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Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps

BACKGROUND: Population-based epidemiological research has established that refugees in low- and middle-income countries (LMIC) are at increased risk for a range of mental, neurological and substance use (MNS) problems. Improved knowledge of rates for MNS problems that are treated in refugee camp pri...

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Autores principales: Kane, Jeremy C, Ventevogel, Peter, Spiegel, Paul, Bass, Judith K, van Ommeren, Mark, Tol, Wietse A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269097/
https://www.ncbi.nlm.nih.gov/pubmed/25420518
http://dx.doi.org/10.1186/s12916-014-0228-9
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author Kane, Jeremy C
Ventevogel, Peter
Spiegel, Paul
Bass, Judith K
van Ommeren, Mark
Tol, Wietse A
author_facet Kane, Jeremy C
Ventevogel, Peter
Spiegel, Paul
Bass, Judith K
van Ommeren, Mark
Tol, Wietse A
author_sort Kane, Jeremy C
collection PubMed
description BACKGROUND: Population-based epidemiological research has established that refugees in low- and middle-income countries (LMIC) are at increased risk for a range of mental, neurological and substance use (MNS) problems. Improved knowledge of rates for MNS problems that are treated in refugee camp primary care settings is needed to identify service gaps and inform resource allocation. This study estimates contact coverage of MNS services in refugee camps by presenting rates of visits to camp primary care centers for treatment of MNS problems utilizing surveillance data from the Health Information System (HIS) of the United Nations High Commissioner for Refugees. METHODS: Data were collected between January 2009 and March 2013 from 90 refugee camps across 15 LMIC. Visits to primary care settings were recorded for seven MNS categories: epilepsy/seizure; alcohol/substance use; mental retardation/intellectual disability; psychotic disorder; emotional disorder; medically unexplained somatic complaint; and other psychological complaint. The proportion of MNS visits attributable to each of the seven categories is presented by country, sex and age group. The data were combined with camp population data to generate rates of MNS visits per 1,000 persons per month, an estimate of contact coverage. RESULTS: Rates of visits for MNS problems ranged widely across countries, from 0.24 per 1,000 persons per month in Zambia to 23.69 in Liberia. Rates of visits for epilepsy were higher than any of the other MNS categories in nine of fifteen countries. The largest proportion of MNS visits overall was attributable to epilepsy/seizure (46.91% male/35.13% female) and psychotic disorders (25.88% male/19.98% female). Among children under five, epilepsy/seizure (82.74% male/82.29% female) also accounted for the largest proportion of MNS visits. CONCLUSIONS: Refugee health systems must be prepared to manage severe neuropsychiatric disorders in addition to mental conditions associated with stress. Relatively low rates of emotional and substance use visits in primary care, compared to high prevalence of such conditions in epidemiological studies suggest that many MNS problems remain unattended by refugee health services. Wide disparity in rates across countries warrants additional investigation into help seeking behaviors of refugees and the capacity of health systems to correctly identify and manage diverse MNS problems.
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spelling pubmed-42690972014-12-18 Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps Kane, Jeremy C Ventevogel, Peter Spiegel, Paul Bass, Judith K van Ommeren, Mark Tol, Wietse A BMC Med Research Article BACKGROUND: Population-based epidemiological research has established that refugees in low- and middle-income countries (LMIC) are at increased risk for a range of mental, neurological and substance use (MNS) problems. Improved knowledge of rates for MNS problems that are treated in refugee camp primary care settings is needed to identify service gaps and inform resource allocation. This study estimates contact coverage of MNS services in refugee camps by presenting rates of visits to camp primary care centers for treatment of MNS problems utilizing surveillance data from the Health Information System (HIS) of the United Nations High Commissioner for Refugees. METHODS: Data were collected between January 2009 and March 2013 from 90 refugee camps across 15 LMIC. Visits to primary care settings were recorded for seven MNS categories: epilepsy/seizure; alcohol/substance use; mental retardation/intellectual disability; psychotic disorder; emotional disorder; medically unexplained somatic complaint; and other psychological complaint. The proportion of MNS visits attributable to each of the seven categories is presented by country, sex and age group. The data were combined with camp population data to generate rates of MNS visits per 1,000 persons per month, an estimate of contact coverage. RESULTS: Rates of visits for MNS problems ranged widely across countries, from 0.24 per 1,000 persons per month in Zambia to 23.69 in Liberia. Rates of visits for epilepsy were higher than any of the other MNS categories in nine of fifteen countries. The largest proportion of MNS visits overall was attributable to epilepsy/seizure (46.91% male/35.13% female) and psychotic disorders (25.88% male/19.98% female). Among children under five, epilepsy/seizure (82.74% male/82.29% female) also accounted for the largest proportion of MNS visits. CONCLUSIONS: Refugee health systems must be prepared to manage severe neuropsychiatric disorders in addition to mental conditions associated with stress. Relatively low rates of emotional and substance use visits in primary care, compared to high prevalence of such conditions in epidemiological studies suggest that many MNS problems remain unattended by refugee health services. Wide disparity in rates across countries warrants additional investigation into help seeking behaviors of refugees and the capacity of health systems to correctly identify and manage diverse MNS problems. BioMed Central 2014-11-24 /pmc/articles/PMC4269097/ /pubmed/25420518 http://dx.doi.org/10.1186/s12916-014-0228-9 Text en © Kane et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kane, Jeremy C
Ventevogel, Peter
Spiegel, Paul
Bass, Judith K
van Ommeren, Mark
Tol, Wietse A
Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps
title Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps
title_full Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps
title_fullStr Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps
title_full_unstemmed Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps
title_short Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps
title_sort mental, neurological, and substance use problems among refugees in primary health care: analysis of the health information system in 90 refugee camps
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269097/
https://www.ncbi.nlm.nih.gov/pubmed/25420518
http://dx.doi.org/10.1186/s12916-014-0228-9
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