Refugee Health Clinic Research Articles

Assessment of San Antonio refugee health clinic telehealth response and refugees’ needs during the COVID-19 pandemic

In March of 2020, Texas declared a statewide public health emergency in response to the rapidly spreading COVID-19 virus, forcing the shutdown of many critical operations across the state. The pandemic has had a massive impact on the refugee population worldwide, increasing displacement and limiting opportunities for resettlement, work, and aid. In an effort to evaluate and address the holistic needs of the San Antonio's vulnerable refugee community during the pandemic, the San Antonio Refugee Health Clinic (SARHC) created a COVID-19 response team that screened and triaged the population, collected data, and provided telemedicine and other urgent teleservices.The SARHC clinic has served the mostly uninsured and underserved refugee population of San Antonio, Texas for over 10 years as a Student-Faculty Collaborative Practice (SFCP). With the collaboration of the Center for Refugee Services in San Antonio, the clinic utilizes the site of a local church on a weekly basis to serve refugees via teams of nursing, dental, and medical students and faculty.At the height of the COVID-19 lockdown, teams of student and faculty volunteers conducted a cross-sectional study of patients’ needs by systematically calling and screening patients. Qualitative data on COVID-19 risk, mental wellness, financial needs, food security, dental needs, and medical needs was collected. Quantitative data on number of patients contacted, country of origin, interpreter use, insurance access, internet access, referrals, appointments, and prescriptions carried out was also collected and analyzed.Of the patients called (N = 216), 57% (n = 123) were successfully reached and completed the survey. 61% (n = 75) required language interpreter services. Only 9% (n = 11) of individuals had health insurance. 46% (n = 52) expressed the need for telemedicine services, and 34% (n = 42) reported access to WiFi. 41% (n = 50) reported a medical concern, 18% (n = 22) reported dental concerns, 41% (n = 51) reported social needs, and 11% (n = 14) reported mental health concerns. 24% (n = 30) of patients requested medication refills.Our snapshot of the San Antonio refugee community during the COVID-19 pandemic captures their social, mental, and physical struggles; the pandemic left many families without access to medications, health services, social services, job, and food security. The telemedicine campaign proved to be an effective method of assessing and addressing a variety of patient needs in a virtual setting. Of concern is the high rates of uninsured families and limited Internet access. These findings reveal important considerations for equitable healthcare delivery to vulnerable populations in the face of prolonged unforeseen events, like the COVID-19 pandemic.

Iron deficiency, anemia and association with refugee camp exposure among recently resettled refugees: A Canadian retrospective cohort study.

Malnutrition and poor health are common among recently resettled refugees and may be differentially associated with pre-migration exposure to refugee camp versus non-camp dwelling. We aimed to investigate the associations of iron deficiency (ID), anemia, and ID anemia (IDA) with pre-migration refugee camp exposure among recently arrived refugees to Canada. To this end, we conducted a retrospective cohort study of 1032 adult refugees who received care between January 1, 2011, and December 31, 2015, within a specialized refugee health clinic in Calgary, Canada. We evaluated the prevalence, severity, and predictors of ID, anemia, and IDA, stratified by sex. Using multivariable logistic regression, we estimated the association of refugee camp exposure with these outcomes, adjusting for age, months in Canada prior to investigations, global region of origin, and parity. Among female refugees, the prevalence of ID, anemia, and IDA was 25% (134/534), 21% (110/534), and 14% (76/534), respectively; among males, 0.8% (4/494), 1.8% (9/494), and 0% (0/494), respectively. Anemia was mild, moderate, and severe in 55% (60/110), 44% (48/110) and 1.8% (2/110) of anemic females. Refugee camp exposure was not associated with ID, anemia, or IDA while age by year (ID OR = 0.96, 95% CI 0.93-0.98; anemia OR = 0.98, 95% CI 0.96-1.00; IDA OR = 0.96, 95% CI 0.94-0.99) and months in Canada prior to investigations (ID OR = 0.85, 95% CI 0.72-1.01; anemia OR = 0.81, 95% CI 0.67-0.97; IDA OR = 0.80, 95% CI 0.64-1.00) were inversely correlated with these outcomes. ID, anemia, and IDA are common among recently arrived refugee women irrespective of refugee camp exposure. Our findings suggest these outcomes likely improve after resettlement; however, given proportionally few refugees are resettled globally, likely millions of refugee women and girls are affected.

