Dataset Information

Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland.

ABSTRACT:

Objective

The increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland.

Methods

At the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospitalizations.

Results

Hundred ninety five of 2'544 and 516 of 6'243 asylum seekers registered at the national asylum reception and procedure centre Basel were referred to the University Hospital Basel in 2004/05 and 2014/15, and originated mainly from Europe (62.3%, mainly Turkey) and Africa (49.1%, mainly Eritrea), respectively. Median age was similar in both study periods (26.9 and 26.2 years). Infectious diseases in asylum seekers increased from 22.6% to 36.6% (p<0.001) and were the main reasons for hospitalizations (33.3% of 45 and 55.6% of 81 hospitalized patients, p = 0.017) in 2004/05 compared to 2014/15. The leading infectious diseases in hospitalized patients were tuberculosis (n = 4) and bacterial skin infections (n = 2) in 2004/05; Malaria (n = 9), pneumonia (n = 6), Chickenpox (n = 5), other viral infections (n = 5) and bacterial skin infections (n = 5) in 2014/15. Infectious diseases like malaria, cutaneous diphtheria, louseborne-relapsing fever or scabies were only found in the second study period. Almost one third of the admitted asylum seekers required isolation precautions with median duration of 6-9.5 days in both study periods.

Conclusions

The changing demography of asylum seekers arriving in Switzerland in the current refugee crisis has led to a shift in disease patterns with an increase of infectious diseases and the re-emergence of migration-associated neglected infections. Physicians should be aware of these new challenges.

SUBMITTER: Bloch-Infanger C

PROVIDER: S-EPMC5472310 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland.

Bloch-Infanger Constantine C Bättig Veronika V Kremo Jürg J Widmer Andreas F AF Egli Adrian A Bingisser Roland R Battegay Manuel M Erb Stefan S

PloS one 20170615 6

<h4>Objective</h4>The increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland.<h4>Methods</h4>At the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referral ...[more]

PMID: 28617860

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Project description:BackgroundSwitzerland, with its decentralized health system, has seen the emergence of a variety of care models to meet the complex needs of asylum seekers. A network of public and private providers was designed in the canton Vaud, in which a nurse-led team acts as a first contact point to the health system and provides health checks, preventive care, and health education to this population. In addition, the service plays a case management role for more complex and vulnerable patients. While the network has been examined from a clinical angle, we provide the first descriptive evidence on the care and cost trajectories of asylum seekers in the canton.MethodsWe used routinely collected administrative, patient-level data in a Swiss region responsible for 10% of the asylum seekers in the country. We extracted data on all asylum seekers aged 18 or older who entered the network between 2012 and 2015. The data covered all healthcare costs during the period until they left the network, either because they were granted residence, they left the country, or until 31 December 2018. We estimated random effects regression models for costs and consultations within and outside the network for each month of stay in the network. We investigated language barriers in access to care by stratifying the analysis between patients who spoke one of the official Swiss languages or English and patients who did not speak any of these languages.Principal findingsWe found that both overall health care costs and contacts with the nurse-led team were relatively high during the first year of stay. Asylum seekers then progressively integrated into the regular health system. Individuals who did not speak the language generally had more contacts with the network and fewer contacts outside.ConclusionsIn this exploratory study, we observe a transition from nurse-led specific care with frequent contacts to care in the regular health system. This leads us to generate the hypothesis that a nurse-led, patient-centered care network for asylum seekers can play an important role in providing primary care during the first year after their arrival and can subsequently help them navigate autonomously within the conventional healthcare system.

Project description:Purpose To estimate the burden of infectious diseases and the seasonality of mosquito-borne diseases seen at The Indus Hospital, Karachi (TIH). Methodology We performed a retrospective data analysis of all infectious diseases (ID) cases, retrieved from medical records over a five-year period starting from 1 January 2012 till 31 December 2016 at The Indus Hospital (TIH), which is a 150-bed, charity-based, tertiary-care health facility. The collected data has been categorized into three groups: (A) public health-related diseases, including community and environmental IDs, i.e., mosquito-borne diseases such as malaria and dengue, respiratory tract infections, diarrheal diseases, typhoid, and hepatitis; (B) systemic infection related IDs that target individual anatomical or physiological systems such as the respiratory tract, urinary tract, skin and soft tissue, and the cardiac system, and lastly, those IDs which are (C) programmatically managed at TIH, namely cases from the tuberculosis (TB), human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), and malaria clinics, and the rabies prevention center. As the study is an audit, ethical approval was waived by the institutional review board (IRB). Result Overall data from 71,815 patients were assessed. In the public health group (A), the main bulk of diseases were due to malaria, tuberculosis, respiratory tract infections (upper and lower), and diarrheal diseases in both males and females in descending order; there was preponderance of malaria, respiratory tract infections, and diarrheal diseases in males, and of tuberculosis among females. Among the systemic diseases group (B), urinary tract infections (UTIs) had a disproportionately high incidence, followed by skin and soft tissue infections, while bone and joint infections and diabetic foot had equal incidence. In the programmatic group (C), the highest number of cases seen was dog bites followed by drug-sensitive TB. Overall, the six most common infections were malaria, cases of dog bites, tuberculosis, respiratory tract infections, diarrheal diseases, and hepatitis C. More women than men had TB; diarrheal disease and respiratory tract infections were more common in children. UTIs were the most common systemic infections among both men and women. Conclusion There is a great need to have an effective surveillance mechanism of preventable diseases at the national level. Our study highlights the diversity of cases that should direct medical curriculum development, post-graduate training, and health services improvement.

