Migrant Populations In Europe Research Articles

Diasporic Medical Tourism: examining tourists’ profiles, antecedents and behavioural intention

This study focuses on diasporic medical tourism (DMT), an offshoot of migration-led tourism and medical tourism. There has been growing recognition of the significance of a diasporic dimension of medical tourism worldwide, yet little is known about these travellers, especially quantitatively. This paper examines the antecedents and behavioural intention of the DMT by applying the extended Theory of Planned Behaviour. A cross-sectional survey was conducted in three European countries (Belgium, the Netherlands, and Luxembourg) among the Polish diaspora (N=1,288), which constitutes one of the largest migrant populations in Europe. The results analysed via PLS-SEM demonstrated that the model explained 53 % of the variance (R²= 0.527, Q²= 0.392), indicating a good model fit. Constructs of Attitude (β = 0.329), Subjective Norms (β = 0.277), Perceived Behavioural Control (β = 0.112), and Past Behaviour (β = 0.302) were all statistically significant. The caring/affective/trusting relationship with doctors, familiarity with the system, second opinion, encouragement/recommendation from referents, and facilitating factors influenced the decisions to undertake the DMT. ‘Committed’ and ‘Contended’ travellers accounted for 76% of all surveyed diasporic medical travellers, indicating the significant potential of those ‘hidden’ medical travellers. Diasporic medical tourism was compared to foreign medical tourism. This study provides theoretical/practical implications and contributes to the research on medical tourism, diaspora tourism and the interrelation between tourism and migration, specifically in the European context.

The immune status of migrant populations in Europe and implications for vaccine-preventable disease control: a systematic review and meta-analysis.

Ensuring vaccination coverage reaches established herd immunity thresholds (HIT) is the cornerstone of any vaccination programme. Diverse migrant populations in European countries have been associated with cases of vaccine-preventable diseases (VPD) and outbreaks, yet it is not clear to what extent they are an under-immunised group. We did a systematic review and meta-analysis to synthesise peer-reviewed published primary research reporting data on the immune status of migrants in EU/EEA countries, the UK and Switzerland, calculating their pooled immunity coverage for measles, mumps, rubella, and diphtheria using random-effects models. We searched on Web of Science, Embase, Global Health and MEDLINE (January 1st 2000 to June 10th 2022), with no language restrictions. The protocol is registered with PROSPERO (CRD42018103666). Of 1103 abstracts screened, 62 met eligibility criteria, of which 39 were included in the meta-analysis. The meta-analysis included 75 089 migrants, predominantly from outside Europe. Pooled immunity coverage among migrant populations was well below the recommended HIT for diphtheria (n = 7, 57.4% [95% CI: 43.1-71.7%] I2= 99% vs HIT 83-86%), measles (n = 21, 83.7% [95% CI: 79.2-88.2] I2= 99% vs HIT 93-95%), and mumps (n = 8, 67.1% [95% CI: 50.6-83.6] I2= 99% vs HIT 88-93%), and midway for rubella (n = 29, 85.6% [95% CI: 83.1-88.1%] I2= 99% vs HIT 83-94%), with high heterogeneity across studies. Migrants in Europe are an under-immunised group for a range of important VPDs, with this study reinforcing the importance of engaging children, adolescents, and adults in 'catch-up' vaccination initiatives on arrival for vaccines, doses, and boosters they may have missed in their home countries. Co-designing strategies to strengthen catch-up vaccination across the life-course in under-immunised groups is an important next step if we are to meet European and global targets for VPD elimination and control and ensure vaccine equity.

Exploring the Effects of the COVID-19 Pandemic on Mental Health and Well-Being of Migrant Populations in Europe: An Equity-Focused Scoping Review.