A telehealth approach addressing refugees' urgent oral health care.

Journal of Dental EducationVolume 86, Issue S3 p. 1767-1770 ADVANCING THROUGH INNOVATION A telehealth approach addressing refugees’ urgent oral health care Moshtagh R. Farokhi DDS, MPH, Corresponding Author Moshtagh R. Farokhi DDS, MPH [email protected] Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio School of Dentistry, San Antonio, Texas, USA Correspondence Moshtagh R. Farokhi, DDS, MPH, Clinical Department of Comprehensive Dentistry, San Antonio Refugee Health Clinic, University of Texas Health Science Center at San Antonio School of Dentistry, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. Email: [email protected]Search for more papers by this authorNurani Kester MD, Nurani Kester MD Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USASearch for more papers by this authorRuth Grubesic DrPH, RN, Ruth Grubesic DrPH, RN Office of Faculty Excellence, University of Texas Health Science Center at San Antonio School of Nursing, San Antonio, Texas, USASearch for more papers by this authorHeidi Worabo DNP, RN, Heidi Worabo DNP, RN Office of Faculty Excellence, University of Texas Health Science Center at San Antonio School of Nursing, San Antonio, Texas, USASearch for more papers by this author Moshtagh R. Farokhi DDS, MPH, Corresponding Author Moshtagh R. Farokhi DDS, MPH [email protected] Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio School of Dentistry, San Antonio, Texas, USA Correspondence Moshtagh R. Farokhi, DDS, MPH, Clinical Department of Comprehensive Dentistry, San Antonio Refugee Health Clinic, University of Texas Health Science Center at San Antonio School of Dentistry, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. Email: [email protected]Search for more papers by this authorNurani Kester MD, Nurani Kester MD Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USASearch for more papers by this authorRuth Grubesic DrPH, RN, Ruth Grubesic DrPH, RN Office of Faculty Excellence, University of Texas Health Science Center at San Antonio School of Nursing, San Antonio, Texas, USASearch for more papers by this authorHeidi Worabo DNP, RN, Heidi Worabo DNP, RN Office of Faculty Excellence, University of Texas Health Science Center at San Antonio School of Nursing, San Antonio, Texas, USASearch for more papers by this author First published: 15 March 2022 https://doi.org/10.1002/jdd.12925Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume86, IssueS3Supplement: Advancing Through InnovationDecember 2022Pages 1767-1770 RelatedInformation

Cervical Cancer Screening by Refugee Category in a Refugee Health Primary Care Clinic in Calgary, Canada, 2011–2016

Newly arrived refugees and refugee claimants experience low cervical cancer screening (CCS) rates in Canada. We investigated CCS at a dedicated refugee clinic. We completed a retrospective cohort study among patients at the Mosaic Refugee Health Clinic in Calgary, Canada, between 2011 and 2016. We investigated CCS offers and completion by refugee category. We then used multivariable logistic regression to estimate the association of CCS screening and refugee category, accounting for sociodemographic and clinical factors. We included 812 refugees. Most were married (71%) and had limited English proficiency (57%). Overall, 88% and 77% of patients were offered and completed screening, respectively. Compared to government assisted refugees, privately sponsored refugees completed CCS more often (OR 1.60, 95% CI [1.02–2.49]). A dedicated refugee clinic may provide effective CCS to newly arrived refugees irrespective of refugee category, insurance status or other barriers.

Providing Care by Telephone to Refugees and Asylum Seekers: An Evaluation of Telephone Mode-of-Care in Monash Health Refugee Health and Wellbeing Clinic in Victoria, Australia.

