Pediatric Refugees Research Articles

Savaş, Göç ve Sağlık: Mülteci Çocuklar İçin Sosyal Hizmetin Önemi

Objective: The conflicts in the Middle East during the last decade displaced millions of people and led to a serious population movement. Many Syrians have had to leave their country and became a refugee in Turkey. Over the last decade, migration has become one of the most important social, political and public health issues in Turkey. In this study, we aimed to review pediatric refugee cases who were consulted to the Social Service at a Tertiary Hospital. Methods: A retrospective study was performed with refugees admitted to our hospital between January 2012 and December 2018. The socio-demographic data (age, sex, birthplace), medical diagnosis, the reason for the social work consultation and the classification of the social problems were recorded. Results: The number of refugee children that were detected from the medical records was 88; the median age was 10 months (IQR 60.5), and nearly half of them were female. The most frequent diagnosis of the cases obtained from the medical charts was acute respiratory system disorders. The main reason for a social work consultation was poverty. Conclusion: We concluded that professionals working with immigrant children and families should be able to access social and psychological support services. Pediatricians and pediatric societies should work to improve the sensitivity of their respective populations towards migrants and refugees.

Pediatric Refugee Health Care Delivery in the Community Setting: An Educational Workshop for Multidisciplinary Family-Centered Care During Resettlement.

IntroductionWith 70.8 million people displaced worldwide, there is an increasing need for medical professionals to provide medical care to refugees. Insufficient training on refugee health poses a barrier to effective care delivery.MethodsThis workshop addressed common challenges in providing family-centered pediatric refugee care in community settings as well as barriers related to policy changes. Presentations covered prearrival experiences, medical screening, and trauma-based care. In small groups, participants discussed cases that featured medical, behavioral health, social, and cultural factors impacting the provision of family-centered pediatric care that was culturally respectful and included shared decision-making. After the breakout session, each small group informed the larger group of topics discussed. Facilitators identified themes and reinforced key learning points. At the workshop's conclusion, participants were guided to create their own personalized action plan.ResultsThis workshop was presented at two international conferences to more than 47 participants, including clinicians, nurse practitioners, pediatric residents, and medical students. Evaluations were completed by 34 individuals. Participants' overall comfort level with taking care of refugee patients increased from 3.3 to 4.0 (on a 5-point scale, p = .24) during the 3-hour version of the workshop and from 3.8 to 4.0 (p = .43) in the 1-hour version of the workshop. Mean overall ratings of the 3- and 1-hour workshop versions on conference-administered evaluations were 4.8 and 4.2, respectively, on a 5-point scale.DiscussionsThis workshop was well received and equipped participants with knowledge, tools, and strategies regarding pediatric refugee health in a community setting.

The Strengths and Difficulties Questionnaire as a Mental Health Screening Tool for Newly Arrived Pediatric Refugees.

Many refugee children have exposure to trauma prior to arrival and during resettlement. Mental health screening in primary care among resettled refugee children is needed. The Strengths and Difficulties Questionnaire (SDQ) was used to screen refugee children age 4-18years at their Domestic Medical Examination and three other primary care visits in their first year of resettlement. We tested the association between time and SDQ score or intervention/referral, and differences based on geographic origin. SDQ scores were highest upon arrival (Ps < .0005). Referrals were most common at the six-month visit compared to arrival and one month (Ps < .01). Iraqi children had higher SDQ scores at all visits (Ps < .03). The SDQ can be used in primary care to screen newly arrived refugee children. Practitioners should screen at arrival to identify difficulties. Those with difficulties continuing at six months may need an intervention or referral.

