Health Needs of Refugee Children in New Zealand

Transcription

1 Health Needs of Refugee Children in New Zealand By Dr Santuri Rungan (Pediatric Fellow at Starship Children s Hospital) Co-Authors: Dr Lesley Voss Dr Martin Reeve Dr Peter Reed

2 New Zealand NZ Population: 4.4 million 750 UNHCR refugees per year 75 women at risk 75 medical conditions or disabilities 600 in urgent need of protection asylum seekers

3 New Zealand Mangere Refugee Resettlement Centre (MRRC): Auckland Groups of 130 people Stay for 6 weeks Collection of agencies: Medical screening Immigration Education Language Welfare Counseling

4 Pediatric Refugees Highly vulnerable and often traumatized Complex medical and psychological needs Screening identifies health needs of asymptomatic children

5 Aim Review outcomes of health screening in under 5 year olds between 2007 to Infectious Diseases: Tuberculosis Parasites Vaccine-preventable diseases Hepatitis B and C HIV Syphilis 2. Non-infectious Diseases: Iron deficiency Vitamin D deficiency Hemoglobinopathy

6 Methods Retrospective audit: Outcomes of screening and referrals: computerized patient management system: MedTech Concerto/CRIS Documentation of: complete vaccination certificates developmental screening need for an interpreter Data Analysis: Microsoft Excel JMP V10 (SAS Institute Inc.)

7 Results a) Demographics b) Infectious Diseases c) Non-infectious Diseases d) Referrals e) Conclusions

8 a) Demographics 343 children under 5 years (10% of total) Females (51%) and males (49%) Age make-up of total population % 3000 Under 5 years Number % 34% Under 15 years Over 15 years Under 5 years Under 15 years Over 15 years Total Refugee Population

9 Mainly Asia (53%) 96% required interpreter a) Demographics Number Africa Americas Asia MiddleEast Ethnic grouping of refugee children under 5 years old in NZ

10 Prevalence of Health Conditions Iron Deficiency 32.7% Vitamin D Deficiency 15.30% Latent TB Infection 14.9% Stool Parasites 10.8% Disease Schistosomiasis Haemoglobinpathy 2.3% 3.5% Hepatitis B carrier 1.0% Hepatitis C 0.6% Syphillis 0.0% HIV 0.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% Percentage Affected

11 b) Infectious Diseases Tuberculosis: Tuberculin skin test (TST): TST > 5mm (no BCG), or > 9mm (with BCG) referral pediatric TB clinic Latent TB infection (LTBI): 15% (n=51) No active TB TB reactivation common in first 5 years after migration No association between Vitamin D deficiency and LTBI (p-value 0.78)

12 b) Infectious Diseases Parasites: Fecal samples (3x): 11% positive (giardia (58%)) Schistosomiasis serology positive: 4% Other: Hepatitis B carriers (1%) Hepatitis C carriers (0.6%) No HIV or syphilis

13 b) Infectious Diseases Vaccine-preventable diseases: 50% immune to rubella and measles Lower than reported elsewhere No pre-departure MMR 2/3 immune to hepatitis B At risk e.g. hepatitis A, VZV Documentation/verbal recounts unreliable: 66% complete vaccination certificate 73% required vaccinations Currently NZ vaccination schedule re-started

14 Tests to Consider 1) Giardia Direct microscopy used Consider direct immunoassays 2) Malaria No mosquito vector in NZ 36 cases in Auckland over a year (Camburn A, E., et al. NZMJ 2012) 11 were refugees 1 in our study 3) Helicobacter pylori Serology or immunoassays Guidelines yet to be established Symptomatic colonization uncommon Symptomatic children: either method +/- referral

15 c) Non-Infectious Diseases Iron deficiency = 33% NZ children (13%-23%) Iron essential for immune function Low ferritin as marker reticulocyte hemoglobin content instead routinely measured in full blood counts