The pandemic is aggravating health inequalities, particularly mental health inequalities, while revealing the social determinants of these inequalities, including migration as a social determinant that mediates the interaction of social, economic, cultural, institutional, and structural factors with health indicators. Therefore, it is of most relevance to identify the multiple interconnected factors that influence the mental health and well-being of migrant populations. A scoping review was developed to map the research performed in this area and to identify any gaps in knowledge, following the PRISMA extension for scoping reviews. MEDLINE, Scopus, and WHO Global Health research databases on COVID-19 were searched from January 2020 to October 2021. The review followed the inclusion criteria Population/Concept/Context (PCC): Population-Adult International migrants (including refugees, asylum seekers, and undocumented migrants); Concept-determinants of (and factors influencing) mental health and well-being; Context-COVID-19 anywhere in the world. Of the sixty-five selected studies, eleven were from European countries and were the focus of this review with special attention to health inequalities experienced by migrants in Europe. The results cover a diversity of themes related to the effects of COVID-19 on the mental health of migrants (country-level environmental factors, social determinants of mental health, mental health indicators and outcomes), responses (such as solidarity and resilience), populations, and study methods. The evidence found can inform recommendations and interventions focused on health promotion and mitigation of the inequalities accentuated by the pandemic.

Schistosomiasis Among Female Migrants in Non-endemic Countries: Neglected Among the Neglected? A Pilot Study.

BackgroundSchistosomiasis among migrant populations in Europe is an underdiagnosed infection, yet delayed treatment may have serious long-term consequences. In this study we aimed to characterize the clinical manifestations of Schistosoma infection among migrant women, and the degree of underdiagnosis.MethodsWe carried out a prospective cross-sectional study among a migrant population living in the North Metropolitan Barcelona area and coming from schistosomiasis-endemic countries. We obtained clinical, laboratory and socio-demographic data from electronic clinical records, as well as information about years of residence and previous attendance at health services. Blood sample was obtained and schistosomiasis exposure was assessed using a specific ELISA serological test.ResultsFour hundred and five patients from schistosomiasis-endemic regions were screened, of whom 51 (12.6%) were female. Seropositivity prevalence was 54.8%, but considering women alone we found a prevalence of 58.8% (30 out of 51). The median age of the 51 women was 41.0 years [IQR (35–48)] and the median period of residence in the European Union was 13 years [IQR (10–16)]. Schistosoma-positive women (N = 30) showed a higher prevalence of gynecological signs and symptoms compared to the seronegative women (96.4 vs. 66.6%, p = 0.005). Among seropositive women, the median number of visits to Sexual and Reproductive Health unit prior to diagnosis of schistosomiasis was 41 [IQR (18–65)].ConclusionThe high prevalence of signs and symptoms among seropositive women and number of previous visits suggest a high rate of underdiagnosis and/or delayed diagnosis of Schistosoma infection, particularly female genital schistosomiasis, among migrant females.

Analysing drivers of routine and COVID-19 vaccination in migrants to develop tailored interventions

Abstract Background Migrants in Europe are at risk of under-immunisation and may also have lower COVID-19 vaccination intent and uptake. There is an urgent need to better understand the drivers of uptake in these groups to inform the development of migrant-sensitive interventions for COVID-19 vaccination and routine vaccination beyond the pandemic. Methods We did a systematic review (PROSPERO: CRD42020219214) following PRISMA guidelines to explore factors influencing vaccine uptake in migrants in the EU/EEA and identify determinants of under-immunisation. We also held 3 participatory workshops with multinational migrant community leaders (n = 23) in London, to explore solutions and approaches to strengthen COVID-19 vaccine roll-out. Results We included 66 papers reporting data on 262,761 migrants in the review. Numerous access-related factors (e.g. government policy, communication barriers) influenced uptake. Vaccine hesitancy was attributed to lack of information, concerns about side-effects, and cultural beliefs/stigma around specific vaccinations. Migrants who had recently arrived, were older, female or of African and Eastern Mediterranean origin were at risk for under-immunisation for key vaccine-preventable diseases. Migrant community leaders reported considerable hesitancy towards COVID-19 vaccination in their communities and misinformation circulating via social media. Leaders requested support in producing simple COVID-19 guidance that could be translated and adapted locally, alongside more meaningful engagement and partnership-working. Conclusions Access barriers and vaccine hesitancy may affect vaccine uptake in some migrant populations in Europe, which needs to be urgently addressed for COVID-19 vaccine roll-out but also beyond the pandemic to strengthen uptake of routine vaccinations. Actively involving migrant communities in the planning, co-production and implementation of tailored and targeted approaches will be essential. On behalf of ESGITM. Key messages Access barriers and vaccine hesitancy (from information gaps, cultural factors) contribute to low vaccine uptake in some migrant populations in the EU/EEA, with implications for COVID-19 vaccination. Meaningful engagement and co-production of tailored approaches with under-immunised migrants are urgently needed to ensure their inclusion in COVID-19 and routine vaccination programmes.

