The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Impact of Enhanced Health Interventions for United States-Bound Refugees: Evaluating Best Practices in Migration Health
Mitchell T1, Lee D1, Weinberg M1, Phares C1, James N2, Amornpaisarnloet K2, Aumpipat L2, Cooley G3, Davies A2, Tin Shwe VD2, Gajdadziev V2, Gorbacheva O2, Khwan-Niam C2, Klosovsky A4, Madilokkowit W2, Martin D3, Htun Myint NZ2, Yen Nguyen TN2, Nutman TB5, O'Connell EM5, Ortega L1, Prayadsab S2, Srimanee C2, Supakunatom W2, Vesessmith V2, Stauffer WM6,1. Am J Trop Med Hyg. 2017 Dec 18. doi: 10.4269/ajtmh.17-0725. [Epub ahead of print]
Author information
1
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia.
2
International Organization for Migration, Bangkok, Thailand.
3
Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia.
4
International Organization for Migration, Washington, DC.
5
Laboratory of Parasitic Diseases, National Institutes of Health, Bethesda, Maryland.
6
Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Abstract
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.