Adolescent refugees present unique health care challenges

Last Updated: 2015-11-02

By Will Boggs MD

NEW YORK (Reuters Health) - Adolescent refugees resettling in high-income countries face unique physical, nutritional, and psychological health care challenges, researchers from Australia report.

"There is a need to recognize that adolescents from a refugee background are a vulnerable population with unique health care needs that should be addressed in an age-appropriate context," Dr. Sarah Cherian and colleagues from Princess Margaret Hospital for Children, Perth, Western Australia, told Reuters Health in a joint email.

"The provision of adequate multidisciplinary services and support within pediatric health care settings and appropriate transition to adult services is key to improving long-term health outcomes," they said.

Dr. Cherian's team reviews the health care needs of adolescent refugees (ages 10-19) in their October 15 Archives of Disease in Childhood online report.

Their preflight phase is commonly marked by economic hardship, interrupted education, social upheaval (including loss of home and family members), exposure to warfare, political persecution, violence, and sexual abuse.

During flight, they can experience separation from or death of family members and transition through refugee camps and detention centers, where poverty, malnutrition, vector exposure, and inadequate living conditions can increase the risk of developing new health problems and exacerbate those that already exist.

Once resettled, health screening is usually voluntary and varies from country to country.

Infectious diseases are a primary concern - these adolescents are at high risk of sexually transmitted infections, hepatitis B, tuberculosis, and a variety of infections related to their countries of origin.

Nutritional deficiencies are common, especially deficiencies in vitamin D, iron, vitamin B12, and other micronutrients.

Post-traumatic stress disorder (PTSD) and other mental health disorders are widely reported among adolescent refugees, and some are prone to develop maladaptive behaviors. Cultural stigma often discourages them from seeking appropriate therapy and counseling.

Adolescent refugees also face language, education, and employment issues; healthcare barriers; acculturation issues; and child maltreatment and child protection issues (including child marriage, female genital mutation, and sexual and emotional abuse and neglect).

To address these issues, the authors offer five recommendations for the assessment and management of adolescent refugees:

* use a standardized refugee health assessment.

* explore broader aspects of adolescent health during assessments.

* network with colleagues in agencies involved in providing support to adolescent refugees.

* highlight and advocate for the need to collect health data in the various age subgroups.

* make use of available resources for education and training to improve knowledge regarding key challenges encountered in adolescents from a refugee background.

"The management of adolescent refugees requires a holistic approach, encompassing physical and psychosocial issues as well as socioeconomic determinants," Dr. Cherian and colleagues said. "There are several barriers to provision of health care that need to be factored into service delivery. Overcoming language barriers in particular requires the use of interpreters during consultations."

"Improving literacy by provision of education to empower youth, particularly marginalized female adolescents has been advocated as a key measure to improve health outcomes in adulthood as well as reduce childhood mortality and morbidity (given that many mothers, especially in low-income countries, are adolescents)," they explain. "However, with a rapidly rising refugee population, there is a critical need to implement these strategies more specifically within this high-risk adolescent cohort."

"Physicians should play a central role in providing advocacy for vulnerable adolescent refugees," they conclude.

Dr. Delma-Jean Watts, co-director of the Global Health Scholarly Concentration, Alpert Medical School of Brown University and co-director of the Brown Resident International/Global Health Training (BRIGHT) Pathway, Providence, Rhode Island, told Reuters Health by email, "The authors highlight the challenges faced by refugee adolescents. In my experience, I have found the reproductive health and acculturation issues to be the most challenging at times. In terms of reproductive health, adolescent refugees have varying degrees of knowledge and experience, often related to their cultural background. It is important for providers to keep this in mind and take the time to assess their needs and understanding to better serve them."

"Refugees are not all the same and come with their own personal and cultural experiences, which can affect what challenges they may face during the resettlement process," Dr. Watts said. "They also have had experiences that make them incredibly strong and resilient. Providers, teachers, and other community workers should take the time to learn their stories, which will help them draw on these strengths and successfully move through the resettlement process."

The authors reported no study funding or disclosures.

SOURCE: http://bit.ly/1l4p5sA

Arch Dis Child 2015.