Beliefs, perceptions, and behaviors impacting healthcare utilization of Syrian refugee children

Approximately 18,000 Syrian refugees have resettled to the United States. Half of these refugees are children, whose age and refugee status jeopardize their abilities to attain quality healthcare. Information on Syrian refugees' health in the U.S. is limited. This qualitative study sought to explore Syrian refugee parents' beliefs, perspectives, and practices regarding their children's health through in-depth interviews. Eighteen Syrian refugee parents residing in Cincinnati, Ohio were interviewed in Arabic by bilingual researchers using semi-structured in-depth interviews. The interviews were recorded, transcribed, and translated. Three members of the research team independently coded each interview using an inductive thematic analysis approach. Analysis identified four salient themes: stressors preclude health seeking behaviors, parents perceive health barriers, parents are dissatisfied with the healthcare system, and parents use resilience behaviors to overcome barriers. Stressors included poor housing and neighborhoods, reliving traumatic experiences, depression and anxiety, and social isolation. Dissatisfaction included emergency room wait times, lack of testing and prescriptions. Health barriers included missed appointments and inadequate transportation, translation services, health literacy and care coordination. Parents reported resilience through faith, by seeking knowledge, use of natural remedies, and utilizing community resources. This qualitative study provides information on the beliefs, practices, and behaviors of Syrian refugee parents related to health care utilization of pediatric refugees in the United States. Psychosocial and environmental stressors as well as perceived systemic health barriers, hinder health seeking behaviors in Syrian refugee parents. Culturally relevant care targeting perceived barriers and incorporating resilience behaviors may improve parental satisfaction and parental health seeking behaviors. Further study is needed to implement and evaluate interventions that target identified barriers.

Schistosoma serology after praziquantel treatment of Schistosoma infection in refugee children resettled in Australia: A retrospective analysis

BackgroundThis study aimed to document changes in serological response before and after treatment of Schistosoma infection in resettled refugee children from endemic countries in Australia. Current Australian guidelines recommend serological screening for Schistosoma infection in children and adults from endemic countries. Data on the utility of follow-up serology after treatment is limited. MethodsWe undertook a retrospective audit of Schistosoma serology in refugee-background children presenting to a specialist paediatric refugee health clinic in Melbourne, Australia, between January 2005 and December 2014. Patients were included with positive Schistosoma serology, documented treatment with praziquantel; clinical and serological followup data after treatment, and no return to endemic areas. ResultsFifty-one refugee-background children were included. Overall, 40/51 (78.4%) children had serology that decreased after treatment, 25/51 (49.0%) had a greater than twofold decrease and 22/51 (43.1%) reverted to negative serology. Six (11.8%) children showed an increasing serology titre and 5/51 (9.8%) had unchanged serology after treatment. ConclusionsThis is the first study describing the changes in Schistosoma serological titres following treatment in immigrant children in a non-endemic country. We observed a majority downward trend in antibody titres after praziquantel treatment, suggesting follow-up serological testing may be useful in children to monitor treatment response.

Distribution and management of the pediatric refugee population with renal replacement: A German pediatric cohort.

With migration rising, the pediatric nephrology community is faced with challenges concerning the management of end-stage kidney disease (ESKD) in the pediatric refugee population. Data on the care of the pediatric refugee cohort on renal replacement therapy (RRT) is not available. A survey conducted by us in 2018 showed that the group of refugee children arriving to Germany during the years 2015-2017 accounts for approximately 20% of the total pediatric dialysis population in Germany. Provision of (medical) care for these children and their families is often hampered by psychosocial problems, cultural differences, language barriers, and administrative issues. Treating centers need to provide additional human as well as financial and logistic resources. In this educational review, we raise awareness and discuss possible challenges occurring in the treatment of refugee children with ESKD.

4.9 INTEGRATED PEDIATRIC AND MENTAL HEALTH CARE FOR CHILD REFUGEES: DESCRIPTIVE ANALYSIS AND REFLECTIONS FROM CLINICAL EXPERIENCE

The world is witnessing one of the largest refugee crises in modern history, with around 25.4 million refugees worldwide. Connecticut carries the second highest number of refugees’ settlement in the United States, with a range of 375–897 families settled yearly. However, child refugees (CRs) do not receive enough mental health care. Yale Child Study Center (YCSC), in collaboration with Yale Pediatric Refugee Clinic (YPRC) and Integrated Refugee and Immigrant Services, established an integrated Pediatric and Mental Health Clinic for CRs newly arrived at New Haven, Connecticut. In this presentation, we will discuss our experience and provide descriptive analysis of the examined population.

