The Health of Resettled Refugee Children: a Modified Systematic Review 2001-2009

<p>Background: New Zealand regularly accepts refugee children and their families for resettlement. Refugees as a population have been reported previously as having high health needs in resettlement. A search for current evidence specifically about resettled refugee child health to inform primary health care nursing practice found limited information. The main evidence to guide practice was Refugee Health Care: A Handbook for Health Professionals (2001a) which provided a useful overview of refugee health care but had limited information about children and as it was published in 2001 was potentially out of date. Question and approach: What does the published research report about the health of resettled refugee children? A modified systematic review process was used due to the broadness of the research question. Search strategy: A two phase search strategy of six electronic databases using key words Refugee, Health, Child, Infant, Baby, Resettle was conducted in January and February 2010. Selection criteria: Primary research studies that were eligible for review inclusion had a study population of refugee children aged 12 years or younger who had resettled in a third country, focused on any aspect of health and were published between 2001-2009. Refugee children not resettled, that is displaced, in camps or immigration detention were excluded as were studies that had an exclusive study population of children aged 13 years or older. Data collection: The abstracts of 194 studies were read and assessed against the inclusion/exclusion criteria and 145 were excluded. The full text was obtained for the remaining 49 studies that were read and assessed against the inclusion/exclusion criteria and 25 studies excluded. The remaining 24 studies were critically appraised using the RAPid appraisal tool from the Joanna Briggs Institute by the researcher and the second reviewer at the Joanna Briggs Institute. Nine were excluded following this appraisal. Results: Of the 15 studies in the review nine focused on physical health, four focused on psychological health and two on health service use. The studies were mainly descriptive and concerned with establishing the population prevalence of infectious or deficiency diseases found in refugee children on arrival or in the first months of resettlement. The synthesis updated three health issues that were elevated blood lead levels that increased after arrival in the USA, an 82% rate of H pylori infection in African refugee children in Australia and the widespread prevalence of low vitamin D levels in refugee children in New Zealand and Australia. Conclusions: Refugee children as a population have special physical health needs at least in early resettlement. There is limited research on the health of resettled refugee children except in early resettlement. Limited comparisons could be made between the review findings and other populations of New Zealand children. These comparisons indicate that resettled refugee children as a population have a higher incidence of the health issues that were identified by the review than the general child population in New Zealand. A review limitation was the exclusion of nine studies because of design issues identified in critical appraisal with RAPid. Although the review findings had little to say about the socio-economic determinants of health of resettled refugee children they are able to inform primary health care nurse practice from a population health and an individual care perspective.</p>

The Health of Resettled Refugee Children: a Modified Systematic Review 2001-2009

<p>Background: New Zealand regularly accepts refugee children and their families for resettlement. Refugees as a population have been reported previously as having high health needs in resettlement. A search for current evidence specifically about resettled refugee child health to inform primary health care nursing practice found limited information. The main evidence to guide practice was Refugee Health Care: A Handbook for Health Professionals (2001a) which provided a useful overview of refugee health care but had limited information about children and as it was published in 2001 was potentially out of date. Question and approach: What does the published research report about the health of resettled refugee children? A modified systematic review process was used due to the broadness of the research question. Search strategy: A two phase search strategy of six electronic databases using key words Refugee, Health, Child, Infant, Baby, Resettle was conducted in January and February 2010. Selection criteria: Primary research studies that were eligible for review inclusion had a study population of refugee children aged 12 years or younger who had resettled in a third country, focused on any aspect of health and were published between 2001-2009. Refugee children not resettled, that is displaced, in camps or immigration detention were excluded as were studies that had an exclusive study population of children aged 13 years or older. Data collection: The abstracts of 194 studies were read and assessed against the inclusion/exclusion criteria and 145 were excluded. The full text was obtained for the remaining 49 studies that were read and assessed against the inclusion/exclusion criteria and 25 studies excluded. The remaining 24 studies were critically appraised using the RAPid appraisal tool from the Joanna Briggs Institute by the researcher and the second reviewer at the Joanna Briggs Institute. Nine were excluded following this appraisal. Results: Of the 15 studies in the review nine focused on physical health, four focused on psychological health and two on health service use. The studies were mainly descriptive and concerned with establishing the population prevalence of infectious or deficiency diseases found in refugee children on arrival or in the first months of resettlement. The synthesis updated three health issues that were elevated blood lead levels that increased after arrival in the USA, an 82% rate of H pylori infection in African refugee children in Australia and the widespread prevalence of low vitamin D levels in refugee children in New Zealand and Australia. Conclusions: Refugee children as a population have special physical health needs at least in early resettlement. There is limited research on the health of resettled refugee children except in early resettlement. Limited comparisons could be made between the review findings and other populations of New Zealand children. These comparisons indicate that resettled refugee children as a population have a higher incidence of the health issues that were identified by the review than the general child population in New Zealand. A review limitation was the exclusion of nine studies because of design issues identified in critical appraisal with RAPid. Although the review findings had little to say about the socio-economic determinants of health of resettled refugee children they are able to inform primary health care nurse practice from a population health and an individual care perspective.</p>

