Post-Doctoral Fellowship in the Epidemiology of Migration and Health

Post-Doctoral Fellowship in the Epidemiology of Migration and Health

Posting Date: October 16, 2018

Closing Date: Review of applications will begin on December 1, 2018. The position will remain open until a suitable candidate is found.

For more information:

[PAPER] A global research agenda on migration, mobility, and health (2017)

A global research agenda on migration, mobility, and health [Open Access]

Hanefeld, J., Vearey, J. and Lunt, N. on behalf of the Researchers on Migration, Mobility and Health Group

The Lancet 2017; 389 2358-2359

Summary

With 1 billion people on the move globally—more than 244 million of whom have crossed international borders – and a recognised need to strengthen efforts towards universal health coverage, developing a better understanding of how to respond to the complex interactions between migration, mobility, and health is vital.

At the 2nd Global Consultation on Migrant Health in Sri Lanka earlier this year, a group of global experts in health and migration discussed the progress and shortfalls in attaining the actions set out in the 2008 World Health Assembly (WHA) Resolution on the Health of Migrants.

An anticipated outcome from the 2017 consultation is a “roadmap towards research and policy dialogue milestones”.  At the 70th WHA in May, 2017, migration and health were discussed with delegates requesting the WHO’s Director-General to provide guidance to countries on promoting the health of refugees and migrants, with a draft global action to be considered at the 72nd WHA in 2019.

The specific challenges we have encountered in our fieldwork in migration contexts highlight the need for better evidence to improve health-system responses to migration, mobility, and health. We have identified five core areas in which action is needed to support the development of a global research agenda on migration, mobility, and health.

[PAPER] Towards a migration-aware health system in South Africa: A strategic opportunity to address health inequity (2017)

Towards a migration-aware health system in South Africa: A strategic opportunity to address health inequity [Open Access]

Vearey, J., Modisenyane, M. and Hunter-Adams, J.

South African Health Review 27(1) 89 – 98 

Abstract

Similar to the rest of the region, South Africa has a high prevalence of communicable diseases, an increasing non-communicable disease burden, and diverse internal and cross-border population movements. Healthy migration should be good for social and economic development, but in South Africa current health responses fail to address migration adequately. A review was done of the available data in order to provide recommendations for improved health-systems responses to migration and health in the country, and we drew on our experience in relevant policy processes.

The findings show that addressing migration and health is a priority globally and locally. The number of people moving internally within South Africa far exceeds the number of cross-border migrants. Contrary to popular assumptions, internal migration presents greater governance, health-system, and health-equity challenges than cross-border migration, but current responses do not recognise this. Our findings show why recognising migration as a determinant of health assists in addressing associated health inequities. Data suggest that a healthy migrant effect, and subsequent health penalty, is at play in South Africa. Evidence shows that both non-nationals and South African nationals who move within the country face challenges in accessing health care; of particular concern is the lack of a co-ordinated strategy to ensure continuous access to treatment, and care and support of chronic conditions.

Migration impacts the South African public healthcare system but not in the ways often assumed, and sectors responsible for improving responses have a poor understanding of migration. The need for better data is emphasised, existing policy responses are outlined, and strategic opportunities for intervention are suggested. Recommendations are made for migration-aware health systems that embed population movement as central to the design of health interventions, policy, and research. Such responses offer strategic opportunities to address health inequity, both nationally and regionally, with resulting health and developmental benefits for all.      

 

[PAPER] Infectious disease testing of UK-bound refugees: a population-based, cross-sectional study (2018)

Infectious disease testing of UK-bound refugees: a population-based, cross-sectional study [Open Access]

Alison F. Crawshaw, Manish Pareek, John Were, Steffen Schillinger, Olga Gorbacheva, Kolitha P. Wickramage, Sema Mandal, Valerie Delpech, Noel Gill, Hilary Kirkbride, and Dominik Zenner

Abstract

Background

The UK, like a number of other countries, has a refugee resettlement programme. External factors, such as higher prevalence of infectious diseases in the country of origin and circumstances of travel, are likely to increase the infectious disease risk of refugees, but published data is scarce. The International Organization for Migration carries out and collates data on standardised pre-entry health assessments (HA), including testing for infectious diseases, on all UK refugee applicants as part of the resettlement programme. From this data, we report the yield of selected infectious diseases (tuberculosis (TB), HIV, syphilis, hepatitis B and hepatitis C) and key risk factors with the aim of informing public health policy.

Methods

We examined a large cohort of refugees (n = 18,418) who underwent a comprehensive pre-entry HA between March 2013 and August 2017. We calculated yields of infectious diseases stratified by nationality and compared these with published (mostly WHO) estimates. We assessed factors associated with case positivity in univariable and multivariable logistic regression analysis.

Results

The number of refugees included in the analysis varied by disease (range 8506–9759). Overall yields were notably high for hepatitis B (188 cases; 2.04%, 95% CI 1.77–2.35%), while yields were below 1% for active TB (9 cases; 92 per 100,000, 48–177), HIV (31 cases; 0.4%, 0.3–0.5%), syphilis (23 cases; 0.24%, 0.15–0.36%) and hepatitis C (38 cases; 0.41%, 0.30–0.57%), and varied widely by nationality. In multivariable analysis, sub-Saharan African nationality was a risk factor for several infections (HIV: OR 51.72, 20.67–129.39; syphilis: OR 4.24, 1.21–24.82; hepatitis B: OR 4.37, 2.91–6.41). Hepatitis B (OR 2.23, 1.05–4.76) and hepatitis C (OR 5.19, 1.70–15.88) were associated with history of blood transfusion. Syphilis (OR 3.27, 1.07–9.95) was associated with history of torture, whereas HIV (OR 1521.54, 342.76–6754.23) and hepatitis B (OR 7.65, 2.33–25.18) were associated with sexually transmitted infection. Syphilis was associated with HIV (OR 10.27, 1.30–81.40).