Griseofulvin vs terbinafine for paediatric tinea capitis: When and for how long.

Outbreaks of tinea capitis (TC) can be a source of medical and economic burden for healthcare systems; Griseofulvin and terbinafine are considered to be effective first-line treatments for TC. In order to compare the efficacy of griseofulvin and terbinafine for the treatment of TC in a paediatric population of African immigrants in the Tel Aviv area, we conducted a retrospective cohort study of all cases of TC diagnosed and treated between March 2016 and February 2018 at a dedicated TC paediatric dermatology clinic at the Tel Aviv Medical Center (which serves as a referral centre for the paediatric refugee population in the Tel Aviv metropolitan area). Epidemiologic, clinical and laboratory data were collected, and 304 patients were included. Trichophyton violaceum (TV), Trichophyton soudanense (TS) and Microsporum audouinii (MA) were the prominent causative organisms. Treatment with griseofulvin suspension for 12weeks was compared with (a) griseofulvin suspension for 8weeks and with (b) terbinafine tablets for 4weeks. There was no statistically significant difference between the groups regarding age, sex, country of birth, ethnicity and the causative organism. Twelve weeks of griseofulvin treatment had a statistically significant better cure rate than 4weeks of terbinafine. Treatment was significantly more effective when TC was due to infections with MA and TS as compared with TV. No statistically significant difference was observed between 12- and 8-week treatment with griseofulvin.

Diabetes care in pediatric refugees from Africa or Middle East: experiences from Germany and Austria based on real-world data from the DPV registry

With increasing migration to Europe, diabetes diagnosis and treatment of refugees became challenging. To describe the current experience with pediatric refugees in Germany and Austria. 43,137 patients (<21 years) with type 1 diabetes from the diabetes patient follow-up registry (DPV) were studied and divided by refugee status into patients born in Middle East (n = 365) or Africa (n = 175) and native patients (child and parents born in Germany/Austria; G/A: n = 42,597). Groups were compared using multivariable regression adjusted for age, sex and diabetes duration (SAS 9.4). In refugees the first year after arrival was studied, and for native children the most recent year of care. After adjustment, HbA1c was highest in refugees (1. ME and 2. AFR vs 3. G/A: 72.3 ± 1.0 and 75.0 ± 1.4 vs 66.0 ± 0.1 mmol/mol, 1 vs 3: P < 0.001 and 2 vs 3: P < 0.001) and microalbuminuria (9.9 and 13.6 vs 6.5%, 1 vs 3: P = 0.039 and 2 vs 3: P = 0.002) was more prevalent. African children experienced severe hypoglycemia (17.8 ± 4.3 and 25.4 ± 8.7 vs 11.5 ± 0.3 per 100 patient years, 1 vs 3: P > 0.05 and 2 vs 3: P = 0.045) significantly more often, whereas hypoglycemia with coma (5.1 ± 1.1 and 4.1 ± 1.6 vs 2.6 ± 0.1 per 100 patient years, 1 vs 3: P = 0.006 and 2 vs 3: P > 0.05) and retinopathy (2.1 and n/a vs 0.2%, 1 vs 3: P < 0.001) were significantly more common in children from Middle East compared to natives. Insulin pumps were used in a markedly larger proportion of native patients (7.4 and 13.2 vs 43.0%, 1 vs 3: P < 0.001 and 2 vs 3: P < 0.001). A relevant number of pediatric refugees with type 1 diabetes are treated in German/Austrian diabetes clinics. Refugee children, parents and caregivers are faced with several problems in diabetes therapy and outcome that should be addressed more intensively by pediatric diabetes teams.

