Use of traditional health practices by Southeast Asian refugees in a primary care clinic.

To determine the prevalence of use of traditional health practices among different ethnic groups of Southeast Asian refugees after their arrival in the United States, we conducted a convenience sample of 80 Cambodian, Lao, Mien, and ethnic Chinese patients (20 each) attending the University of Washington Refugee Clinic for a new or follow-up visit. Interpreters administered a questionnaire that dealt with demographics, medical complaints, traditional health practices, health beliefs, and attitudes toward Western practitioners. In all, 46 (58%) patients had used one or more traditional health practices, but the prevalence varied by ethnic group. Coining and massage were used by all groups except the Mien, whereas moxibustion and healing ceremonies were performed almost exclusively by the Mien. Traditional health practices were used for a variety of symptoms and, in 78% of reported uses, patients reported alleviation of symptoms. The use of traditional health practices is common among Southeast Asian refugees. Clinicians who care for this population should be aware of these practices because they may supersede treatments prescribed by physicians or leave cutaneous stigmata that may be confused with disease or physical abuse. Good patient care may necessitate the use or tolerance of both Western and traditional modalities in many Southeast Asian refugees.     

Health of Hmong in Thailand: Risk factors,morbidity and mortality in comparison with other ethnic groups

Demographic and health conditions among Hmong in Thailand were examined in comparison with other ethnic groups which closely resemble the ethnic origins of Southeast Asian refugees in the U.S. Thailand Hmong have very large extended family households, very high birth rates, low use of contraception, very young age at first marriage, and, compared with other highland minorities, relatively low infant and crude mortality rates. Hmong use of tobacco and alcohol and other stimulants is lower than other ethnic groups, and is much more frequent among men than among women. Opium was used by 15% of the men in the surveyed village, lower than among another highland group, but higher than in surveyed lowland villages. Fewer illnesses were reported by Hmong in the 7 days prior to survey than in other rural groups. Relatively low Hmong morbidity and mortality as compared with other highland ethnic groups may be associated with low use of tobacco and alcohol, and with the sharing of child care responsibilities within the large Hmong extended family households]This is the revised version of a paper presented at the Psychosocial Workshop of the Population Association of America Annual Meeting, Boston, 27 March 1985. Research was supported by National Science Foundation grant BNS 7914093, and by the East-West Center. Opinions expressed are those of the author.     

Increasing Neonatal Mortality among Palestine Refugees in the Gaza Strip

Background

The United Nations Relief and Works Agency for Palestine refugees in the Near East (UNRWA) has periodically estimated infant mortality rates among Palestine refugees in Gaza. These surveys have recorded a decline from 127 per 1000 live births in 1960 to 20.2 in 2008.

Methods

We used the same preceding-birth technique as in previous surveys. All multiparous mothers who came to the 22 UNRWA health centres to register their last-born child for immunization were asked if their preceding child was alive or dead. We based our target sample size on the infant mortality rate in 2008 and included 3128 mothers from August until October 2013. We used multiple logistic regression analyses to identify predictors of infant mortality.

Findings

Infant mortality in 2013 was 22.4 per 1000 live births compared with 20.2 in 2008 (p = 0.61), and this change reflected a statistically significant increase in neonatal mortality (from 12.0 to 20.3 per 1000 live births, p = 0.01). The main causes of the 65 infant deaths were preterm birth (n = 25, 39%), congenital anomalies (n = 19, 29%), and infections (n = 12, 19%). Risk factors for infant death were preterm birth (OR 9.88, 3.98–24.85), consanguinity (2.41, 1.35–4.30) and high-risk pregnancies (3.09, 1.46–6.53).

Conclusion

For the first time in five decades, mortality rates have increased among Palestine refugee newborns in Gaza. The possible causes of this trend may include inadequate neonatal care. We will estimate infant and neonatal mortality rates again in 2015 to see if this trend continues and, if so, to assess how it can be reversed.     