16 c) Non-Infectious Diseases Sufficiency Mild Deficiency Moderate Deficiency Severe Deficiency mol/L 26-50nmol/L nmol/L <12.5nmol/L Vitamin D deficiency:15% (n = 41) Mild deficiency (n = 34, 83%) Moderate deficiency (n = 7, 17%) Current NZ guidelines (Paxton G, A et al. Medical Journal of Australia 2013): Screen those with risk factors Treatment: daily or intermittent supplement Compliance problems: appropriate education and interpreters

17 d) Referrals 58% requiring referral: 37% to primary care services (community-based): 50% health support services 21% developmental services 14% primary care physician 63% to secondary care services (hospital-based): 16 services consulted: TB clinic (33%), pediatric surgery (10%), pediatrician (9%) 51% required ongoing follow up > 1 referral needed by 19% (n = 65)

18 e) Conclusions Current screening appropriate Small defined population in a single center setting Opportunity to optimize health Minimize transmission of infectious diseases Provide continuity of care Screening needs regular review Proportion requiring more intensive support adequately resourced, comprehensive pediatric and family-centered refugee service in NZ

19 References (1) McLeod A, Reeve M. The health status of quota refugees screened by New Zealand s Auckland Public Health Service between 1995 and New Zealand Medical Journal 2005;118(1224): (2) Reed R, V et al. Mental health of displaced and refugee children resettled in low-income and middle-income countries: risk and protective factors.. Lancet ;2012: (3) Murray R et al. Australasian Society for Infectious Diseases: Diagnosis, management and prevention of infections in recently arrived refugees. Sydney: Dreamweaver Publishing Pty Ltd; (4) Paxton G, A et al. Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: a position statement.. Medical Journal of Australia 2013;198(3):142. (5) Woodland L, Burgner D, Paxton G, Zwi K. Health service delivery for newly arrived refugee children: a framework for good practice. Journal of Paediatrics and Child Health 2010;46(10): (6) Sheikh M, et al. The epidemiology of health conditions of newly arrived refugee children: a review of patients attending a specialist health clinic in Sydney. Journal of Paediatrics and Child Health 2009;45(9): (7) Martin J, A., Mak D, B. Changing faces: A review of infectious disease screening of refugees by the Migrant Health Unit, Western Australia in 2003 and (11-12):607-10, 2006 Dec Medical Journal of Australia 2006;185(11-12): (8) Raman S, Wood N, Webber M, Taylor K, A., Isaacs D. Matching health needs of refugee children with services: how big is the gap? Australian & New Zealand Journal of Public Health 2009;33(5): (9) El-Nahas H, A., et al. Giardia diagnostic methods in human fecal samples: a comparative study. Cytometry Part B (Clinical Cytometry) 2013;84B: (10) Joshua P, R., et al. Australian population cohort study of newly arrived refugee children: how effective is predeparture measles and rubella vaccination? The Pediatric Infectious Disease Journal 2013;32(2): (11) Davidson N, et al. Comprehensive health assessment for newly arrived refugee children in Australia. Journal of Paediatrics and Child Health 2004;40(9): (12) Grant C, C., Wall C, R., Wilson C, Taua N. Risk factors for iron deficiency in a hospitalized urban New Zealand population. Journal of Paediatrics and Child Health 2003;39: (13) Seal A, J., et al. Iron and vitamin A deficiency in long-term African refugees. Journal of Nutrition 2005;135(4): (14) Mast A, E., Blinder M, A., Dietzen D, J. Reticulocyte hemoglobin content. American Journal of Hematology 2008;83(4): (15) Gray K, et al. Vitamin D and tuberculosis status in refugee children. Pediatric Infectious Diseases Journal 2012;31(5): (16) Camburn A, E., Ingram J, H., Holland D, Read K, Taylor S. Imported malaria in Auckland, New Zealand. New Zealand Medical Journal 2012;125(1365): (17) O Ryan M, L., Rabello M, Cortés H, Lucero Y, Pena A, Torres J, P. Dynamics of Helicobacter pylori detection in stools during the first 5 years of life in Chile, a rapidly developing country. The Pediatric Infectious Disease Journal 2013;32(2):

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