An evaluation of accessibility, appropriateness, acceptability and efficiency of telephone consultations, implemented at Monash Health Refugee Health and Wellbeing (MH RHW) throughout the COVID-19 pandemic, was conducted. A convergent mix-methods design was used, with both patients (n = 50) and clinicians (n = 11) participating in a survey, and two focus groups (n = 14) involving clinicians being conducted. Service utilization data was sourced from the MH RHW database. During May to December 2020, 61% (n = 3012) of the consultations were conducted by telephone, 42% (n = 11) of these required interpreters in a 3-way conversation Most patients were satisfied with telephone as a medium for providing care and with the quality of telephone-based care. Similarly, clinicians considered telephone consultations to be an acceptable mode-of-care for most patients during the pandemic, however, expressed caution in relation to certain patient cohort. Finally, the provision of care by telephone was considered no more efficient than face-to-face service provision, as reflected in the time required for each consultation, with some clinicians reporting adverse workload outcomes. This study highlighted the benefits and challenges of telephone consultations from patient and clinician perspectives. It also highlighted the types of patients that may not be suited to telephone consultations. Overall, this study showed that telephone service delivery is a feasible option in providing care to people of refugee background and should be considered in future decisions as an ongoing Medicare (Australia's universal healthcare insurance scheme) billing item. However, clinical discretion should prevail in determining the most appropriate means of delivering care.

Training and Integrating Public Service Interpreters in a Refugee Health Clinic: A Mixed-Method Approach to Evaluate an Innovative Program

Language barriers can harm refugees’ health, and trained interpreters are a solution to overcome these barriers in all health consultations. This study trained interpreters and integrated them in a refugee clinic. Nepali-speaking migrants were recruited and underwent 50 hours of training to serve as interpreters for recently arrived Bhutanese refugees in Quebec City. To evaluate the project, mixed data were collected. At baseline and follow-up, patients’ health (as perceived by practitioners) and satisfaction were evaluated. Interpreters and practitioners were also interviewed and took part in joint discussion workshops. Patients’ health remained stable but, interestingly, patients were slightly less satisfied at follow-up. Practitioners and interpreters described both benefits and difficulties of the program. For example, integrating interpreters within the clinical team allowed for better collaboration and mutual knowledge of cultures. Challenges included work overload, conflicts between interpreters and practitioners, and role conflicts for interpreters. Overall, the full-time integration of trained interpreters in the clinic facilitated communication and case administration. This practice could be especially beneficial for refugee clients. In future interventions, interpreter roles should be better clarified to patients and practitioners, and particular attention should be paid to selection criteria for interpreters.

Voices of the community: Exploring the experiences of resettled refugee interpreters at a refugee clinic in a large multicultural city in Texas, United States of America.

Worldwide refugees numbered nearly 25.9 million in 2018 and, according to the United Nations High Commissioner for Refugees, the crisis grows each year. Research reports that refugees have a high prevalence of mental health conditions and are at increased risk for emotional and mental distress during resettlement. Furthermore, interpreters have been shown to be at increased risk for secondary re-traumatisation, a condition similar to Post Traumatic Stress Disorder, where client trauma shares commonalities with trauma experienced by the interpreter. The purpose of this study was to explore the experiences of resettled refugee interpreters. Based on previous data from this community, the research team determined that a qualitative methodology was best practice to explore the experiences of resettled refugee interpreters. In May of 2019, seven participants were recruited from a pool of resettled refugee interpreters who worked at a refugee health clinic in a large multicultural city in Texas. One-on-one interviews were conducted, and the data were analysed using content analysis. Five themes emerged that represented the experiences of these participants: speaking for others, developing interpretation strategies, advocating for the community, receiving social support and overcoming challenges specific to the healthcare setting. The findings from this study add to the current body of literature that addresses the experiences of resettled refugee interpreters. Furthermore, these data may be used to create additional resources for refugee interpreters who work at health clinics, such as training on medical terminology, access to mental health services and site-specific incentives.

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.

San Antonio refugees: Their demographics, healthcare profiles, and how to better serve them.