BCG immunization age in urban and rural areas of Akita Prefecture, Japan

BCG immunization, utilizing whole-body coordination, is a highly cost-effective means of health intervention for preventing miliary tuberculosis (TB) and TB meningitis. In this study, we investigated the appropriate age by which a child should have completed his or her BCG immunization and discuss the current BCG immunization rate in Akita Prefecture, Japan. BCG immunization rates in urban and rural areas were 90.1% and 80.7%, respectively. Our immunization data were lower than the World Health Organization's (WHO) recommended rate. Immunization coverage rates in urban settings were higher than those in rural areas among infants four months to fifteen months of age, except for those six months old. We recommend: (1) completing BCG immunization by the age of twelve months, (2) preparing and educating parents for BCG immunization by means of a health policy, and (3) changing BCG immunization methods from group to individual inoculation. Immunization coverage rates may be increased or maintained to prevent miliary TB and TB meningitis.     

Status of intestinal helminthic infections of borderline residents in North Korea

The present authors investigated intestinal parasitic infections among North Korean residents and refugees in China in 2003. The Kato-Katz method was applied to 236 residents and soldiers in a town on the North Korea-China border and to 46 people at a refugee camp in China. Only eggs of Ascaris and Trichuris were detected, with egg positive rates of 41.1% and 37.6%, respectively. The total egg positive rate was 55.0% and most of those who were egg positive were only lightly infected. Women of 61.2% and men of 53.1% were egg positive. The refugees from rural areas showed higher egg positive rates than those from urban areas. The present investigation confirmed high prevalence of soil-transmitted intestinal helminths in rural borderline areas of North Korea.     

National survey of notifications of tuberculosis in England and Wales in 1983. Medical Research Council Tuberculosis and Chest Diseases Unit.

In a survey of all notifications of tuberculosis in England and Wales for the first six months of 1983 56% of the 3002 newly notified patients who had not been treated before were of white and 37% were of Indian subcontinent (Indian, Pakistani, or Bangladeshi) ethnic origin, findings similar to those of a survey in 1978-9. In the four and a quarter years between the surveys the number of patients notified had declined by 26%, the decline being 28% among those of white and 23% among those of Indian subcontinent ethnic origin. The white patients were on average older than the patients of Indian subcontinent ethnic origin, and a higher proportion of them had respiratory disease (82% compared with 66%). The pulmonary lesions were on average larger and more often bacteriologically positive in the white patients. There were considerable differences between the ethnic groups in the estimated yearly rates of notifications per 100 000 population in England in 1983. The highest rates occurred in the Indian (178) and the Pakistani and Bangladeshi (169) populations and were roughly 25 times the rate in the white population (6 X 9). In the Indian subcontinent ethnic groups the highest rates occurred among those who had arrived in the United Kingdom within the previous five years.     

Diphtheria morbidity in Russia today

The data on diphtheria morbidity and the occurrence of carrier state for its causative agent at the period of 2001-2002 were analyzed. The rates of morbidity and detected carrier state for these years were 0.63-0.55 and 0.65-0.64 respectively. Nevertheless, in spite of the relatively low morbidity rates the presence of the toxic forms of diphtheria (400 patients for two years) and lethal cases (with lethality rate reaching 5.4%) indicated that the epidemic situation in diphtheria remained tense. The most unfavorable situation was observed in the North-Western and Central regions of Russia. In urban areas morbidity rates were still 2- to 3-fold higher in than in rural ones, but the latter showed a higher percentage of severe cases (46.6% in 2001 and 39.7% in 2002) and lethal outcomes (13.6% and 19.2%). The latter was indicative of drawbacks in the immunoprophylaxis, diagnostics and treatment of diphtheria in rural areas. In the total structure of diphtheria patients adults prevailed: 75%. The highest morbidity rates were registered among children aged 3-6 years, among adults in the age groups of 18-19 years and 50-59 years. The epidemic process developed mainly among the immunized population, which was indicated by a high proportion of vaccinated persons among those affected by this infection (62.8-66.6%) and a mild course of the disease in the majority of them. The present epidemiological situation in diphtheria was determined by patients not vaccinated against this infection. The proportion of severe cases among nonvaccinated children was 42.4-51.6% and lethal outcomes, 12.9-15.1%. Among nonimmunized adults these figures were equal to 43.1% and 9.3% respectively. The highest percentage of children, not vaccinated during the first years of their life, was registered among those in the asocial families, refugees and homeless persons. Among adults these were persons above 50 years old, as well as jobless persons of working age, pensioners and invalids, who had limited possibilities of undergoing vaccination due to their social position. It was these social and age groups that should be regarded as risk groups with respect to the severity of the course of diphtheria and lethality. To stabilize diphtheria morbidity, the full complex of prophylactic and antiepidemic measures, and primarily the immunization of the population, should be systematically carried out.     

