scholarly journals Yield of tuberculosis screening in asylum-seekers by country of origin: analysis of screening data in a German federal state (2002–2015)

2017 ◽  
Vol 49 (4) ◽  
pp. 1602327 ◽  
Author(s):  
Kayvan Bozorgmehr ◽  
Brigitte Joggerst ◽  
Ulrich Wagner ◽  
Christian Stock
Keyword(s):  
Asylum Seekers ◽  
Country Of Origin ◽  
Federal State ◽  
Tuberculosis Screening ◽  
German Federal State ◽  
Origin Analysis

scholarly journals Cost-effectiveness of targeted screening for active pulmonary tuberculosis among asylum-seekers: A modelling study with screening data from a German federal state (2002-2015)

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241852
Author(s):  
Katharina Wahedi ◽  
Louise Biddle ◽  
Kayvan Bozorgmehr
Keyword(s):  
Cost Effectiveness ◽  
Pulmonary Tuberculosis ◽  
Incremental Cost ◽  
Asylum Seekers ◽  
Country Of Origin ◽  
Federal State ◽  
Active Pulmonary Tuberculosis ◽  
Screening Measure ◽  
Targeted Screening ◽  
German Federal State

Screening asylum-seekers for active pulmonary tuberculosis is common practice among many European countries with low incidence of tuberculosis. The reported yields vary substantially, partly due to the heterogeneous and dynamic nature of asylum-seeking populations. Rather than screening all new arrivals (indiscriminate screening), a few countries apply targeted screening based on incidence of tuberculosis in asylum-seekers’ country of origin. However, evaluations of its cost-effectiveness have been scarce. The aim of this modelling study was to assess whether the introduction of a screening threshold based on the tuberculosis incidence in the country of origin is sensible from an economic perspective. To this end, we compare the current, indiscriminate screening policy for pulmonary tuberculosis in Germany with a hypothetical targeted screening programme using several potential screening thresholds based on WHO-reported incidence of tuberculosis in countries of origin. Screening data is taken from a large German federal state over 14 years (2002–2015). Incremental cost-effectiveness is measured as cost per case found and cost per case prevented. Our analysis shows that incremental cost-effectiveness ratios (ICERs) of screening asylum-seekers from countries with an incidence of 50 to 250/100,000 range between 15,000€ and 17,000€ per additional case found when compared to lower thresholds. The ICER for screening asylum-seekers from countries with an incidence <50/100,000 is 112,000€ per additional case found. Costs per case prevented show a similar increase in costs. The high cost per case found and per case prevented at the <50/100,000 threshold scenario suggests this threshold to be a sensible cut-off for targeted screening. Acknowledging that no screening measure can find all cases of tuberculosis, and that reactivation of latent infections makes up a large proportion of foreign-born cases, targeting asylum-seekers from countries with an incidence above 50/100,000 is likely to be a more reasonable screening measure for the prevention and control of tuberculosis than indiscriminate screening measures.

scholarly journals Subjective social mobility, quality of life and mental health of asylum seekers/refugees in Germany

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Costa ◽  
L Biddle ◽  
C Mühling ◽  
K Bozorgmehr
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Social Status ◽  
Social Mobility ◽  
Asylum Seekers ◽  
Country Of Origin ◽  
Subjective Social Status ◽  
Downward Mobility ◽  
Asylum Seekers And Refugees

Abstract Background Changes in the subjective social status (SSS) of migrants, specifically between the pre- and post-migratory movement, can be a relevant determinant of their mental health condition. This study analyzed the effect of downward subjective social mobility to the mental health of asylum seekers and refugees (ASR) in Germany. Methods Through a random sampling procedure, 560 adult ASR (18+ years) were recruited across 58 collective accommodation centers in Germanys' 3rd largest state (2018). SSS was assessed with the MacArthur social ladder (10-rungs), in reference to the participants' position in the country of origin and in Germany. Quality of Life (QoL, measured with EUROHIS-QOL), anxiety (General Anxiety Disorder-2) and depressive symptoms (Patient Health Questionnaire-2), were considered as mental health outcomes. Generalized linear regression models were fitted to measure associations between changes in SSS and each outcome. Results A loss of 3 or more steps in SSS from origin to Germany (compared to no-change) was significantly associated with poorer scores in QoL (B, standardized coefficient= -2.679, standard error, se = 1.351, p = 0.047), with more symptoms of depression (B = 1.156, se = 0.389, p = 0.003) and anxiety (B = 0.971, se = 0.432, p = 0.025), in models adjusted for SSS in the country of origin. The strength and direction of associations was unaltered after further adjusting for sex, age, educational level and time since arrival, although the coefficient for QoL was non-significant for those declaring a 3-step downward mobility (B= -2.494, se = 1.351, p = 0.066 for QoL; B = 1.048, se = 0.393, p = 0.008 for depression; and B = 1.006, se = 0.438, p = 0.022 for anxiety). Discussion The results suggest that interventions should focus on those experiencing social downward mobility and not only prioritize individuals with low social status. Early integration efforts and intersectoral measures to counter social downward mobility could prevent poor mental health among ASR. Key messages We analysed the impact to the quality of life and mental health of asylum seekers and refugees, of a change in subjective social status from country of origin to Germany. Asylum seekers and refugees residing in Germany, who perceived a downward social status mobility following their migration process, are at risk for poorer mental health.

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