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Health Needs of Refugee Children Identified on Arrival in Reception Countries: a Systematic Review and Meta- Analysis

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Health Needs of Refugee Children Identified on Arrival in Reception Countries: a Systematic Review and Meta- Analysis Open access Review bmjpo: first published as 10.1136/bmjpo-2019-000516 on 11 September 2019. Downloaded from Health needs of refugee children identified on arrival in reception countries: a systematic review and meta- analysis Albertine Baauw, 1,2,3 Joana Kist-van Holthe, 3 Bridget Slattery,1 Martijn Heymans,4 Mai Chinapaw,3 Hans van Goudoever5 To cite: Baauw A, ABSTRACT Europe, thus increasing the total number of Kist-van Holthe J, Slattery B, Background The worldwide number of refugees has refugees living within the continent to just . Health needs of refugee et al considerably increased due to ongoing wars, national under 4.4 million.2 children identified on arrival instability, political persecution and food insecurity. In in reception countries: a This global humanitarian situation is Europe, about one-third of all refugees are children, an systematic review and meta- complicated by the fact that approximately increasing number of which are travelling alone. There are analysis. BMJ Paediatrics Open half of all refugees and asylum seekers world- often no systematic medical health assessments for these 2019;3:e000516. doi:10.1136/ wide are children. Eurostat numbers indicate bmjpo-2019-000516 refugee children on entry in reception countries despite the fact that they are recognised as an at-risk population that nearly 400 000 children claimed asylum ► Additional material is due to increased burden of physical and mental health in Europe in 2016; 15.9% of these children 2 published online only. To view conditions. We aimed to perform a systematic review of the were registered as unaccompanied minors. please visit the journal online literature to describe the health status of refugee children Country of origin, ethnicity and preflight (http:// dx. doi. org/ 10. 1136/ on entering reception countries. conditions are all factors that contribute to bmjpo- 2019- 000516). Methods A systematic search of published literature was the unique health risks of refugee children. conducted using the terms refugee, immigrant or migrant, Previous research has also shown that refugee Received 11 May 2019 medical or health, and screening. children often have complex healthcare Revised 14 August 2019 Results Of the 3487 potentially relevant papers, 53 needs.3 The health status of many children Accepted 24 August 2019 http://bmjpaedsopen.bmj.com/ population-based studies were included in this review. residing in reception countries is known This systematic review showed that refugee children through antenatal screening, neonatal exhibit high estimated prevalence rates for anaemia (14%), haemoglobinopathies (4%), chronic hepatitis B (3%), latent screening, immunisation programmes and tuberculosis infection (11%) and vitamin D deficiency regular medical follow-ups. However, this is (45%) on entry in reception countries. Approximately one- often not the case for refugee children. third of refugee children had intestinal infection. Nutritional We aimed to systematically review the liter- problems ranged from wasting and stunting to obesity. ature to describe the health status of refugee Conclusions Refugee children entering reception children on entering reception countries. countries should receive comprehensive health Specifically to describe the prevalence of assessments based on the outcomes of this systematic anaemia, haemoglobinopathies (HbP), infec- review, national budgets, cost-effectiveness and personal tious diseases, growth and nutrition disor- on October 1, 2021 by guest. Protected copyright. factors of the refugees. The health assessment should ders as identified through health screening be tailored to individual child health needs depending on preflight, flight and postarrival conditions. programme and their vaccination status. A paradigm shift that places focus on child health and development will help this vulnerable group of children integrate into their new environments. HEALTH CONCERNS IN REFUGEE CHILDREN © Author(s) (or their PROSPERO registration number Anaemia and genetic disorders of the red blood employer(s)) 2019. Re-use 122561. cells permitted under CC BY-NC. No Anaemia is a significant public health commercial re-use. See rights problem worldwide. A WHO global report and permissions. Published by BMJ. INTRODUCTION revealed that children are prone to devel- The global population of forcibly displaced For numbered affiliations see oping anaemia if they reside in a country with end of article. persons has substantially increased over the a high burden of infectious diseases, nutri- last two decades (ie, from 37.3 million indi- tional deficiencies or HbP. Among refugee 1 Correspondence to viduals in 1996 to 68.5 million in 2018). children in Jordan in 2014, 48% of the chil- Dr Albertine Baauw; a. baauw@ Throughout 2016, 1.2 million new refu- dren living in Zaatari refugee camp suffered amsterdamumc. nl gees and asylum seekers (box 1) arrived in from any kind of anaemia. Refugee children Baauw A, et al. BMJ Paediatrics