ObjectiveThe recent refugee crisis has resulted in the largest burden of displacement in history, with the US being the top resettlement country since 1975. Texas welcomed the second most US-bound refugees in 2016, with a large percentage arriving in San Antonio. Yet, the composition of the San Antonio refugees has not been described and their healthcare needs remain ill-defined. Through this study, we aim at elucidating their demographics and healthcare profiles, with the goal of devising recommendations to help guide refugee program development and guide other refugee resettlement programs.MethodsData from 731 charts belonging to 448 patients at the San Antonio Refugee Health Clinic (SARHC) were extracted and analyzed. Data included age, gender, country of origin, first language, interpretation need, health insurance status, medical history, vital signs, diagnoses, and prescribed medications.ResultsWomen constituted the majority of patients (n = 267; 56.4%), and the median age of all patients was 39 (Q1:26, Q3:52). Nepali-speaking Bhutanese patients were the most represented group (n = 107, 43.1%), followed by Iraqi (n = 35, 14.1%), Burmese (n = 30, 12.1%), and Iranian (n = 19, 7.7%) refugees. Of those who responded, 200 (86.6%) did not have any form of health insurance. Additionally, 262 (50.9%) had a body-mass index (BMI) in the overweight or obese range. Further, 61.4% (n = 337) had blood pressures in the hypertensive range, while 9.3% (n = 51) had an elevated blood pressure. On average, each patient had 1.9 complaints, with abdominal pain, headaches, and cough being the predominant complaints. Allergic rhinitis, viral upper respiratory infections, and elevated blood pressure were the most common diagnoses. However, the list of common diagnoses differed per country of origin.ConclusionThe SARHC demographics were different from those of other Texas refugees. The rate of the uninsured and the burden of non-communicable diseases were high. Furthermore, each refugee subgroup had a different set of common problems. These findings reveal important considerations for refugee healthcare providers and the unique approach that may be required for different communities.

Caring for pregnant refugee women in a turbulent policy landscape: perspectives of health care professionals in Calgary, Alberta

BackgroundFemale refugees can be a vulnerable population, often having suffered through traumatic events that pose risks to their health, especially during pregnancy. Pregnancy can be an entry point into the health care system, providing health care professionals the opportunity to gain women’s trust, connect refugees with resources, and optimize the health of mother and child. Policies surrounding the provision and funding of health care services to refugees can impact access to and quality of care. The aim of our study was to understand the experiences of health care professionals caring for pregnant refugee women in Calgary, AB, taking into consideration recent contextual changes to the refugee landscape in Canada.MethodsWe conducted ten semi-structured interviews with health care professionals who provided regular care for pregnant refugee women at a refugee health clinic and major hospital in Calgary, Alberta. Interviews were recorded, transcribed, and analyzed using an interpretive description methodology.ResultsHealth care providers described several barriers when caring for pregnant refugees, including language barriers, difficulty navigating the health care system, and cultural barriers such as managing traditional gender dynamics, only wanting a female provider and differences in medical practices. Providers managed these barriers through strategies including using a team-based approach to care, coordinating the patient’s care with other services, and addressing both the medical and social needs of the patient. The federal funding cuts added additional challenges, as many refugees were left without adequate health coverage and the system was complicated to understand. Health care providers developed creative strategies to maximize coverage for their patients including paying out of pocket or relying on donations to care for uninsured refugees. Finally, the recent Syrian refugee influx has increased the demand on service providers and further strained already limited resources.ConclusionHealth care providers caring for pregnant refugee women faced complex cultural and system-level barriers, and used multiple strategies to address these barriers. Additional system strains add extra pressure on health care professionals, requiring them to quickly adjust and accommodate for new demands.