Visual impairment and unmet eye care needs among a Syrian pediatric refugee population in a Canadian city

To assess the ocular health status of Syrian pediatric refugees in Canada and report the prevalence of vision impairment within this population. Cross-sectional descriptive study. Syrian refugees 18 years old or younger. Five clinic days were organized from July 2016 to November 2017 in Toronto, Ontario. A total of 274 patients were enrolled. Data collection involved surveys, vision screening, and ocular examinations. χ2 was used for statistical analysis. The prevalence of uncorrected vision was 17.2% for distance, 4.7% for near, and 0.7% for both distance and near vision, including loss of vision. Of these, 95.3% had not visited an eye specialist in the past year, and 25.2% of parents were dissatisfied with their children's vision. The presenting visual acuity in the better-seeing eye was 20/50 or worse in 5.8% (95% confidence interval [CI] 3.6%-9.3%), and this did not correct with pinhole. This rate is 32 times (p < 0.01) higher than the prevalence rate in the average Canadian pediatric population (0.17%). Uncorrected refractive error prevalence was 26.3% (95% CI 21.2%-31.9%), with the most common etiology being myopia (19.7% CI 15.2%-24.9%). Myopia was 17.9 times (p < 0.0001) more prevalent among our Syrian refugee children compared with the average Canadian pediatric population (1.1%). Syrian pediatric refugees residing in Canada have a high prevalence of vision problems. Comprehensive vision screening, improved access to eye clinics, and developing evidence-based guidelines may help address the unmet eye care needs of this vulnerable population.

Treatment of thalassemia among paediatric Syrian refugees in Lebanon: MSF experience

Treatment of thalassemia among paediatric Syrian refugees in Lebanon: MSF experience

Preventing Harm on Arrival: Lead Prevention in Newly Resettled Pediatric Refugees.

* Abbreviations: BLL — : blood lead level CDC — : Centers for Disease Control and Prevention EBLL — : elevated blood lead level Lead is a neurotoxin at low levels, and its effect on a child’s brain is not reversible.1 Given that there are no effective treatments to reverse the neurodevelopmental effects of elevated blood lead levels (EBLLs), prevention must be the primary strategy.2 EBLLs are twice as likely to be seen in newly arrived refugee children when compared with US-born children and may be particularly high in subpopulations of refugee children related to country of departure.3,4 Lead has a half-life of 35 days5; therefore, lead levels should fall at retesting of refugees 3 to 6 months after arrival in the United States. Pezzi et al’s4 “Blood Lead Levels Among Resettled Refugee Children in Select US States, 2010–2014” confirms EBLLs as a result of overseas exposures yet found that 10% of children, resettled in Colorado, Illinois, Indiana, Minnesota, and New York, with normal initial lead screen results had increased blood lead levels (BLLs) 3 to 6 months postresettlement. These findings support studies done in New Hampshire and Massachusetts that revealed that 6% to 29% of refugee children … Address correspondence to Andrea Green, MD, Department of Pediatrics, University of Vermont Children’s Hospital Pediatric Primary Care, 1 South Prospect St, Rehab 3, Burlington, VT 05401. E-mail: andrea.green{at}uvmhealth.org

Lead Exposure in Newly Resettled Pediatric Refugees in Syracuse, NY

Lead is a major environmental toxin that presents numerous health consequences for children. Refugee children are at a risk of lead poisoning post-resettlement due to urban housing and environmental inequalities stemming from lack of funding, legislation, and advocacy. This article addresses lead exposure upon arrival and post-resettlement in 705 refugee children (age 0–16 years) attending a university clinic in Syracuse, NY, a city with a large refugee population. 17% of the newly arrived children had elevated blood lead levels (BLLs) (≥ 5 µg/dL); 10% had elevated BLL upon follow-up; 8.3% of the children’s follow-up elevated BLL were new exposures. 30% were found to have increased BLL at follow-up regardless of arrival status. An analysis of new exposures found a significant proportion of children would have been missed on routine screening that targets children < 2 years old. Primary prevention efforts are needed to prevent exposure and address risks to improve the health of all children locally, including newly resettled refugees.

