factors of suicide risk in a sample of Burundian refugee families living in three refugee camps in Tanzania.MethodsChildren (n = 230) and their parents (n = 460) were randomly selected and interviewed about suicidality (suicidal ideation, plans, and attempts) and a range of sociodemographic, psychological, and environmental factors. Multinomial logistic regression analyses were conducted to examine factors associated with children and parents’ lower and moderate or high current suicide risk.ResultsPast-month prevalence of suicidal ideation, plans, and attempts were 11.3%, 0.9% and 0.9%, respectively, among children; 37.4%, 7.4% and 5.2%, respectively, among mothers; and 29.6%, 4.8% and 1.7%, respectively, among fathers. Older age in years (aORlower = 2.20, 95% CI 1.38–3.51; aORmoderate/high = 3.03, 95% CI 1.15–7.99) and higher levels of posttraumatic stress disorder symptoms (aORlower = 1.64, 95% CI 1.05–2.57; aORmoderate/high = 2.30, 95% CI: 1.02–5.16), internalizing (aORmoderate/high = 2.88, 95% CI 1.33–6.26) and externalizing problems (aORlower = 1.56, 95% CI: 1.06–2.31; aORmoderate/high = 3.03, 95% CI 1.42–6.49) were significantly positively associated with children’s current suicide risk. For mothers, higher perceived instrumental social support (aORmoderate/high = 0.05, 95% CI < 0.01–0.58) was significantly negatively related to suicide risk, whereas exposure to community violence (aORlower = 1.97, 95% CI 1.30–2.99; aORmoderate/high = 1.59, 95% CI 1.00–2.52), living in larger households (aORlower = 1.74, 95% CI 1.17–2.57), and higher psychological distress (aORmoderate/high = 1.67, 95% CI 1.05–2.67) were significantly positively associated with suicide risk. For fathers, higher perceived instrumental social support (aORmoderate/high = 0.04, 95% CI < 0.01–0.44) and having more years of formal education (aORmoderate/high = 0.58, 95% CI 0.34–0.98) were significantly negatively and exposure to war-related trauma (aORmoderate/high = 1.81, 95% CI 1.03–3.19) was significantly positively associated with suicide risk.ConclusionPrevention programs should target psychopathology, community violence and social support to mitigate children and parents’ current suicide risk.

Prevalence of pediatric surgical problems among east African refugees: estimates from a cross-sectional survey using random cluster sampling

ImportanceSurgery is a foundational aspect to high functioning health care systems. In the wake of the Lancet Commission on Global Surgery, previous research has focused on defining the burden of surgical conditions among a pediatric population, however these studies often fail to include forced migrant or refugees. The goal of this study was to estimate the prevalence of pediatric surgical conditions among refugees in east Africa.MethodsWe used the previously validated Surgeons OverSeas Assessment of Surgical Need (SOSAS) that utilizes cross-sectional design with random cluster sampling to assess prevalence of surgical disease among participants aged 0 to 18 years in Nyarugusu refugee camp, Tanzania. We used descriptive and multivariable analyses including an average marginal effects model.ResultsA total of 1,658 participants were included in the study. The mean age of our sample was 8.3 ± 5.8 years. A total of 841 participants (50.7%) were male and 817 participants (49.3%) were female. A total of 513 (n = 30.9%) reported a history or presence of a problem that may be surgical in nature, and 280 (54.6%) of them reported the problem was ongoing or untreated. Overall, 16.9% had an ongoing problem that may be amenable to surgery. We found that increasing age and recent illness were associated with having a surgical problem on both our multivariable analyses.ConclusionTo our knowledge, this is the first and largest study of prevalence of surgical conditions among refugee children in sub-Saharan Africa. We found that over 16% (one-in-six) of refugee children have a problem that may be amenable to surgery. Our results provide a benchmark upon which other studies in conflict or post-conflict zones with refugee or forced migrant populations may be compared.

Untreated Surgical Problems Among East African Refugees: A Cluster Randomized, Cross-Sectional Study.

The goal of this study was to estimate the prevalence of surgical conditions among refugees in East Africa. Surgery is a foundational aspect to high functioning health care systems. In the wake of the Lancet Commission on Global Surgery, previous research has focused on defining the burden of surgical conditions in low- and middle-income countries. Despite numbering over 80 million people globally, forced migrant populations have often been neglected from this body of research. We administered a validated survey using random cluster sampling to determine surgical need among refugees in western Tanzania. Primary outcome was history or presence of a surgical problem. Analysis included descriptive and multivariable logistic regression including an average marginal effects model. We analyzed data from 3,574 refugee participants in East Africa. A total of 1,654 participants (46.3%) reported a history or presence of at least one problem that may be surgical in nature. Of those 1,654 participants who did report a problem 1,022 participants (61.8%) reported the problem was still ongoing. Multivariable analysis revealed several factors associated with having a surgical problem (increasing age, occupation, illness within past year). To our knowledge, this is the first and largest population-based survey in estimating the prevalence of surgical disease among refugees in sub-Saharan Africa. Our results imply that more than one-in-four refugees has an ongoing surgical problem, suggesting over double the burden of surgical need in refugee populations compared to non-refugee settings.

