Model to improve cardiometabolic risk factors in Palestine refugees with diabetes mellitus attending UNRWA health centers

Kishk, Nada Abu; Shahin, Yousef; Mitri, Joanna; Turki, Yassir; Zeidan, Wafaa; Seita, Akihiro

doi:10.1136/bmjdrc-2018-000624

Cited by 10 publications

(16 citation statements)

References 22 publications

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“…Moreover, the health of AS&R varies by their country of origin [ 6 , 22 ]. Refugee-specific determinants of health include the circumstances and experiences of individuals before they fled, during their journey, and after their arrival in a host country [ 16 , 20 , 21 ]. Moreover, access to health care services in the destination country has been shown to be a key factor in the health of AS&R. There is, for example, evidence that when AS&R face no formal access barriers to care, they tend to be in better health and have higher levels of social inclusion.…”

Section: Introductionmentioning

confidence: 99%

“…To date, the political, societal, and scientific discourses on this wave of refugees have focused mainly on its effects on the economies and welfare systems of the receiving countries in Europe [2][3][4][5], while less attention has been paid to refugees' health and their access to health services [6][7][8][9][10][11][12][13]. While a number of studies have examined the mental and physical health of refugees in large refugee camps and in low-income countries [14][15][16][17], the health of refugees in high-or mediumincome country contexts remains under-researched [9][10][11]13]. The previous studies that have examined this topic have found that compared to the health status of the total population, AS&R in Germany have better physical but worse mental health [18], while male AS&R in Austria have better self-rated health [19].…”

Section: Introductionmentioning

confidence: 99%

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Health determinants among refugees in Austria and Germany: A propensity-matched comparative study for Syrian, Afghan, and Iraqi refugees

et al. 2021

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In recent years, Germany and Austria have been among the leading European receiving countries for asylum seekers and refugees (AS&R). The two countries have cultural and economic similarities, but differ, for example, in their health care systems, with AS&R having unrestricted access to health services upon arrival in Austria, but not in Germany. This study investigates the determinants of health among refugees in Austria and Germany, and how these determinants differ between the two countries. We analyze comparable and harmonized survey data from both countries for Syrian, Afghan, and Iraqi nationals aged 18 to 59 years who had immigrated between 2013 and 2016 (Germany: n = 2,854; Austria: n = 374). The study adopts a cross-sectional design, and uses propensity score matching to examine comparable AS&R in the two receiving countries. The results reveal that the AS&R in Germany (72%) were significantly less likely to report being in (very) good health than their peers in Austria (89%). Age and education had large impacts on health, whereas the effects of length of stay and length of asylum process were smaller. Compositional differences in terms of age, sex, nationality, education, and partnership situation explained the country differences only in part. After applying propensity score matching to adjust for structural differences and to assess non-confounded country effects, the probability of reporting (very) good health was still 12 percentage points lower in Germany than in Austria. We conclude that many of the determinants of health among AS&R correspond to those in the non-migrant population, and thus call for the implementation of similar health policies. The health disadvantage found among the AS&R in Germany suggests that removing their initially restricted access to health care may improve their health.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Health determinants among refugees in Austria and Germany: A propensity-matched comparative study for Syrian, Afghan, and Iraqi refugees

et al. 2021

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“…The majority ( n = 37, 82%) involved populations living in or fleeing from conflict-affected countries while only eight were of populations affected by natural disasters ( Ramachandran, 2005 ; Chan and Kim, 2011 , 2010 ; Hung et al , 2013 ; Sun et al , 2013 ; Martinez et al , 2015 ; Mobula et al , 2016 ; Adrega et al , 2018 ). Among the studies from conflict-affected contexts, almost half ( n = 18, 49%) concerned the protracted displacement of Palestinian populations served by UNRWA in their five fields of operation within the MENA region ( Yusef, 2000 ; Mousa et al , 2010 ; Khader et al , 2012a,b, 2013 , 2014a,b ,c; Alabed et al , 2014 ; Saadeh et al , 2015 ; Shahin et al , 2015 ; Santoro et al , 2016 ; Radwan et al , 2017 ; Damiri et al , 2018 ; Saleh et al , 2018a,b ,c; Abu Kishk et al , 2019 ); 10 concerned Syrian refugees in the host countries Jordan, Lebanon, and Turkey ( Kallab, 2015 ; Collins et al , 2017 ; Doocy et al , 2017 ; Hyatt, 2017 ; Sethi et al , 2017 ; Elliott et al , 2018 ; Alawa et al , 2019 ; Kayali et al , 2019 ; McNatt et al , 2019 ; Boulle et al , 2019b ); three described forcibly displaced Iraqis in Iraq and Jordan ( Mateen et al , 2012 ; Istepanian et al , 2014 ; Baxter et al , 2018 ); five concerned protracted conflicts in Mali, Democratic Republic of Congo (DRC), or Myanmar (Burma) and one described an acute conflict setting in the Philippines ( Besancon et al , 2015 ; Murphy et al , 2017 ; Naing and Bakker, 2018 ; <...>…”