Service Evaluation of the English Refugee Health Information System: Considerations and Recommendations for Effective Resettlement

Since 2015, the UK has resettled over 25,000 refugees. To support resettlement and integration, refugees undergo a pre-arrival medical health assessment (MHA), which is used for healthcare planning by local government in England. This study aimed to understand the utility and effectiveness of the MHA and flow of data to support resettlement planning. Seven local government representatives were interviewed regarding their experiences and perceptions of the refugee health information system (HIS) and the MHA for resettlement in England. Data was analyzed using thematic analysis. The three themes indicated that the HIS was perceived to be effective, however, issues on governance, timeliness of information and access were identified. Findings showed that for the MHA to be more useful for planning, assessments for mental health issues and child special educational needs (SEN) are needed. Findings also indicated resettlement promoted joint working and acceptability of refugee resettlement. In areas where data sharing and governance processes are well defined, the HIS is effective and the MHA supports resettlement. National agencies should put structures in place to support timely health information flow.

Using an IT-Based Algorithm for Health Promotion in Temporary Settlements to Improve Migrant and Refugee Health

The application of the electronic algorithm developed by the Mig-Healthcare project was pilot tested in a sample of migrants and refugees in 2 Reception and Identification Centres (RICs), temporary settlements, in Greece using portable devices. The questions relate to health literacy issues, to mental health, to vaccination history, to lifestyle habits such as smoking, alcohol intake, diet, to the presence of diseases such as heart disease or diabetes, to the use of prevention services and to dental care. A total of 82 adults, 50 women and 32 men, participated. Data analysis showed that 67.1% (55) of the respondents had difficulty in understanding medical information and 57.3% (47) did not know where to seek medical help for a specific health problem. Four main areas of health problems were identified and further action is required: (A) mental health concerns, (B) vaccinations, (C) obesity, and (D) dental hygiene. Direct linkage with the “Roadmap and Toolbox” section of the project’s website gave the respondents access to many sources and tools, while through the use of the interactive map, specific referral points of healthcare delivery in their area were identified. IT-based intervention in migrant and refugee populations in Greece are effective in increasing health literacy levels and identifying areas for health promotion interventions in these groups. Through linkage with the project’s database, access to healthcare provision points and action to seek appropriate healthcare when necessary are encouraged. Given the attenuated vulnerability profile of people living in temporary settlements, this algorithm can be easily used in primary care settings to improve migrant and refugee health.

A Logic Model Framework for Planning an International Refugee Health Research, Evaluation, and Ethics Committee

Collaborative approaches to supporting the health of refugees and other newcomer populations in their resettlement country are needed to address the complex medical and social challenges they may experience after arrival. Refugee health professionals within the Society of Refugee Healthcare Providers (SRHP)—the largest medical society dedicated to refugee health in North America—have expressed interest in greater research collaborations across SRHP membership and a need for guidance in conducting ethical research on refugee health. This article describes a logic model framework for planning the SRHP Research, Evaluation, and Ethics Committee. A logic model was developed to outline the priorities, inputs, outputs, outcomes, assumptions, external factors, and evaluation plan for the committee. The short-term outcomes include (1) establish professional standards in refugee health research, (2) support evaluation of existing refugee health structures and programs, and (3) establish and disseminate an ethical framework for refugee health research. The SRHP Research, Evaluation, and Ethics Committee found the logic model to be an effective planning tool. The model presented here could support the planning of other research committees aimed at helping to achieve health equity for resettled refugee populations.