Challenges in the equitable access to COVID-19 vaccines for migrant populations in Europe.

Challenges in the equitable access to COVID-19 vaccines for migrant populations in Europe.

5.H. Workshop: Developing more responsive systems to deliver catch-up vaccination to migrants arriving in Europe

Abstract Background and Objectives Migrants are thought to be one of several under-immunised groups in Europe, and involved in outbreaks of vaccine preventable diseases - including the recent large pan-European outbreak of measles. They may be under-immunised because of poor functioning of the health systems in countries they come from, because of barriers to catch-up vaccination and health services on arrival to Europe, and vaccine hesitancy may play a role. Amid substantial migration to Europe in recent years, ECDC public health guidelines for newly arrived migrants to EU/EEA countries have defined new recommendations, including focusing on catch-up vaccination in adult migrants. Yet there is an urgent need to better define what strategies work to improve vaccine coverage and to better understand the views of migrant communities, which will be the focus of this workshop. In this workshop we will explore various facets of migration and vaccination in the European context, and seek audience participation in better defining innovative implementation models and models of best practice to improve vaccine coverage in migrant populations residing in the region. Workshop plan The workshop will start with 15-minute presentations by each of the 4 speakers (to include a short Q&A after each talk). This will then move into a 30-minute audience discussion centred around seeking specific feedback on examples of innovation, good practice, and lessons learned across EU/EEA countries in engaging migrants and improving vaccine coverage in this group. Speakers and topics Sally Hargreaves (St George's, University of London): Are migrants to Europe an under-immunised group and involved in outbreaks? implications for health systems, policy, and practice. Elizabeth de Vito (Università degli Studi Di Cassino e del Lazio Meridionale, Italy) Barriers and facilitators to catch-up vaccination in migrant populations: defining effective and cost-effective implementation strategies. Ines Campos-Matos (Public Health England, UK) Vaccination on the move for asylum seekers and refugees: evidence, policies and practicalities. Christina Louka (University of Groningen, The Netherlands) Perspectives of asylum seekers, refugees, and other migrant groups on approaches to catch-up vaccination on arrival to Europe. Key messages Migrants are likely to be an under-immunised group in Europe, with new ECDC guidelines outlining key recommendations for catch-up vaccination on arrival. There is a need to better define more effective strategies to improve vaccine coverage in migrant populations in Europe.

The role of culture in the gendered division of domestic labor: Evidence from migrant populations in Europe

An attractive explanation of the persistence of gender inequality in the division of domestic labor hinges on the role of culture. However, it is difficult to demonstrate the impact of cultural factors (e.g. social norms), as they are confounded with other institutional factors (e.g. social policies). This article deals with this issue by applying the emerging ‘epidemiological approach’ which focuses on international migrants as individuals who bring cultures differing from that prevailing in the national contexts in which they live. The study analyzes the gender division of housework of first- and second-generation immigrants living in countries covered by the second and fifth round of the European Social Survey. Applying cross-classified multilevel models and using several indicators of gender culture at both origin and destination, it is found that the female share of housework increases in couples when the man or the woman comes from a gender-traditional cultural background. The effect of culture is homogenous across destination countries and only partly explained by parental background. However, it tends to disappear among second generations.

Introducing Care Ethics into Humanitarianism Comment on "A Crisis of Humanitarianism: Refugees at the Gates of Europe".

Since 2015, the so-called refugee crisis has transformed ‘humanitarianism’ into a word devoid of meaning or value for European politics. By now, we all know there are numerous migrant populations in Europe living under inhuman conditions and denied their inalienable human rights; still, it seems futile to argue that equal value should be attached to all lives. Introducing care ethics into relief work calls to reflect upon humanitarianism differently, as a relationship between local communities, Non-Governmental Organization (NGO) workers and refugees that is embedded in space and time and might be allowed to have a future.