Paediatric asylum seekers in Western Australia: Identification of adversity and complex needs through comprehensive refugee health assessment.

Asylum seekers (ASs) report high rates of trauma and difficulty accessing health and educational services. This study aims to ascertain the needs of paediatric ASs managed by the tertiary Western Australian paediatric Refugee Health Service (RHS), including demographic features, the range of health and psychosocial issues and ongoing management challenges. An audit of multidisciplinary RHS assessments, health records and hospital admissions for new AS patients (<16 years) between July 2012 and June 2016 was undertaken. Records for 110 ASs were reviewed (mean age 6 years, standard deviation 4.72 years). Multiple issues (medical, psychological, developmental, educational) were identified after the first tertiary assessment (median 4, interquartile range (IQR) 3-6) compared to referral sources (median 1, IQR 0-2, P < 0.001). The median number of issues per child at audit completion was 6 (IQR 4-7, P < 0.001). Multiple refugee adverse childhood experiences were identified, with all experiencing >3 (median 4, IQR 4-5). Most had detention experience (107/110, 97.2%), family separation (91/108, 84%) and interrupted education (41/46, 89.2%). The median duration of detention was 7 months (IQR 3-12.5 months) at time of initial review across multiple sites (median 2, IQR 1-3 locations). High rates of hospital interaction were evident, with 45.4% requiring hospital admission and 36% presenting to the emergency department. The median number of outpatient appointments attended per child was 5 (IQR 2-8). Parental and child mental health concerns were identified in 53.6 and 46.3%, respectively. Paediatric ASs have complex trauma backgrounds with exposure to multiple adverse events within disrupted family units. The majority of Western Australian ASs assessed demonstrated negative health or education sequelae compounded by detention not previously identified prior to comprehensive paediatric review. Our data support the urgent removal of ASs from held detention. Ongoing holistic assessment and management engaging multidisciplinary trauma-informed paediatric refugee services to optimise health and well-being is recommended.

Latent tuberculosis may be missed by current screening practices: Analysis of interferon-gamma release assay results from a paediatric refugee clinic.

(i) To determine the prevalence of latent tuberculosis infection (LTBI) and characteristics associated with LTBI in children attending a paediatric refugee clinic and (ii) to determine whether current New South Wales (NSW) Health screening practices could miss LTBI cases. This was a retrospective analysis of tuberculosis (TB) screening data from refugee and asylum seeker children who attended a refugee clinic in a tertiary children's hospital during 2014 and 2015. We determined associations between LTBI and child characteristics at 5% significance levels. Of 358 children attending the clinic, 235 children (66%) received interferon-gamma release assay (IGRA) testing, of whom 28 (11.9%) had positive results. Of the 28 with positive IGRAs, 12 (42.9%) would have been missed using NSW Health screening guidelines: two because they were younger than 2 years old, one who was born in Australia and 10 because they were not born in high TB incidence countries. IGRA results were not significantly associated with any of the child characteristics examined, including age, gender, travel through transit countries, boat versus plane arrival into Australia, whether the child had been in a detention centre or TB incidence in the source country. We identified 12 children with LTBI who would have been missed using current NSW Health Department screening practices. These children are at risk of progression to active disease, particularly the two aged younger than 2 years old. We recommend universal screening.

Nutritional assessment of resettled paediatric refugees in Western Australia.

