Defining key indicators for migrant health outcomes and health policy: a suite of systematic reviews

BACKGROUND: 46 million migrants reside in the Middle East and North Africa (MENA) region, a proportion of whom will transit to Europe. Yet little is known about policy and practice in relation to data collection and healthcare provision. We synthesised evidence on health indicators, policies, and provision for migrants in the MENA to inform the development of a new tool to strengthen data collection around key diseases. METHODS: We did 12 systematic reviews (18 countries) to explore the burden, clinical outcomes, policies, and access for the following disease areas in migrants: TB, HIV and hep B/C, malaria and neglected tropical diseases, non-communicable diseases (NCDs) and mental health, maternal and neonatal health, and vaccine-preventable diseases. We searched electronic databases (PubMed/Embase) from 2000 to April 2023, with no exclusion criteria. Migrants were defined as persons who move away from their place of residence within or across a country. PRELIMINARY RESULTS: Most studies on migrants in the MENA are descriptive or cross-sectional, focus on disease burden, and few have counterfactual host population groups. We found data on multiple outbreaks of vaccine-preventable diseases in migrant populations, particularly in conflict-stricken areas. Data show that prevalence for TB may be higher among migrants in certain contexts, which is largely due to reactivation of latent TB potentially due to poor living conditions. Diabetes and hypertension are the most common NCDs in migrant populations. There is a paucity of data on clinical outcomes in migrants, and on the coverage and uptake of interventions. Of the studies that do report interventions, majority assess acceptability, perceptions, or knowledge. CONCLUSIONS: This suite of systematic reviews syntheses evidence from across the MENA to address key evidence gaps. We found there is a need to strengthen data and surveillance around migrant health as an urgent next step to informing policy for disease elimination. KEY MESSAGES: • Migrants in the Middle East and North Africa may be at an increased risk of communicable and non-communicable diseases compared with host populations. • To better inform public health policy, stronger and more comprehensive surveillance on migrant populations and more robust research is needed.