Significance and challenges of assessing health literacy among migrants

Abstract Background People with a migration background account for a large part of the population in many European countries. Although health literacy - knowledge, motivation, and competencies to process health information - is a key determinant of health, research on health literacy specifically among migrants in Europe is scarce. The aim is therefore to review and further develop the concept and assessment of migrant-specific health literacy for future use in a migrant health literacy survey (HLS-MIG) in Germany. Methods A literature search in Pubmed was performed in April 2019 to identify studies regarding health literacy, health outcomes and knowledge among migrant populations in Europe. A special focus was put on the conceptualization and operationalization of health literacy among migrants. Results So far, health literacy among migrants has mostly been measured using general health literacy measurement tools, that is, performance-based and self-assessment instruments as the HLS-EU-Q. Migration-specific competences, such as finding information about health in mother tongue, or outcomes of deficient HL have so far received little attention, except for e.g. the GMK-12, developed as a complement to the HLS-EU-Q16 in the Austrian context. Conclusions The use of performance-based instruments in the local language primarily provides information about existing linguistic deficits, but hardly on competencies and abilities in dealing with health information. General self-assessment tools, on the other hand, allow the identification of such competences, difficulties and challenges. However, it is necessary to take greater account of migration-specific competences, habits and obstacles in the future, in order to develop tailored interventions for individuals and organizational aspects, supporting health information processing among migrants. Furthermore, studies also need to pay attention to migrant specific health problems and prerequisites. Key messages Research focussing on migrant health literacy is scarce. More attention needs to be paid to migrant specific competencies, habits and challenges.

Editorial on the Special Issue “New Aspects on Migrant Populations in Europe: Norms, Attitudes and Intentions in Fertility and Family Planning”

This paper reviews the most recent literature on the fertility of migrant populations in Europe. In a systematic review of 21 peer-reviewed journals, we found that the literature has focused almost exclusively on actual behaviours related to the quantum and timing of births; it primarily investigates the determinants of demographic behaviour related to the structural integration of migrants. Previous literature on the demographic behaviour of migrants in Europe used factors related to culture more as a residual explanation for group differences, but it barely addressed their role specifically. The aim of our Special Issue is to draw attention to the normative side of fertility and to include aspects of reproductive health and family planning in the picture – both aspects are related to culture. This paper includes a short introduction to the articles contained in this Special Issue and proposes recommendations for future research.

Hepatitis B virus prevalence and risk factors in hard-to-reach Turkish population living in Belgium: A protocol for screening.

Background:Hepatitis B virus (HBV) infection is an important public health problem in the Turkish population, that is, one of the largest migrant populations in Europe. With the introduction of cost-effective antiviral treatments in the past decade, there is a need to identify HBV-infected patients who may benefit from treatment. This study describes the design of a study to assess the HBV prevalence in the Turkish population living in Belgium. Additionally, we will determine the risk factors of HBV infection and the uptake of screening, vaccination, and antiviral treatment in this hard-to-reach Turkish population.Methods:A longitudinal, epidemiological study will be conducted in the region Middle Limburg Belgium, where the Turkish adult population, 18 years of age and older, will be screened for hepatitis B surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), and antibodies against hepatitis B core antigen (anti-HBc). Educational meetings concerning viral hepatitis B will be organized and there will be 3 ways to be screened for HBV: immediately after the educational meetings, at the Outpatient Hepatology Department of Ziekenhuis Oost-Limburg, and at home visits. Subsequently, participants will be asked to fill in a questionnaire regarding sociodemographic factors, migration history, risk factors for HBV infection (e.g., sharing toothbrushes, HBV-infected family member), and HBV vaccination status. Six months after screening, HBsAg-positive patients will be assessed whether they are under follow-up at the general practitioner or hepatologist. We will also gather information regarding the uptake of vaccination in nonimmunized subjects.Discussion:This study will provide information about the HBV prevalence and distribution of the stages of liver disease in the Turkish population in Belgium. By determining the risk factors for HBV infection, subgroups with an increased prevalence of HBV infection can be identified.Clinical trial number:This clinical trial is registered at clinicaltrials.gov (NCT03396458).