Comprehensive analysis of genetic polymorphisms in the interleukin-10 promoter: implications for immune regulation in specific ethnic populations

The association of interleukin-10 (IL-10) promoter single-nucleotide polymorphisms (SNPs) as risk factors for certain inflammatory diseases, viral infections, cancers, and transplant rejection have been the subject of recent studies. The SNPs -1082 G --> A, -819 C --> T, and -592 C --> A, which have been associated with differential IL-10 production, are strongly linked with ethnicity. In this study, we determined the ethnic distribution of IL-10 promoter SNPs and their haplotype rates among Hispanics, African Americans, and Caucasians from Texas and Ashkenazi Jews from New York. Significant differences in prevalence rates of IL-10 SNPs (and their haplotype distribution) were found. African Americans and Hispanics have a lower rate of putative high-producer SNPs and a higher rate of low IL-10 producers when compared to Caucasians or Ashkenazi Jews. No statistically significant differences in allelic frequencies and haplotype rates were observed between Caucasians and Ashkenazi Jews. This study provides critical new information on the ethnic distribution of IL-10 promoter SNPs in a regional U. S. population and is the first to analyze the rate of SNPs in an unstudied ethnic population, Ashkenazi Jews. Knowledge of IL-10 promoter polymorphisms may prove useful in prediction of immunization responses, disease severity, and in the intelligent design of customized immunotherapy.     

Injury mortality in New Mexico's American Indians,Hispanics, and non-Hispanic whites, 1958 to 1982.

New Mexico has extraordinarily high injury mortality rates. To better characterize the injury problem in New Mexico, we calculated proportionate injury mortality and age-adjusted and age-specific injury mortality rates for the state''s 3 major ethnic groups--American Indians, Hispanics, and non-Hispanic whites. According to death certificate data collected from 1958 to 1982 and US population census figures, age-adjusted mortality rates for total external causes varied widely between the sexes and among the ethnic groups. Males in each ethnic group consistently had higher average annual age-adjusted external mortality rates than females. Injury mortality rates for American Indians of both sexes were 2 to 3 times higher than those for the other New Mexico ethnic groups. Motor vehicle crashes were the leading cause of death from injury for all 3 groups. Homicide accounted for twice the proportion of injury death in Hispanic compared with non-Hispanic white males (12.5% and 6.1%, respectively), while the proportion of males dying of suicide was highest in non-Hispanic whites. Deaths from excessive cold and exposure were leading causes of injury mortality for American Indians, but these causes were not among the leading causes of injury mortality for Hispanics or non-Hispanic whites. We conclude that the minority populations in New Mexico are at high risk for injury-related death and that the major causes of injury mortality vary substantially in the state''s predominant ethnic populations.     

Cesarean Sections Among Syrian Refugees in Lebanon from December 2012/January 2013 to June 2013: Probable Causes and Recommendations

Introduction: There are nearly 3 million Syrian refugees, with more than 1 million in Lebanon. We combined quantitative and qualitative methods to determine cesarean section (CS) rates among Syrian refugees accessing care through United Nations High Commissioner for Refugees (UNHCR)-contracted hospitals in Lebanon and possible driving factors.Methods: We analyzed hospital admission data from UNHCR’s main partners from December 2012/January 1, 2013, to June 30, 2013. We collected qualitative data in a subset of hospitals through semi-structured informant interviews.Results: Deliveries accounted for almost 50 percent of hospitalizations. The average CS rate was 35 percent of 6,366 deliveries. Women expressed strong preference for female providers. Clinicians observed that refugees had high incidence of birth and health complications diagnosed at delivery time that often required emergent CS.Discussion: CS rates are high among Syrian refugee women in Lebanon. Limited access and utilization of antenatal care, privatized health care, and male obstetrical providers may be important drivers that need to be addressed.     

