Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan

Abstract

BackgroundThere are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan.MethodsA cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian refugees outside of camps. To obtain information on chronic conditions, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences by care-seeking for these conditions were examined using chi-square and t-test methods and characteristics of interest were included in the adjusted logistic regression model.ResultsAmong adults, hypertension prevalence was the highest (9.7 %, CI: 8.8–10.6), followed by arthritis (6.8 %, CI: 5.9–7.6), diabetes (5.3 %, CI: 4.6–6.0), chronic respiratory diseases (3.1 %, CI: 2.4–3.8), and cardiovascular disease (3.7 %, CI: 3.2, 4.3). Of the 1363 NCD cases, 84.7 % (CI: 81.6–87.3) received care in Jordan; of the five NCDs assessed, arthritis cases had the lowest rates of care seeking at 65 %, (CI:0–88, p = 0.005). Individuals from households in which the head completed post-secondary and primary education, respectively, had 89 % (CI: 22–98) and 88 % (CI: 13–98) lower odds of seeking care than those with no education (p = 0.028 and p = 0.037, respectively). Refugees in North Jordan were most likely to seek care for their condition; refugees in Central Jordan had 68 % (CI: 1–90) lower odds of care-seeking than those in the North (p = 0.047).ConclusionMore than half of Syrian refugee households in Jordan reported a member with a NCD. A significant minority did not receive care, citing cost as the primary barrier. As funding limitations persist, identifying the means to maintain and improve access to NCD care for Syrian refugees in Jordan is essential.

Health needs and priorities of Syrian refugees in camps and urban settings in Jordan: perspectives of refugees and health care providers

“…Health care providers and Syrian refugees highlighted the high burden of chronic disease in this population, which is consistent with the World Health Organization data from Syria (15) and studies regarding Syrian refugees (16)(17)(18)(19)(20). Participants also identified the high smoking prevalence among Syrian refugees as a major contributor to the increase in chronic conditions.…”

Medical conditions and treatment in a transit camp in Serbia for Syrian, Afghani, and Iraqi migrants

“…The low percentage of patients with chronic diseases is not in line with Doocy et al (2015), who found a 50.3% of chronic diseases. First, the clinical setting in the present study was primarily for emergency medicine for patients en route, while the study in Jordan included settled refugees.…”

“…It is also possible that among settled refugees in nearby Jordan, more elderly people lived, while the present sample included mainly young and more mobile people, thus, with low frequency of chronic diseases. Indeed, when observing both Doocy et al (2015) and Cetorelli et al (2017), older age was correlated with higher prevalence of NCD.…”

“…Table 1 presents the percentages of people within categories as a function of the main variables in the present study. The participants' age was divided into four groups: infants (≤ 1), pre-school (Bradby et al 2015;Glass et al 1980;Ackerman 1997;Lim et al 2005;Doocy et al 2015), schoolage (Cetorelli et al 2017;Ozaras et al 2016b;Ozaras et al 2016a;Natan-iha.org, 2018;Humedica.org, 2016; http:// data2.unhcr.org/en/situations/mediterranean, 2018; Gulacti et al 2017;van Berlaer et al 2016;Sharara and Kanj 2014;Alpak et al 2015;Kimerling et al 2006) and adults (≥ 18) years. There were too few elderly to include as a separate age group (Only 68 patients, 3.2%, were above the age of 60 years).…”

“…Among 4710 refugees treated after the South Asia tsunami, respiratory problems and skin problems were prevalent, while diarrhea was not common, due to provision of potable water (Lim et al 2005). According to Doocy et al (2015), 1550 Syrian households of refugees residing outside camps in Jordan reported the following leading chronic diseases among their care seekers, data relate to households: hypertension (9.7%), arthritis (6.8%), diabetes (5.3%), cardiovascular diseases (3.7%), and respiratory diseases (3.1%). Cetorelli et al (2017) conducted among 1300 households in settled camps in Kurdistan (Northern Iraq) reported hypertension (19.4%), musculoskeletal conditions (13.5%), diabetes (9.7%), and cardiovascular diseases (6.3%) among 8360 of the household members.…”