Project description:BackgroundMore than 120,000 refugees and asylum seekers are currently living in Switzerland. The prevalence of mental disorders among this population is significantly higher than that in the general population. While effective treatment options and cross-cultural, specialized treatment centers exist, they tend to be overloaded by their target populations. General outpatient primary health care providers might be able to compensate for the lack of specialized treatment slots. To date, however, it is unknown how often and under what conditions (e.g., length of waiting lists) refugees and asylum seekers are treated outside of specialized centers and whether there are barriers that prevent providers in outpatient settings from treating more patients in this subgroup. The present study aimed to assess the challenges and barriers faced by psychiatrists and psychotherapists working in outpatient settings in Switzerland in treating refugees and asylum seekers to determine the potential capacity of this group to provide mental health care.MethodsAn online survey was conducted during the winter of 2017/2018. The survey was constructed in three official languages and took 10-15?min to complete. Spearman's correlations, Mann-Whitney U-Tests, and Chi-squared tests were conducted to analyze the data.ResultsEight hundred and sixty-seven (N?=?867) psychotherapists and psychiatrists working in outpatient settings completed the survey: 43% of them reported having treated between 1 and 9 refugees or asylum seekers in the past 12?months, and a further 13% reported treating 10 or more. Interpreters were used for almost every other patient with a refugee or asylum-seeker background. At the same time, the funding of interpreters, as well as the funding of treatment in general, were reported to be the biggest hurdles to treating more refugees and asylum seekers.ConclusionsGiven the low number of patients rejected for capacity reasons (between 2 and 5%) and the median waiting times for the admission of new patients ranging between 2 and 3?weeks, outpatient primary mental health care providers might treat more refugees and asylum seekers and relieve specialized treatment centers. However, barriers such as lack of funding of interpreters seem to hinder them. Appropriate steps by the authorities are needed to improve the current situation.

Project description:BackgroundForced migration significantly endangers health. Women face numerous health risks, including sexual violence, lack of contraception, sexually transmitted disease, and adverse perinatal outcomes. Therefore, sexual and reproductive healthcare is a significant aspect of women asylum seekers' health. Even when healthcare costs of asylum seekers are covered by the government, there may be strong barriers to healthcare access and specific needs may be addressed inadequately. The study's objectives were a) to assess the accommodation and healthcare services provided to women asylum seekers in standard and specialised health care, b) to assess the organisation of healthcare provision and how it addresses the sexual and reproductive healthcare needs of women asylum seekers.MethodsThe study utilised a multi-method approach, comprising a less-dominant quantitative component and dominant qualitative component. The quantitative component assessed accommodation conditions for women in eight asylum centres using a survey. The qualitative component assessed healthcare provision on-site, using semi-structured interviews with health and social care professionals (n?=?9). Asylum centres were selected to cover a wide range of characteristics. Interview analysis was guided by thematic analysis.ResultsThe accommodation in the asylum centres provided gender-separate rooms and sanitary infrastructure. Two models of healthcare were identified, which differed in the services they provided and in their organisation: 1) a standard healthcare model characterised by a lack of coordination between healthcare providers, unavailability of essential services such as interpreters, and fragmented healthcare, and 2) a specialised healthcare model specifically tailored to the needs of asylum-seekers. Its organisation is characterised by a network of closely collaborating health professionals. It provided essential services not present in the standard model. We recommend the specialised healthcare model as a guideline for best practise.ConclusionsThe standard, non-specialised healthcare model used in some regions in Switzerland does not fully meet the healthcare needs of women asylum seekers. Specialised healthcare services used in other regions, which include translation services as well as gender and culturally sensitive care, are better suited to address these needs. More widespread use of this model would contribute significantly toward protecting the sexual and reproductive integrity and health of women asylum seekers.

Dataset Information

Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland.

Objective

Methods

Results

Conclusions

Publications

Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland.

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