Health issues of refugees attending an infectious disease refugee health clinic in a regional Australian hospital

Refugees in Australia present with conditions different to those of the general population. The aim of this study was to review the reasons for referral, prevalence of conditions and treatment outcomes for refugee patients attending a specialist referral clinic in regional Victoria. A retrospective review was undertaken of patients attending the refugee health clinic at University Hospital Geelong from January 2007 to December 2012. Two hundred and ninety-one refugee patients attended the clinic over the six-year period. Latent tuberculosis infection (LTBI) (54.6%), vitamin deficiencies (15.8%), hepatitis B (11%) and schistosomiasis (11%) were the most common diagnoses. Less than two-thirds of the patients completed LTBI treatment; 35.4% of patients attended all scheduled clinic appointments. LTBI, vitamin deficiencies, parasitic infections and hepatitis B were the most common diagnoses among refugees referred to the University Hospital Geelong (UHG) Refugee Health Clinic from January 2007 to December 2012. General practitioners play an important role in the care of refugees, guiding referral to specialist services when necessary and recognising the potential implications of suboptimal clinic attendance and treatment completion.

Prevalence of Nutritional Deficiencies Among Populations of Newly Arriving Government Assisted Refugee Children to Kitchener/Waterloo, Ontario, Canada

This study examined the variation among ethnic populations in prevalence of anemia, vitamin D and B12 deficiencies among refugee children. A retrospective chart review of 388 government assisted refugee children ≤ 16years of age, seen at the Refugee Health Clinic in Kitchener, Canada from January 2009 to December 2014 was conducted. Vitamin D levels were only collected until December 1st 2010 (116 children). 15.7% were anemic (25% < 5years, 8.7% 5-11 years, and 18.3% 12-16years old) with Somali children having the lowest hemoglobin levels compared to those from Iraq, Afghanistan and Myanmar. 53.5% were vitamin D deficient (25(OH)D < 50nmol/L), seen most commonly in Iraqis and Afghans. 11.2% had vitamin B12 levels < 150pmol/L. Providers' knowledge of prevalence of nutritional deficiencies related to region of origin, can guide appropriate screening and treatment options to promote longer term cognitive, physical and developmental health.

The mental health status of refugees and asylum seekers attending a refugee health clinic including comparisons with a matched sample of Australian-born residents

BackgroundThe aim of this study was to survey refugees and asylum-seekers attending a Refugee Health Service in Melbourne, Australia to estimate the prevalence of psychiatric disorders based on screening measures and with post-traumatic stress disorder (PTSD) specifically highlighted. A secondary aim was to compare the prevalence findings with Australian-born matched comparators from the 2007 National Survey of Mental Health and Well-Being.MethodsWe conducted a cross-sectional survey of 135 refugees and asylum-seeker participants using instruments including Kessler-10 (K10) and PTSD-8 to obtain estimates of the prevalence of mental disorders. We also performed a comparative analysis using matched sets of one participant and four Australian-born residents, comparing prevalence results with conditional Poisson regression estimated risk ratios (RR).ResultsThe prevalence of mental illness as measured by K10 was 50.4%, while 22.9% and 31.3% of participants screened positive for PTSD symptoms in the previous month and lifetime, respectively. The matched analysis yielded a risk ratio of 3.16 [95% confidence interval (CI): 2.30, 4.34] for abnormal K10, 2.25 (95% CI: 1.53, 3.29) for PTSD-lifetime and 4.44 (95% CI: 2.64, 7.48) for PTSD-month.ConclusionsThis information on high absolute and relative risk of mental illness substantiate the increased need for mental health screening and care in this and potentially other refugee clinics and should be considered in relation to service planning. While the results cannot be generalised outside this setting, the method may be more broadly applicable, enabling the rapid collection of key information to support service planning for new waves of refugees and asylum-seekers. Matching data with existing national surveys is a useful way to estimate differences between groups at no additional cost, especially when the target group is comparatively small within a population.

