Changing landscape of paediatric refugee health in South Western Sydney, Australia: a retrospective observational study

OBJECTIVES: To examine the changing health needs of refugee children and young people (CYP) entering Australia, in relation to key government policy changes. STUDY DESIGN: Retrospective analysis of health service use data over 11 years. SETTING: Paediatric refugee clinics in South Western Sydney (SWS), the Australian region with the largest annual resettlement of refugees. PARTICIPANTS: Refugee CYP (≤25 years) attending the SWS paediatric refugee clinics for their first visit between 2009 and 2019. MEASURES: Clinician defined health conditions categorised as communicable and non-communicable disease (NCD). RESULTS: Data were analysed for 359 CYP, mean age 9.3 years; 212 male (59.1%). Most CYP (n=331, 92.2%) had health problems identified; 292 (81.3%) had ≥1 NCD and 24 (6.7%) had ≥1 communicable disease. The most frequent individual NCDs were dental disease (n=128, 35.7%) and vitamin D deficiency (n=72, 20.1%). Trend analysis showed increased odds of identifying an NCD from 2013 onwards (crude OR 1.77, 95% CI 1.06 to 2.96). Neurodevelopmental problems, especially Global Developmental Delay (n=31, 8.6%), emerged as more prevalent issues in the latter half of the decade. There were significantly increased odds of identifying a neurodevelopmental problem in 2016–2019, especially in 2016–2017 (adjusted OR 2.93, 95% CI 1.34 to 6.40). Key policy changes during this period included acceptance of refugees with disabilities from 2012, additional Australian Humanitarian Programme intake from the Eastern Mediterranean region and mandatory offshore processing for those seeking asylum by boat from 2013. In response to the changing needs, local health services adopted nurse-led primary healthcare screening, early childhood services, youth and disability clinics. CONCLUSIONS: Refugee CYP in Australia are presenting with a growing burden of NCDs, with neurodevelopmental problems contributing. Government policy changes affect the sociodemographics of resettled populations, influencing health profiles. Paediatric refugee health services need to be responsive to the changing needs of these populations to optimise well-being.