TY - JOUR
T1 - Impact of enhanced health interventions for United States–bound refugees
T2 - Evaluating best practices in migration health
AU - Mitchell, Tarissa
AU - Lee, Deborah
AU - Weinberg, Michelle
AU - Phares, Christina
AU - James, Nicola
AU - Amornpaisarnloet, Kittisak
AU - Aumpipat, Lalita
AU - Cooley, Gretchen
AU - Davies, Anita
AU - Shwe, Valerie Daw Tin
AU - Gajdadziev, Vasil
AU - Gorbacheva, Olga
AU - Khwan-Niam, Chutharat
AU - Klosovsky, Alexander
AU - Madilokkowit, Waritorn
AU - Martin, Diana
AU - Myint, Naing Zaw Htun
AU - Nguyen, Thi Ngoc Yen
AU - Nutman, Thomas B.
AU - O’Connell, Elise M.
AU - Ortega, Luis
AU - Prayadsab, Sugunya
AU - Srimanee, Chetdanai
AU - Supakunatom, Wasant
AU - Vesessmith, Vattanachai
AU - Stauffer, William M.
N1 - Funding Information:
Financial support: This work was supported in part by the Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases.
Publisher Copyright:
Copyright © 2018 by The American Society of Tropical Medicine and Hygiene.
PY - 2018
Y1 - 2018
N2 - With an unprecedented number of displaced persons worldwide, strategies for improving the health of migrating populations are critical. United States–bound refugees undergo a required overseas medical examination to identify inadmissible conditions (e.g., tuberculosis) 2–6 months before resettlement, but it is limited in scope and may miss important, preventable infectious, chronic, or nutritional causes of morbidity. We sought to evaluate the feasibility and health impact of diagnosis and management of such conditions before travel. We offered voluntary testing for intestinal parasites, anemia, and hepatitis B virus infection, to U.S.-bound refugees from three Thailand–Burma border camps. Treatment and preventive measures (e.g., anemia and parasite treatment, vaccination) were initiated before resettlement. United States refugee health partners received overseas results and provided post-arrival medical examination findings. During July 9, 2012 to November 29, 2013, 2,004 refugees aged 0.5–89 years enrolled. Among 463 participants screened for seven intestinal parasites overseas and after arrival, helminthic infections decreased from 67% to 12%. Among 118 with positive Strongyloides-specific antibody responses, the median fluorescent intensity decreased by an average of 81% after treatment. The prevalence of moderate-to-severe anemia (hemoglobin < 10 g/dL) was halved from 14% at baseline to 7% at departure (McNemar P = 0.001). All 191 (10%) hepatitis B–infected participants received counseling and evaluation; uninfected participants were offered vaccination. This evaluation demonstrates that targeted screening, treatment, and prevention services can be conducted during the migration process to improve the health of refugees before resettlement. With more than 250 million migrants globally, this model may offer insights into healthier migration strategies.
AB - With an unprecedented number of displaced persons worldwide, strategies for improving the health of migrating populations are critical. United States–bound refugees undergo a required overseas medical examination to identify inadmissible conditions (e.g., tuberculosis) 2–6 months before resettlement, but it is limited in scope and may miss important, preventable infectious, chronic, or nutritional causes of morbidity. We sought to evaluate the feasibility and health impact of diagnosis and management of such conditions before travel. We offered voluntary testing for intestinal parasites, anemia, and hepatitis B virus infection, to U.S.-bound refugees from three Thailand–Burma border camps. Treatment and preventive measures (e.g., anemia and parasite treatment, vaccination) were initiated before resettlement. United States refugee health partners received overseas results and provided post-arrival medical examination findings. During July 9, 2012 to November 29, 2013, 2,004 refugees aged 0.5–89 years enrolled. Among 463 participants screened for seven intestinal parasites overseas and after arrival, helminthic infections decreased from 67% to 12%. Among 118 with positive Strongyloides-specific antibody responses, the median fluorescent intensity decreased by an average of 81% after treatment. The prevalence of moderate-to-severe anemia (hemoglobin < 10 g/dL) was halved from 14% at baseline to 7% at departure (McNemar P = 0.001). All 191 (10%) hepatitis B–infected participants received counseling and evaluation; uninfected participants were offered vaccination. This evaluation demonstrates that targeted screening, treatment, and prevention services can be conducted during the migration process to improve the health of refugees before resettlement. With more than 250 million migrants globally, this model may offer insights into healthier migration strategies.
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U2 - 10.4269/ajtmh.17-0725
DO - 10.4269/ajtmh.17-0725
M3 - Article
C2 - 29260657
AN - SCOPUS:85043512193
SN - 0002-9637
VL - 98
SP - 920
EP - 928
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 3
ER -