Hepatitis C prevalence among the migrant population in Spain: A systematic review and meta-analysis

IntroductionSpain, which has one of the largest migrant populations in Europe, has committed to eliminating the hepatitis C virus (HCV). The aim of this study was to estimate the prevalence of HCV among migrant groups in Spain, a country of 46 million people, with an estimated HCV-antibody prevalence of 1.7%. MethodsStudies on HCV and migration in Spain were identified by systematically searching three databases from the first records to 30 November 2017, and consulting experts at the Ministry of Health and in the 17 Spanish autonomous communities. A meta-analysis was conducted to determine pooled HCV prevalence for the general migrant population. Prevalences were also calculated for high-risk migrant populations and populations who had undergone hospital screening, stratified by region of origin. ResultsOut of 243 studies identified, 26 met the eligibility criteria. The meta-analysis of the general migrant population found HCV antibody prevalence to be 1.6%. Migrants originating from European countries, including those at high or moderate risk for HCV, had the highest pooled prevalence (7.1%). In the general migrant population, prevalence was highest among sub-Saharan African migrants (3.1%) and lowest among Latin American migrants (0.2%). ConclusionBased on the limited available data, the prevalence among the general migrant population was found to be the same as the general Spanish population. Further research is needed to more accurately determine HCV prevalence for the overall migrant population and specific migrant subpopulations with a higher risk in the country as a whole and in each of Spain's 17 autonomous communities.

Medication non-adherence and blood pressure control among hypertensive migrant and non-migrant populations of sub-Saharan African origin: the RODAM study.

Large differences in blood pressure (BP) control rates have been observed between sub-Saharan African migrant populations in Europe compared to their counterparts living in Africa. Our main objective was to investigate whether inter-geographical differences in BP control rates can be explained by differences in medication non-adherence. Additionally, we studied the prevalence of medication non-adherence and associations between medication non-adherence, socio-demographic-related, clinical/treatment-related, lifestyle factors, and experienced stress on the one hand and BP control on the other hand. We used data from the multi-center RODAM (Research on Obesity and Diabetes Among African Migrants) study, from Ghanaians receiving antihypertensive therapy and residing in three European countries versus non-migrants residing in rural and urban Ghana (n = 1303). Bivariate and multivariate logistic regression analyses stratified by sex were applied. We found inter-geographical differences in BP control rates among Ghanaian males but not among females. Ghanaian males residing in Amsterdam and Berlin had not only the lowest BP control rates but also the lowest rates of medication non-adherence. Inter-geographical differences in BP control rates among males became therefore more pronounced after adjustment for medication adherence. Medication non-adherence was significantly and independently associated with suboptimal BP control in males and females. Other factors associated with suboptimal BP control in females were a higher number of prescribed antihypertensives, higher fasting glucose levels, and pregnancy-induced diabetes. When adjusted for medication non-adherence and socio-demographic-, clinical/treatment-, lifestyle-, and stress-related factors, inter-geographical differences in BP control in males disappeared, except for Berlin. In conclusion, the observed inter-geographical differences in BP control rates in Ghanaian males cannot be explained by differences in medication non-adherence.

Hepatitis C prevalence among the migrant population in Spain: A systematic review and meta-analysis

IntroductionSpain, which has one of the largest migrant populations in Europe, has committed to eliminating the hepatitis C virus (HCV). The aim of this study was to estimate the prevalence of HCV among migrant groups in Spain, a country of 46 million people, with an estimated HCV-antibody prevalence of 1.7%. MethodsStudies on HCV and migration in Spain were identified by systematically searching three databases from the first records to 30 November 2017, and consulting experts at the Ministry of Health and in the 17 Spanish autonomous communities. A meta-analysis was conducted to determine pooled HCV prevalence for the general migrant population. Prevalences were also calculated for high-risk migrant populations and populations who had undergone hospital screening, stratified by region of origin. ResultsOut of 243 studies identified, 26 met the eligibility criteria. The meta-analysis of the general migrant population found HCV antibody prevalence to be 1.6%. Migrants originating from European countries, including those at high or moderate risk for HCV, had the highest pooled prevalence (7.1%). In the general migrant population, prevalence was highest among sub-Saharan African migrants (3.1%) and lowest among Latin American migrants (0.2%). ConclusionBased on the limited available data, the prevalence among the general migrant population was found to be the same as the general Spanish population. Further research is needed to more accurately determine HCV prevalence for the overall migrant population and specific migrant subpopulations with a higher risk in the country as a whole and in each of Spain's 17 autonomous communities.