Nutritional Rickets in Adolescent East African Refugees: A Case Report

Rickets is a pediatric medical condition characterized by inadequate bone mineralization with potentially serious outcomes. The most common cause is nutritional vitamin D and/or calcium deficiency, and the incidence is disproportionately higher among refugee children. The mainstay of treatment is dietary supplementation.

A network analysis of posttraumatic stress symptoms among help-seeking refugees in Kenya

We analyzed the network structure of DSM-IV PTSD symptoms among 2792 help-seeking Central and East African refugees in Kenya exposed to multiple, severe traumatic events and on-going stressors. To some extent, our results reproduced structures identified among clinical populations in Europe, including strong links within traditional symptom clusters, such as between avoidance of thoughts and situations, and hypervigilance and startling. However, we found substantial differences in most central symptoms, with detachment and disinterest far less and emotional numbing and concentration problems more central in our analyses. Our networks did not reproduce the common finding of particularly low centrality of amnesia. We further noted substantive similarities in network structure, but also differences, between refugees living in an urban environment and in refugee camps. Concentration problems were most central among mainly Somali refugees at a refugee camp, and associated with amnesia and sense of foreshortened future, while emotional numbing was the most central symptom among majority Congolese refugees in Nairobi. Our findings highlight the importance of contextual and cultural factors for PTSD symptomatology, and are informative for assessment and treatment among help-seeking refugees.

A Functional Network Perspective on Posttraumatic Stress in Refugees: Implications for Theory, Classification, Assessment, and Intervention

There is an important, long-standing debate regarding the universality vs. specificity of trauma-related mental health symptoms in socio-culturally and linguistically diverse population groups, such as refugees and asylum seekers. Network theory, an emerging development in the field of psychological science, provides a novel data analytic methodology to evaluate and empirically examine long-standing questions about the structure and function of posttraumatic stress symptoms. We sought to empirically model the functional network of posttraumatic stress symptoms among East African refugees who survived multiple potentially traumatic events. A sample of 148 Sudanese and Eritrean male asylum seekers (M(SD)age = 32.60(7.13) were recruited from the community in Israel. The nature and function(s) of posttraumatic symptoms (Harvard Trauma Questionnaire) were modeled using regularized partial correlation models to derive a network of symptoms. Spinglass and exploratory graph analysis walktrap algorithms were then used to identify functional "circuits of symptoms" or clusters of nodes within the network. Analyses revealed a functional symptom circuitry that shares features with the predominant western model of posttraumatic stress disorder; as well as unique functional clusters of symptoms inconsistent with nosology and symptomatology observed in studies of Western populations. Findings may have important implications for theory, classification, assessment, candidate mechanisms that may drive and maintain posttraumatic stress, and in turn may inform prevention or treatment for socio-culturally diverse forcibly displaced population groups.

“Children are our pension”: Livelihood diversification, social security, and kinship constraints among East African refugees

Stereotypical ideas about poverty and life in refugee camps make it difficult to understand the choices that individual refugees make when moving from one place to another within Africa, including from refugee settlements to town, to refugee camps and vice versa. Certain choices which individual migrants make, and which may appear incomprehensible, respond in fact to a clear logic and represent, as it were, diversified forms of social security. Recent trends in migration theories have emphasised the importance of the positive role of the group of kin in the decision to set out on the migration path, but this article reveals a much more complex dynamic underlying such movements within Africa: a vision of livelihood diversification that goes beyond the stark reality of forced displacement or the opportunity of acquiring refugee status. The article will take into consideration the migratory trajectories of a number of young persons, across the Horn and some eastern African nations, first as forced migrants and later as refugees migrating at will, as observed over a period of years. Over and above the war that initially prompted migration, the movements of these young people result from negotiating the demands of individual agency and the constraints imposed by kinship ideologies.

Barriers and facilitators of immunisation in refugees and migrants in Australia: an east-African case study

BackgroundImmunisation programs available in low and middle-income countries include fewer vaccines in comparison to Australia’s National Immunisation Program. As a result, refugees and migrants may have a heightened risk of being inadequately immunised upon arrival to Australia. Several studies have suggested that East African immigrants have low vaccination coverage. As such, the aim of this study was to explore the underlying attitudes, barriers and facilitators to immunisation in east African communities in two states of Australia: New South Wales and Victoria. MethodsA qualitative study involving 17 semi-structured, in-depth interviews were undertaken with East African refugees and migrants living in two states of Australia: New South Wales and Victoria. These refugees and migrants were from four key East African countries: Kenya, Somalia, Ethiopia and South Sudan. Thematic analysis was undertaken to analyse and interpret the results. ResultsLanguage barriers, low risk perception and a lack of education were the key barriers identified by participants. Facilitators mentioned included the development of resources in participants’ languages and the implementation of reminder systems consistently across all GP practices. There was also a unanimous agreement amongst participants that community organisations need to play a greater role in the dissemination of information about immunisation. ConclusionsFurther research needs to be undertaken with regards to how education about immunisation is delivered and disseminated to refugee and migrant communities. Current findings also support the need to improve the health literacy of refugees and migrants by providing culturally and linguistically appropriate resources in participants’ respective languages.