Migration as a determinant of marriage pattern: preliminary report on consanguinity among Afghans

Two sample populations, one refugee and one resident, were studied. The frequencies of consanguineous marriages came out to be 49.8%and 55.4%, respectively, for the refugees and the residents. Caste endogamy was dominant both in the residents and the refugees. The mean coefficient of inbreeding was calculated to be 0.0303 for the refugee population and 0.0332 for the resident population samples. First cousin marriage was the dominant type of marriage in both samples; father's brother's daughter (FBD) marriage was more frequent among the refugees while mother's brother's daughter(MBD) marriage was more frequent among the residents. Education has no decreasing effect on the incidence of consanguineous marriages. A significant difference in the pattern of marriages in the refugees is observed after the Saur Revolution of 1979.     

Size and sociodemographic characteristics of the Afghan refugee population in Pakistan

Some recent data are presented on the size and selected sociodemographic characteristics of the Afghan refugee population in Pakistan. Although the official figures show that there were 3.27 million registered Afghan refugees in Pakistan, it is estimated that the actual number may be as high as 3.6 million. There is an excess of females over males, mainly due to war-related activities and excessive casualties particularly among males. While infant and childhood mortality rates are declining and are lower than the levels prevalent in Pakistan, as well as in Afghanistan during the pre-war period, the fertility levels among Afghan refugees seem very high indeed.     

A New Approach to Improving Healthcare Personnel Influenza Immunization Programs: A Randomized Controlled Trial

Background

Healthcare personnel influenza immunization rates remain sub-optimal. Following multiple studies and expert consultations, the “Successful Influenza Immunization Programs for Healthcare Personnel: A Guide for Program Planners” was produced. This trial assessed the impact of the Guide with facilitation in improving healthcare personnel influenza immunization rates in Canadian healthcare organizations.

Methods

A sample of 26 healthcare organizations across six Canadian provinces (ON, MB, NS, BC, SK, NL) was randomized to Intervention (n=13) or Control groups (n=13). Baseline influenza immunization rates were obtained for 2008–2009; the study groups were followed over two subsequent influenza seasons. The Intervention group received the Guide, facilitation support through workshops for managers and ongoing support. The Control groups conducted programs as usual. The Groups were compared using their reported influenza healthcare personnel influenza immunization rates and scores from a program assessment questionnaire.

Findings

Twenty-six organizations agreed to participate. 35% (9/26) of sites were acute care hospitals, 19% (5/26) continuing care, long-term care organizations or nursing homes, and 46% (12/26) were mixed acute care hospitals and long-term care or regional health authorities. The median rate of influenza immunization among healthcare personnel for the Intervention group was 43%, 44%, and 51% at three points in time respectively, and in the Control group: 62%, 57%, and 55% respectively. No significant differences were observed between the groups at the three points in time. However, there was a 7% increase in the median rates between the Baseline Year and Year Two in the Intervention group, and a 6% decrease in the Control group over the same time period, which was statistically significant (0.071 versus -0.058, p < 0.001).

Interpretation

This pragmatic randomized trial of the Guide with facilitation of its implementation improved healthcare personnel immunization rates, but these rates continued to be sub-optimal and below rates achievable in programs requiring personnel to be immunized.

Trial Registration

ClinicalTrials.gov NCT01207518     

Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan

IntroductionThe influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings.MethodsA survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households.ResultsOf 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications.DiscussionForced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs.     

Intestinal parasites in southeast Asian refugees two years after immigration.