Mixed marriages in Switzerland: A test of the segmented assimilation hypothesis

Switzerland hosts one of the largest and most diversified migrant populations in Europe, while currently reinforcing restrictive immigration policies. Knowledge on Swiss immigrant-native marriages, as ultimate signposts of integration, is limited.

Acute hepatitis E virus infection in a migrant population in North East Italy: A retrospective analysis.

To study the epidemiological and clinical features of Hepatitis E Virus (HEV) infection in a migrant population. We performed a retrospective chart review, identifying a cohort of 21 symptomatic patients of migrant origin with confirmed HEV infection admitted in the period between January 1995-November 2014. 20 (95%) patients came from South Asian countries highly endemic for HEV, all positive for HEV genotype 1. Recent travel to a highly endemic country was the most consistent risk factor identified in 90% of cases, duration from return to Italy to hospitalization ranged from 10 to 120 days. Nausea and vomiting (100%), jaundice (95.2%), and anorexia (85.7%) were the most common reported symptoms. Fever was present in 57.1% of cases. Transaminase values were elevated in all patients and serum bilirubin was raised in 86% of patients. We found no statistically significant differences between clinical symptoms, laboratory results or duration of hospitalization in patients with co-morbidities compared to those without. We also report a secondary case of HEV genotype 1 transmitted within Italy. Our study highlights the epidemiological risk factors and clinical features of HEV infection in a migrant population in Italy and should stimulate further research regarding the prevalence and morbidity of HEV within migrant populations in Europe.

Association between socioeconomic position and the prevalence of type 2 diabetes in Ghanaians in different geographic locations: the RODAM study

BackgroundThe prevalence of diabetes has been shown to be socially patterned but the direction of the association in low-income countries and among migrant populations in Europe has varied in the...

Atrial fibrillation in first generation Chinese migrants living in Europe: A proof of concept study

BackgroundDespite the public health burden of atrial fibrillation (AF) and its complications in China, there is no literature on AF among Chinese living in Europe. The present study was performed to investigate the prevalence of and risk factors for AF in Chinese first generation migrants settled in Europe. MethodsA cross-sectional survey was performed in 2014 on Chinese first generation migrants aged 16 to 59years settled in Prato (Italy) adopting principles of community based participatory research. All participants underwent recording of 30s of a single-channel ECG and associations of AF with socio-demographic, anthropometric, clinical factors, and sleep history were examined using logistic regression. ResultsOf the 1608 participants, 12 had AF (0.75%; 95% CI 0.33 to 1.17) — four men and eight women. All subjects with AF had a CHA2DS2VASc index≥1. Although no participant with AF had contraindications to oral anticoagulation, none was treated with oral anticoagulants.At multivariable adjusted logistic regression AF was associated with hypertension with an OR of 4.40 (95% CI 1.09–17.81; p=0.038). ConclusionsChinese are one of the fastest growing migrant populations in Europe and their health has become a key issue to host nations. The issue of AF is to be considered in future prevention programs for elusive ethnic minorities and adequately powered trials specifically designed to investigate AF prevalence and to test prevention approaches are now needed.

Sociocultural aspects of consanguinity

Consanguinity is usually defined as the result of a sexual reproduction between two related individuals. It can also refer to populations sharing at least one common ancestor, as those who live within isolates or within communities practicing endogamy. Second or higher order related couples and their offspring represent more than 10% of the current world population. The highest levels of consanguinity are found in the Southern and Eastern shores of the Mediterranean Basin, and the most concerned region extends from the southern shore of the Mediterranean Sea to Southeast Asia through Middle-East, Gulf and India. In Maghreb countries, consanguineous marriages are wide-spread. The rates for this practice vary from 23% in Morocco to 60% in Tunisia, with highest rates being found in rural areas. In Algeria, consanguineous marriages represent more than 38% of all marriages. Large scale migrations from South countries to North countries in the second half of the twentieth century had legal impact on migrants for these specific unions. As a consequence, controversies have been rising in the United States and the United Kingdom especially when a fast decrease of inter-related individuals unions seems unlikely. Consanguinity certainly increases the risk of autosomal recessive pathology, but what about mental pathologies with complex and polygenic heredity? The necessity of an awareness of the genetic risks of consanguinity is as essential in countries where inter-cousin unions are culturally encouraged as among migrant populations in Europe.