Nutritional deprivation, inadequate diet and food insecurity are common refugee experiences. The growth and nutritional status of paediatric refugees following resettlement in developed countries and the related interplay with socio-economic factors remain less defined; this study aims to describe these features. Standardised dietary, medical and socio-demographic health assessments of new refugee patients attending a multidisciplinary paediatric Refugee Health Service (RHS) in Western Australia between 2010 and 2015 were analysed. Demographic data from 1131 paediatric refugees are described (age 2 months to 17.8 years). The majority experienced socio-economic disadvantage, had limited parental education and required interpreters. Nutritional deficiencies were common but varied across ethnicities: iron deficiency (ID) (12.3%), anaemia (7.3%) and inadequate dairy intake (41.0%). A third of children (32.6%) did not consume meat. Infant breastfeeding was sustained (77.8%) in infants <12 months. Prolonged breastfeeding (44.9% aged 12-24 months) was associated with an increased risk of ID (odds ratio 4.0, 95% confidence interval 1.4-11.6). Median body mass index increased significantly for those >24 months between referral and RHS assessment (median period 1.8 months). Overall, 27.1% required additional formal dietetic follow-up, with higher nutritional concerns in refugee children <24 months compared to older patients. Identification of frequent post-settlement nutritional concerns has been captured through structured multidisciplinary paediatric health screening. Specific screening for socio-economic influencing factors, including education, poverty and food insecurity, during refugee clinical assessments is recommended. Development of targeted, culturally appropriate parental education resources and interventions may improve management following resettlement. Longitudinal research assessing resettlement growth trajectories is required.

OBESITY TRENDS AND RISK FACTORS AMONG REFUGEE CHILDREN/YOUTH: A SCOPING REVIEW

Abstract BACKGROUND Overweight and obese children are at a heightened risk of adult-onset health complications including hypertension, cardiovascular disease, type 2 diabetes, certain cancers, and psychosocial complications. These disorders can begin in childhood, which increases the likelihood of early morbidity and mortality. In parallel, over the past two decades, the global population of refugees has grown substantially. OBJECTIVES Given the rapid increase of refugee populations in Canada, it is important to understand how obesity and overweight patterns for refugee children and youth differ from those of native-born populations. To date, no review has comprehensively documented weight gain trends and risk factors in paediatric refugee populations. DESIGN/METHODS A scoping review of the literature was conducted using Medline, CINAHL, and EMBASE for publications in English from August 1991 to April 2017. A total of 11 articles were identified relating to prevalence and risk factors for becoming overweight/obese in refugee children and youth aged 0 to 18 years old after arrival in a high-income setting. RESULTS Paediatric refugees were at increased risk of rapid weight gain after migration. After living in a HIC for 1.5 to 9 years, refugee children demonstrated a prevalence of obesity that ranged from 1.4 to 21%. The prevalence of overweight children and youth ranged from 5.7 to 22.8%. Refugee children and youth had a steeper increase in their BMI compared with non-refugees (P &lt; 0.001). Younger children (&lt; 2 years) experienced an increase in BMI at a slower rate (P = 0.002) than older children and youth. A longer length of stay in HICs was associated with an increase in BMI percentile among refugee children. Populations of Eastern European, African, and Middle Eastern ethnic backgrounds demonstrated a higher risk of becoming overweight/obese in comparison to other paediatric refugees or non-refugee children. CONCLUSION This review demonstrates that despite methodological differences between the 11 included studies, 6 of them consistently demonstrate a direct relationship between increased BMI and length of residence in HICs among refugee children. Multiple studies (n=7) emphasize the need for culturally tailored prevention strategies including timely orientation to nutrition in HICs. Preventing the development of obesity among refugee children is crucial for reducing the short and long-term health consequences associated with childhood obesity.

Nutritional Assessment of Resettled Paediatric Refugees in Western Australia

Nutritional Assessment of Resettled Paediatric Refugees in Western Australia

Oral Health and Dental Clinic Attendance Trends Within Pediatric Refugees

Oral Health and Dental Clinic Attendance Trends Within Pediatric Refugees

Helping refugee children thrive: what we know and where to next

Australia offers a small but well-regarded refugee programme offering extensive support to the 13 750 refugees settled in the country each year, after the processing of their protection claims by...