Section: Resultsmentioning

confidence: 99%

Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review

Jaung

Willis

Sharma

et al. 2021

Health Policy and Planning

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Care for non-communicable diseases, including hypertension and diabetes (HTN/DM), is recognized as a growing challenge in humanitarian crises, particularly in low- and middle-income countries (LMICs) where most crises occur. There is little evidence to support humanitarian actors and governments in designing efficient, effective, and context-adapted models of care for HTN/DM in such settings. This article aimed to systematically review the evidence on models of care targeting people with HTN/DM affected by humanitarian crises in LMICs. A search of the MEDLINE, Embase, Global Health, Global Indexus Medicus, Web of Science, and EconLit bibliographic databases and grey literature sources was performed. Studies were selected that described models of care for HTN/DM in humanitarian crises in LMICs. We descriptively analysed and compared models of care using a conceptual framework and evaluated study quality using the Mixed Methods Appraisal Tool. We report our findings according to PRISMA guidelines. The search yielded 10 645 citations, of which 45 were eligible for this review. Quantitative methods were most commonly used (n = 34), with four qualitative, three mixed methods, and four descriptive reviews of specific care models were also included. Most studies detailed primary care facility-based services for HTN/DM, focusing on health system inputs. More limited references were made to community-based services. Health care workforce and treatment protocols were commonly described framework components, whereas few studies described patient centredness, quality of care, financing and governance, broader health policy, and sociocultural contexts. There were few programme evaluations or effectiveness studies, and only one study reported costs. Most studies were of low quality. We concluded that an increasing body of literature describing models of care for patients with HTN/DM in humanitarian crises demonstrated the development of context-adapted services but showed little evidence of impact. Our conceptual framework could be used for further research and development of NCD models of care.

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“…Several actors in Jordan have introduced communitybased healthy living interventions or peer support groups for people with diabetes on project or pilot bases [59][60][61][62]. Some reported positively impacting intermediate clinical outcomes, such as weight and blood glucose levels.…”

Section: Lessons Learned and Potential Solutionsmentioning

confidence: 99%

MSF experiences of providing multidisciplinary primary level NCD care for Syrian refugees and the host population in Jordan: an implementation study guided by the RE-AIM framework

Ansbro

Homan

Qasem

et al. 2021

BMC Health Serv Res

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Background In response to the rising global NCD burden, humanitarian actors have rapidly scaled-up NCD services in crisis-affected low-and-middle income countries. Using the RE-AIM implementation framework, we evaluated a multidisciplinary, primary level model of NCD care for Syrian refugees and vulnerable Jordanians delivered by MSF in Irbid, Jordan. We examined the programme’s Reach, Effectiveness, Adoption and acceptance, Implementation and Maintenance over time. Methods This mixed methods retrospective evaluation, undertaken in 2017, comprised secondary analysis of pre-existing cross-sectional household survey data; analysis of routine cohort data from 2014 to 2017; descriptive costing analysis of total annual, per-patient and per-consultation costs for 2015–2017 from the provider-perspective; a clinical audit; a medication adherence survey; and qualitative research involving thematic analysis of individual interviews and focus group discussions. Results The programme enrolled 23% of Syrian adult refugees with NCDs in Irbid governorate. The cohort mean age was 54.7 years; 71% had multi-morbidity and 9.9% self-reported a disability. The programme was acceptable to patients, staff and stakeholders. Blood pressure and glycaemic control improved as the programme matured and by 6.6 mmHg and 1.12 mmol/l respectively within 6 months of patient enrolment. Per patient per year cost increased 23% from INT$ 1424 (2015) to 1751 (2016), and by 9% to 1904 (2017). Cost per consultation increased from INT$ 209 to 253 (2015–2017). Staff reported that clinical guidelines were usable and patients’ self-reported medication adherence was high. Individual, programmatic and organisational challenges to programme implementation and maintenance included the impact of war and the refugee experience on Syrian refugees’ ability to engage; inadequate low-cost referral options; and challenges for MSF to rapidly adapt to operating in a highly regulated and complex health system. Essential programme adaptations included refinement of health education, development of mental health and psychosocial services and addition of essential referral pathways, home visit, physiotherapy and social worker services. Conclusion RE-AIM proved a valuable tool in evaluating a complex intervention in a protracted humanitarian crisis setting. This multidisciplinary programme was largely acceptable, achieving good clinical outcomes, but for a limited number of patients and at relatively high cost. We propose that model simplification, adapted procurement practices and use of technology could improve cost effectiveness without reducing acceptability, and may facilitate replication.

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Model to improve cardiometabolic risk factors in Palestine refugees with diabetes mellitus attending UNRWA health centers

Cited by 10 publications

References 22 publications

Health determinants among refugees in Austria and Germany: A propensity-matched comparative study for Syrian, Afghan, and Iraqi refugees

Health determinants among refugees in Austria and Germany: A propensity-matched comparative study for Syrian, Afghan, and Iraqi refugees

Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review

MSF experiences of providing multidisciplinary primary level NCD care for Syrian refugees and the host population in Jordan: an implementation study guided by the RE-AIM framework

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