We collected stool specimens from 2,520 Southeast Asian refugees who had resided in the United States for an average of 2.1 years. More than half reported receiving prior treatment of parasites. At least one parasite was discovered in 32%, and multiple parasites were found in 8% of patients. Hookworm, Giardia, Strongyloides, and Hymenolepis nana were most commonly found. In comparison to studies done at the time of immigration, all parasites had decreased in frequency, but Giardia, hookworm, and H nana remain common. Although initial screening efforts may have failed to identify substantial numbers of infected refugees, poor compliance with treatment may also explain the persistence of intestinal parasites in our patients. The continued presence of Giardia and H nana, especially among children, may be explained by person-to-person transmission or autoinfection.     

Cross-Cultural aspects of bereavement. II: Ethnic and cultural variations in the development of bereavement practices

Despite a growing interest in bereavement in cross-cultural perspective, few reports have described a comparative analysis of bereavement. By examining the social contexts in the transformations of Western bereavement practices, structures common to bereavement in a range of cultures can be identified. The paper compares the contemporary bereavement practices of several ethnic and cultural groups in North America: Blacks; ethnic Chinese; Southeast Asian refugees; Haitians; Italians; Greeks; and Spanish-speaking groups. Consideration is given to the state of widowhood in different cultural systems. The impact of modernization among traditional societies demonstrates that even though Western technologies are incorporated into the procedures followed by these modernizing societies, the deep cultural code remains intact. Five questions require further clarification: is bereavement an illness, or a rite de passage and a normal life event? How widespread and useful are protective factors, such as group support, that facilitate successful resolution of grief? How effective are mourning practices of various ethnic groups in preventing “bad grief”, and might some of these practices be beneficial if taken up by other ethnic groups? How can the Western health practitioner know that a bereaved person from an unfamiliar cultural group is suffering “bad grief”? How acceptable is Western grief counseling to non-Western clients?     

Difference in the distribution of e antigen among different ethnic groups in a population of blood donors.

Sensitive techniques were used to detect e antigen and the corresponding antibody (anti-e) among 368 voluntary blood donors positive for hepatitis B surface antigen in the Montreal area and 310 people living in close contact with them. Neither e nor anti-e was found in the absence of markers of hepatitis B virus (HBV). Among the blood donors e antigen was detected in 23 and anti-e in 313, and 32 were negative for both markers. Of the 368 blood donors 330 were of French origin and 38 from other ethnic groups. The 23 e-positive subjects were unequally distributed among the ethnic groups: only 14 (4.2%) were recruited among the French group while 9 (23.7%) were recruited among other ethnic groups (P less than 0.001). This differences among ethnic groups might be related to the vertical or horizontal mode of dissemination of HBV infection.     

Epidemiological assessment of the health and nutrition of Ethiopian refugees in emergency camps in Sudan, 1985.

The findings from epidemiological data that were collected from emergency camps for Ethiopian refugees during a mass influx of refugees into Eastern Sudan in 1985 are presented. An overall mortality of 8.9 per 10,000 a day was recorded during February 1985, and in children under 5 years of age the rate was 22 per 10,000 a day. The estimated prevalence of malnutrition (calculated as less than 80% of the reference weight for height) ranged from 32% to 52% among children of preschool age. The principal causes of morbidity and mortality were measles, diarrhoea and dysentery, respiratory infections, and malaria. The findings suggest that malnutrition and disease increased in these refugees after they arrived in the camps. Epidemiological assessment is essential to help to maintain the health and nutrition of refugees in emergency camps.     

Britain's Welfare State Needs Aid

Thirteen Canadians with a mild hypochromic anemia were found to have beta thalassemia trait. The families of these individuals had resided in Canada for two to five generations and, where known, had not emigrated from areas with a high incidence for the thalassemia gene. A Negro family with abnormal erythrocyte morphology was suspected to be carrying the thalassemia gene although the hemoglobin A₂ concentration was normal and abnormal minor components were not detected. Thalassemia trait has been detected in practically every ethnic group, and its sporadic occurrence among Canadians without Mediterranean ancestry can be expected.