Open 2019;3:e000516. doi:10.1136/bmjpo-2019-000516 1 Open access bmjpo: first published as 10.1136/bmjpo-2019-000516 on 11 September 2019. Downloaded from Box 1 Definitions In this article, the term ‘refugee children’ is used to describe the entire child population of asylum seekers, refugees, status-holders and undocumented migrants. The term ‘children from refugee and refugee-like backgrounds’ is also widely used. There is no universally accepted term to describe refugee children. Refugee: An asylum seeker that has fled their home country and has a ‘well-founded fear of persecution’ if they return home. Refugee status is granted when an asylum seeker has been acknowledged as a refugee according to the United Nations Refugee Convention. A refugee has completed the asylum process when they have been granted a residence permit.34 Asylum seeker: An individual who has left their home country and calls on the protection of another country and whose request for sanctuary has yet to be processed.35 Unaccompanied minor or unaccompanied minor refugee: An individual under the age of 18 applying for asylum without a relative Figure 1 Flowchart selection process. WoS, Web of older than 18 years of age. In the past, this group was also referred to Science. as unaccompanied minor asylum seekers. the red blood cells, HbP (eg, sickle cell disease), thalas- residing outside the camp were better off with 26% semia and glucose-6-phosphate dehydrogenase (G6PD) suffering from anaemia.4 For refugee children entering deficiency are common genetic conditions in children the USA, Yun et al found anaemia prevalence ranging originating from Africa, Asia and the Middle East. These from 6% to 23% depending on the country of origin, with disorders not only contribute to the development of the highest prevalence up to 35% in children less than anaemia in carriers, but they can also lead to severe 5 years of age.3 Similar results were found by Geltman et diseases, adverse birth outcomes and lowered life expec- al among refugee children entering the Massachusetts tancy rates.7 Hereditary and metabolic disorders are also between 1995 and 1998, with 12% of anaemia in the responsible for a substantial number of infant morbidi- overall population and 28% in the group younger than 2 ties and mortalities in Arab countries. A total of 60% of years.5 Anaemia increases the risk of child morbidity and children born to Iraqi refugees settling in the USA had mortality while also contributing to poor physical and http://bmjpaedsopen.bmj.com/ parents from the same ethnic group or who were consan- cognitive development and performance.6 Disorders of guine; this may account for their high prevalence of inherited blood disorders (ie, G6PD (39.5/10 000) and 8 Box 2 Study selection criteria thalassemia (10.5/10 000)). Study inclusion criteria, grading and classification Infectious diseases Publication type: Although the hepatitis B virus (HBV) disease can be ► Studies: observational, retrospective, prospective prevented through vaccination, HBV infection remains a ► Language: published in English major public health problem globally. Perinatal infections Study population: with HBV in children result in chronic HBV infections ► Refugee children from Africa, Asia or the Middle East in 90% of all cases; additionally, 25% of these affected on October 1, 2021 by guest. Protected copyright. ► Age: reported results specific to children or adolescents (0–18 years) children will develop primary liver cancer or cirrhosis as ► Medical screening on children’s entry in reception countries adults. The estimated global prevalence of the disease ► Sample size: minimum of 25 children is 3%.9 However, there is wide regional variation in this Study exclusion criteria number also seen in refugee children.9 10 Chronic hepa- Publication type: titis B infection was found in 4% of refugee children ► Guidelines Surveillance registration attending a specialist health clinic in Sydney and in 8% of ► 10 11 ► National notifiable disease reports the unaccompanied minor refugees in Germany. The ► Case studies Joint UnitedNations Programme on HIV and AIDS Study population estimate indicated that approximately 1.8 million chil- ► Age not clearly defined dren under the age of 15 were living with HIV. Preva- ► Results of children and adults combined lence data for HIV among refugee children are scarce ► Screening of adoptees because HIV testing is not routinely performed. Circum- ► Children attending curative services stantial evidence from the Netherlands were 80 out of ► Outbreak control 4854 pregnant asylum-seeking women were found to be Children from the Americas, Europe or the Western Pacific ► living with HIV in the period from 2000 to 2008. Among ► Mental disorders in refugee children African pregnant women, the prevalence rate was 3.4% 2 Baauw A, et al. BMJ Paediatrics Open 2019;3:e000516. doi:10.1136/bmjpo-2019-000516 Open access bmjpo: first published as 10.1136/bmjpo-2019-000516 on 11 September 2019. Downloaded from Table 1 Reception countries of refugee children Three reviewers (AB, BS and JKvH) independently screened all search results and systematically reviewed Countries Studies n=223 037 the retrieved records by applying the eligibility criteria Australia 8 3497 (box 2).
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