Screening tool for Asylum-Seeker Mental Health (STAMH): A pilot study

Aims and rationale The development of a brief, highly sensitive screening tool (STAMH) easily administered by non-mental health workers to screen for mental disorders in adult asylum-seekers (AS) aims to facilitate timely access to treatment. Methods An initial version of the STAMH developed from validated scales from a previous study was refined to 10 questions through an iterative piloting process. Adult AS without a known current psychiatric diagnosis was recruited through two Melbourne-based agencies (Asylum Seeker Resource Centre & Monash Health Refugee Health Clinic), which meet AS health and psychosocial needs. All participants were administered the STAMH by non-mental health professionals and subsequently interviewed by the researcher using the MINI 6.0, to determine psychiatric morbidity. Data was analysed through CART and ROC curve analyses, and sensitivity (SN)/specificity (SP) determined the most accurate cut-off score to detect PTSD &/or major depressive disorder (MDD). Findings Preliminary findings are based on 150 AS from 37 countries. The majority was male (71%) and required an English language interpreter (62%). 36% met criteria for at least one clinical diagnosis: 33% for MDD, 22% for PTSD. However, only 30% of these participants had received mental health treatment in Australia. A cut-off score of≥2 produced .94 (SN) and .65 (SP) for PTSD &/or MDD with a ROC of .80 P Relevance to policy, research and/or practice needs The STAMH shows promise in its aim to fill a service gap of detecting mental disorders in AS, through its brevity and sensitivity.

Lessons of resilience provided by refugee children

As the number of families seeking refuge has skyrocketed, questions have been raised throughout the world community about what it means to grant refuge and resettlement and how this can affect the communities that become the new homes for resettled families. Arguably, something that is missing from the public discourse is a discussion about how refugee families may truly and deeply benefit Americans. As providers working in the Hasbro Children's Hospital Refugee Health Clinic in Providence, Rhode Island, we have had the privilege to experience firsthand the ways that refugee families can enrich and teach the larger communities where they are resettled. In this commentary, we want to share perspectives that we have found that our refugee families bring to their daily lives — perspectives we believe can be enriching to the communities where they are resettled.

Refugee children's play: Before and after migration to Australia.

Play is vital to children's development, health and resilience. Play modulates cognitive, emotional and social well-being. Children constitute approximately half of all humanitarian refugee entrants resettled in Australia. Refugee children are commonly victims and witnesses of war and persecution, living across resource-poor environs during transit. Little is known about the effects of refugee migration on play. This study explores how refugee children engaged in play pre-migration (in their home country) and post-migration (Australia). Refugee children attending the Refugee Health Clinic of a tertiary children's hospital were invited to complete a qualitative descriptive study of play. The children were asked to draw how they played pre- and post-migration. Drawings were analysed for (i) the presence of play; (ii) location of play; and (iii) drawing detail. Nineteen refugee children were recruited (mean age 8.5 years ± standard deviation 6.4 months). Significantly fewer children drew play pre- versus post-migration (11/19, 58% vs. 18/19, 95% P < 0.03). Girls had greater comparative changes in play with migration (pre: 2/8, 25% vs. post: 7/8, 87%, P = 0.06), trending to significance. Of those children who drew play, almost all drew playing outside (pre-migration: 10/11, 90.9%; post-migration: 17/18, 94.4%). Drawings showed equivalent detail pre- and post-migration. Resettled refugee children, especially girls, demonstrated limited play pre-migration, with higher levels of engagement post-resettlement. Facilitating opportunities for variety of play may strengthen positive resettlement outcomes for children and parents. Larger longitudinal studies examining play in refugee children and associations with physical, development and psychological well-being are warranted.

Caries burden and efficacy of a referral pathway in a cohort of preschool refugee children.

This study aimed to assess the early caries experience and the efficacy of a community based dental referral pathway in preschool refugees in Western Australia. Preschool refugee children referred to the Western Australian paediatric hospital Refugee Health Clinic were prospectively screened for caries by a paediatric dentist before being referred to community dental clinics. Dental forms and medical records were audited to assess decayed, missing and filled teeth (dmft), medical data and dental services engagement. Poisson regression analysis determined the contribution of count variables to the final model. Among the 105 screened children (54% male, median age 3.2 years, 41% Burmese), community dental clinic engagement was low (46%, n=48). Of the 62% with caries (n=65/105, mean dmft 5.2, SD 4.1), 45% were recommended for specialist dental services and 48% were treated. After adjustment for age, gender and total number of teeth, caries incidence was significantly associated with BMI-for-age Z score (p=0.02). Preschool refugee caries burden was high. The community dental referral pathway was ineffective compared to co-located intersectorial dental screening. Specialist dental service needs are high in this cohort and require a targeted approach.