Does Duration of Residency in the United States Influence Psychological Symptoms and Postmigration Stressors Among Refugees? Potential Implications of Populism for Refugee Mental Health

After relocation, refugees may experience significant difficulty adjusting to a host culture, and this difficulty may persist even after many years following resettlement. However, the influence of time on postmigration living difficulties (PMLD) and psychological distress has not been extensively investigated. In this investigation, we used regression analyses to examine whether length of residence in the United States would moderate the relationship between psychological symptoms and PMLD in a sample of 52 adult East African refugees. The sample was predominantly male (female n = 13) with a mean age of ∼37 years ( SD = 20.91) and mean length of residence in the United States of 9.9 years ( SD = 5.85). The moderating effect of years living in the United States on the depression–PMLD relationship was significant, and explained an additional 9% of variance in PMLD. The relationship between depressive symptoms and PMLD became significantly related at ∼7 years of residence in the United States, and became more positive as values in the sample approached the longest duration in the United States (30 years). No such moderating effect was found for the association between posttraumatic stress disorder symptoms and PMLD. These results highlight the risk of marginalization as well as the need for early and sustained psychosocial interventions for refugee populations in the United States.

Does Time in Migration Exacerbate Posttraumatic Symptoms Among Internationally Displaced East African Refugees?

Refugees often experience a prolonged period of migration. We examined the potential moderating influence of time in migration on the relationship between trauma exposure and psychological distress in a sample of 60 East African refugees. Results indicated that increased time in migration exacerbated the trauma-posttraumatic-stress-symptom relationship, accounting for an additional 12% of model variance (t[54] = 2.25, b = .09, p = .03). No such moderation was found for symptoms of depression (t[54] = .74, b = .03, p = .46). These preliminary findings highlight the need for early, community-based interventions that target the interaction between trauma- and migration-related stressors.

Exploring the Potential Distinction Between Continuous Traumatic Stress and Posttraumatic Stress in an East African Refugee Sample

Posttraumatic stress (PTS) indicates a continuous stress response that persists though threats to life had been experienced in the past. However, threats to life are frequently ongoing. For these contexts, the concept of continuous traumatic stress (CTS) has been put forward. Based on structured clinical interviews with Congolese refugees ( N = 226), this study investigated the CTS concept and whether it can be distinguished from PTS. We found that current exposure to violence correlated positively with concerns about its recurrence in the CTS group ( r = .46). An ANCOVA indicated that higher intrusion symptom severity in the PTS group (no symptom reduction under safe conditions) was explained by higher lifetime trauma exposure (η2 = .125). In contexts of continuous trauma exposure, symptom-like responses may be regarded as appropriate responses to realistic danger. In these contexts, the possibility that symptom changes are a response to real threats should be considered to avoid overestimation of PTSD prevalences.

Documenting Refugee Stories: Resettlement and Integration Challenges of East African Refugees

&lt;p&gt;Recently we have witnessed forced displacement and migration on a globalized scale and the human suffering that this creates. Since early 2014, events have escalated in Syria and other Middle Eastern countries as religious-based interest groups such as ISIS push to make territorial gains. One cannot escape media reports documenting the devastating impact this has as refugees try to reach safety, whether by crossing the Mediterranean Sea or European borders.&lt;/p&gt;&lt;p&gt;In this article, I present my personal experience of refugee life as a survivor of war and multiple forced migrations and as a professional service provider to immigrants and refugees who make Canada their new home. In many ways, my story is the story of other refugees who also encounter issues of race, religion and geopolitical locations as they migrate and resettle in a new country.&lt;/p&gt;

Louse-borne relapsing fever among East African refugees in Europe.

Louse-borne relapsing fever a neglected and forgotten disease by western physicians has recently re-emerged among East African migrants seeking asylum in Europe. We review here the cases observed so far together with a critical reappraisal of several issues regarding clinical presentation, diagnosis and treatment.

Adaptation of an Acculturation Scale for African Refugee Women

Newly-arrived African refugees are a vulnerable group of immigrants for whom no validated acculturation measures exist. A valid measurement tool is essential to understand how acculturative processes impact health and health disparities. We adapted the Bicultural Involvement Questionnaire (BIQ) to characterize its reliability among ethnic Somali women residing in Minnesota, and Somali, Somali Bantu, and Burundian women in Arizona. Surveys were administered to 164 adult women. Analyses were conducted along socio-demographic variables of ethnicity, geographic residence, age, and length of time in the United States through t tests and one-way analysis of variance. Exploratory factor analysis was conducted on the modified BIQ. Exploratory factor analyses yielded five subscales: "Speak Native Language", "Speak English Language", "Enjoy Native Activities", "Enjoy American Activities", and "Desired Ideal Culture". The subscales of the modified BIQ possessed Cronbach's α ranging from 0.68 to 0.92, suggestive that all subscales had acceptable to excellent internal consistency. The modified BIQ maintained its psychometric properties across geographic regions of resettled Central and East African refugees.