Visual Health and Visual Healthcare Access in Refugees and Displaced Persons: A Systematic Review

ObjectivesThe aims of our study were to describe the disease spectrum of refugees, to analyse to what extent their healthcare needs could be met in an outpatient primary care walk-in clinic and which cases required additional services from secondary care (ie, outpatient specialists or hospitals).DesignRetrospective longitudinal observational study.SettingThe study was based on routine data from a walk-in clinic in the largest central first reception centre in Hamburg, Germany between 4 November 2015 and 21 July 2016.Participants1467 asylum seekers with 4006 episodes of care (ie, distinctive health problems) resulting in 5545 consultations. The patients were 60% men and had a mean age of 23.2 years. About 90% of the patients were from Central Asia or from the Middle East and North Africa.Primary and secondary outcome measuresThe endpoint of our analyses was referral to secondary care. Time to event was defined as days under treatment until the first referral. Predictor variables were the patients’ diagnoses grouped in 46 categories. The data set was analysed by Cox regression allowing for multiple failure times per patient. This analysis was adjusted for age, sex and country of origin.ResultsReferrals to secondary care occurred in 15.5% of the episodes. The diagnosis groups with the highest referral rates were ‘eye’ (HR 4.9; 95% CI 3.12 to 7.8; p≤0.001), ‘teeth/gum symptom/complaint or disease’ (3.51; 2.52 to 4.9; p≤0.001) and ‘urological system/female or male genital’ (2.50; 1.66 to 3.77; p≤0.001). Age, sex and country of origin had no significant effect on time until referral.ConclusionsIn most cases, the walk-in clinic physicians could provide first-line medical care for the health problems of patients not integrated in the German healthcare system. Additional resources were needed particularly not only for visual impairment and dental problems but also for psychological disorders, antenatal care and certain infections and injuries.

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“… 33 A systematic review in refugee populations worldwide also found a high prevalence of visual impairment and refractive error. 34 …”

Section: Discussionmentioning

confidence: 99%

Referrals to secondary care in an outpatient primary care walk-in clinic for refugees in Germany: results from a secondary data analysis based on electronic medical records

et al. 2020

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“…myopia generally reported in economically deprived settings [20] and may also indicate a higher prevalence of other, nonrefractive ocular conditions such as infections [21,22], which have been documented in the Rohingya camps. The existing literature on visual health among displaced populations, including a recent review [11], has documented high prevalence of blindness [12,[22][23][24][25] in these communities, ranging from 1.3% to 26.2% [11]. However, few published studies [26][27][28][29] have focused on the delivery of eye care services rather than simply assessing the existing burden, and none of these have measured the demand for comprehensive eye care service in a defined refugee community, beyond a single disease focus such as refractive error [27][28] or trachoma [29].…”

Section: Plos Medicinementioning

confidence: 99%

“…However, these initiatives have largely focused on the needs of settled populations. A growing body of information exists about the visual health and unique eye care needs of displaced people [11,12], and there is increasing awareness of the unmet need for vision care in these populations.…”

Section: Introductionmentioning

confidence: 99%

Burden of eye disease and demand for care in the Bangladesh Rohingya displaced population and host community: A cohort study

Ahmed¹,

Whitestone²,

Patnaik

et al. 2020

PLoS Med

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Background There is a growing awareness that addressing chronic as well as acute health conditions may contribute importantly to the well-being of displaced populations, but eye care service has generally not been prioritized in crisis situations. We describe a replicable model of eye care provision as delivered by Orbis International and local partners to the Rohingya and host population in Cox's Bazar, Bangladesh, and characterize the burden of vision impairment and demand for sight-restoring services in this setting. Methods and findings Orbis International and local secondary facility Cox's Bazar Baitush Sharaf Hospital (CBBSH) provide eye care support to the Rohingya population and the host community of all ages in Cox's Bazar, Bangladesh, with fixed vision screening locations established in Camps 4 and 11 of the Kutupalong refugee settlement. Structured outreach targets these camps and four surrounding local subdistricts, with referrals made as needed for refraction (glasses measurement) and cataract surgery to CBBSH. Between February 2018 and March 2019, 48,105 displaced Rohingya (70.3%, among whom 71.6% were children and 46.5% women) and 20,357 local residents (29.7%, 88.5% children, 54.4% women) underwent vision screening. Displaced Rohingya sought services from a total of 12 surrounding camps, within which coverage was 17.3%, including 43.3% (27,027/62,424) of children aged 5-11 years and 60.0% (5,315/8,857) of adults � 60 years old. The prevalence of blindness (presenting acuity < 3/60) among Rohingya patients exceeded that among local residents by 3-to 6-fold in each 10-year age group between 18 and 59 years (P < 0.001 comparing vision between the two groups in this age range), and the prevalence of cataract requiring surgery was also higher in Rohingya patients (18-29 years: 4.67% versus 1.80%,

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“…Evidence suggests that the prevalence of vision impairments and blindness among refugees are common and often higher than the general population. A recent systematic review found that the prevalence of blindness in the refugee camps can range from 1.3% to 26.2% [11]. A study with Afghan refugees in Pakistan revealed that 2.1% of all refugees there were blind, and 6.9% were visually impaired [12].…”

Section: Introductionmentioning

confidence: 99%

“…Studies show that the major interventions, in most places, including refugee camps, to control childhood blindness are public health in nature (vitamin A supplementation and measles immunisation) [14]. However, the need for eye care interventions for refugees are unique, and in every stage of displacement, such interventions should be targeted [11].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Eye Problems among Young Infants of Rohingya Refugee Camps: Findings from a Cross-Sectional Survey

Hussain

Azdi

Islam³

et al. 2020

TropicalMed

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Early detection of pediatric eye problems can prevent future vision loss. This study was to estimate the prevalence of common eye problems among infants born in a resource-constrained emergency setting with a broader aim to prevent future vision loss or blindness among them through early detection and referral. We conducted a cross-sectional survey among 670 infants (0–59 days old) born in Rohingya refugee camps in Bangladesh between March and June of 2019. The most common eye problem found was watering from the eye and accumulation of discharge by which 14.8% of the children were suffering (95% CI: 12.2–17.7). More than 5% of the infants had visual inattention (95% CI: 3.5–7.0), and 4% had redness in their eyes (95% CI: 2.7–5.8). Only 1.9% of infants (95% CI: 1–3.3) had whitish or brown eyeballs, and 1.8% of children might have whitish pupillary reflex (95% CI: 0.9–3.1). None of the eye problems was associated with the gender of the infants. The prevalent eye problems demand eye care set up for the screening of eye problems in the camps with proper referral and availability of referral centres with higher service in the districts.

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Visual Health and Visual Healthcare Access in Refugees and Displaced Persons: A Systematic Review

Cited by 17 publications

References 25 publications

Referrals to secondary care in an outpatient primary care walk-in clinic for refugees in Germany: results from a secondary data analysis based on electronic medical records

Referrals to secondary care in an outpatient primary care walk-in clinic for refugees in Germany: results from a secondary data analysis based on electronic medical records

Burden of eye disease and demand for care in the Bangladesh Rohingya displaced population and host community: A cohort study

Prevalence of Eye Problems among Young Infants of Rohingya Refugee Camps: Findings from a Cross-Sectional Survey

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