A cross-sectional survey of the mental health needs of refugees and asylum seekers attending a refugee health clinic: a study protocol for using research to inform local service delivery.

BackgroundRefugees and asylum seekers have high rates of risk factors for mental disorders. In recent years, Australia has experienced a rapid increase in asylum seeker arrivals, creating new challenges for services in areas with high settlement numbers. This paper describes the design, including analytic framework, of a project set in a refugee health service in the state of Victoria, Australia, as part of their response to meeting the mental health needs of their burgeoning local population of refugees and asylum seekers. In order to assist service planning, the primary aim of this study is to determine: 1) an overall estimate of the prevalence of psychiatric disorders; 2) the specific prevalence of post-traumatic stress disorder 3) the perceived need and unmet need for mental health treatment. The secondary aim of the study is to establish matched risk ratios based on an Australian-born matched comparison group from the 2007 National Survey of Mental Health and Well-Being.Methods/DesignA cross-sectional survey is used to estimate the prevalence of psychiatric disorders in refugees and asylum seekers attending a local refugee health service. Measures include the Kessler Psychological Distress Scale-10, the Post-Traumatic Stress Disorder-8, the General-practice User’s Perceived-need Inventory together with service utilisation questions from the National Survey of Mental Health and Well-Being. Data collected from refugees and asylum seekers (n = 130) is matched to existing data from Australian-born residents drawn from the 2007 National Survey of Mental Health and Well-Being (n = 520) to produce estimates of the risk ratio.DiscussionThe paper describes a prototype for what is possible within regular services seeking to plan for and deliver high quality mental health care to refugees and asylum seekers. A novel project output will be the development and dissemination of an epidemiological methodology to reliably compare mental health status in a relatively small target sample with a matched comparator group.

Comparison of Infant Vitamin D Supplement Use Among Canadian-Born, Immigrant, and Refugee Mothers

This study compares knowledge and practice of infant vitamin D supplementation among immigrant, refugee, and Canadian-born mothers. Focus group discussions with 94 mothers of children aged 0 to 3 years recruited from early childhood centers and a refugee health clinic. Both immigrant and Canadian-born mothers indicated good knowledge and use of infant vitamin D supplementation. In contrast, Canadian government-assisted refugees were less likely to supplement with vitamin D. The main source of information about vitamin D was public health prenatal classes. Many mothers reported inconsistent guidance from health care providers. Exclusively breastfed infants of refugees may be more at risk of vitamin D deficiency. All mothers require clear recommendations, both in clinical and public health settings. Mothers, both new Canadian and Canadian-born, require clear and consistent messaging from health professionals. Refugee mothers, however, require more educational support to promote infant vitamin D supplementation.

Integrated Primary Care Improves Access to Healthcare for Newly Arrived Refugees in Canada

In this study we quantify the impact of a partnership between a dedicated health clinic for government assisted refugees (GARs), a local reception centre and community providers, on wait times and referrals. This study used a before and after, repeated survey study design to analyze archived administrative data. Using various statistical techniques, outcomes for refugees arriving 18 months prior to the introduction of the clinic were compared with those of refugees arriving in the 18 months after the clinic was established. Our investigation revealed wait times to see a health care provider decreased by 30 % with the introduction of a dedicated refugee health clinic. The likelihood of GARs being referred to physician specialists decreased by 45 %, but those referred were more likely to require multiple referrals due to increasingly complex medical needs. Referrals to non-physician specialist health care providers nearly doubled following the availability of the clinic. The time-limited, but intense health needs of GARs, require an integrated community-based primary healthcare intervention that includes dedicated health system navigators to support timely, more culturally appropriate care and successful integration.