Conclusions

Testing refugees in an overseas setting through a systematic HA identified patients with a range of infectious diseases. Our results reflect similar patterns found in other programmes and indicate that the yields for infectious diseases vary by region and nationality. This information may help in designing a more targeted approach to testing, which has already started in the UK programme. Further work is needed to refine how best to identify infections in refugees, taking these factors into account.

[PAPER] Missing: Where Are the Migrants in Pandemic Influenza Preparedness Plans? (2018)

Missing: Where Are the Migrants in Pandemic Influenza Preparedness Plans? [Open Access]

Kolitha Wickramage, Lawrence O. Gostin, Eric Friedman, Phusit Prakongsai, Rapeepong Suphanchaimat, Charles Hui, Patrick Duigan, Eliana Barragan, and David R. Harper

Health and Human Rights Journal June 2018 Vol 20 number 1, 251-258.

 

Background

Influenza pandemics are perennial global health security threats, with novel and seasonal influenza affecting a large proportion of the world’s population, causing enormous economic and social destruction. Novel viruses such as influenza A(H7N9) continue to emerge, posing zoonotic and potential pandemic threats.[1] Many countries have developed pandemic influenza preparedness plans (PIPPs) aimed at guiding actions and investments to respond to such outbreak events.[2]

Migrant and mobile population groups—such as migrant workers, cross-border frontier workers, refugees, asylum seekers, and other non-citizen categories residing within national boundaries—may be disproportionately affected in the event of health emergencies, with irregular/undocumented migrants experiencing even greater vulnerabilities. Because of a combination of political, sociocultural, economic, and legal barriers, many migrants have limited access to and awareness of health and welfare services, as well as their legal rights.[3] The conditions in which migrants travel, live, and work often carry exceptional risks to their physical and mental well-being. Even if certain migrant groups have access to health services, they tend to avoid them due to fear of deportation, xenophobic and discriminatory attitudes within society, and other linguistic, cultural, and economic barriers.[4] Evidence indicates that social stigmatization and anxieties generated by restrictive immigration policies hinder undocumented immigrants’ access to health rights and minimizes immigrants’ sense of entitlement to such rights.[5]

[PAPER] Prevention and assessment of infectious diseases among children and adult migrants arriving to the European Union/European Economic Association: a protocol for a suite of systematic reviews for public health and health systems (2017)

Prevention and assessment of infectious diseases among children and adult migrants arriving to the European Union/European Economic Association: a protocol for a suite of systematic reviews for public health and health systems [Open Access]

Pottie K, Mayhew A, Morton R, Greenaway C, Akl EA, Rahman P, Zenner D , Pareek M, Tugwell P, Welch V, Meerpohl J, Alonso-Coello  P, Hui C, Biggs BA, Requena-Méndez A, Agbata E, Noori T, Schünemann HJ.

BMJ Open 7 (9), e014608. 2017

https://bmjopen.bmj.com/content/7/9/e014608

 

Abstract

Introduction The European Centre for Disease Prevention and Control is developing evidence-based guidance for voluntary screening, treatment and vaccine prevention of infectious diseases for newly arriving migrants to the European Union/European Economic Area. The objective of this systematic review protocol is to guide the identification, appraisal and synthesis of the best available evidence on prevention and assessment of the following priority infectious diseases: tuberculosis, HIV, hepatitis B, hepatitis C, measles, mumps, rubella, diphtheria, tetanus, pertussis, poliomyelitis (polio), Haemophilus influenza disease, strongyloidiasis and schistosomiasis.

Methods and analysis The search strategy will identify evidence from existing systematic reviews and then update the effectiveness and cost-effectiveness evidence using prospective trials, economic evaluations and/or recently published systematic reviews. Interdisciplinary teams have designed logic models to help define study inclusion and exclusion criteria, guiding the search strategy and identifying relevant outcomes. We will assess the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Ethics and dissemination There are no ethical or safety issues. We anticipate disseminating the findings through open-access publications, conference abstracts and presentations. We plan to publish technical syntheses as GRADEpro evidence summaries and the systematic reviews as part of a special edition open-access publication on refugee health. We are following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols reporting guideline. This protocol is registered in PROSPERO: CRD42016045798.

[PAPER] Immigrant Arrival and Tuberculosis among Large Immigrant and Refugee Receiving Countries, 2005–2009 (2017)

Immigrant Arrival and Tuberculosis among Large Immigrant and Refugee Receiving Countries, 2005–2009 [Open Access]

Zachary White, John Painter, Paul Douglas, Ibrahim Abubaker, Howard Njoo, Chris Archibald, Jessica Halvers, John Robson, Drew Posey

Tuberculosis Research and Treatment; Volume 2017

https://doi.org/10.11552017/8567893

Abstract

Objective. Tuberculosis control in foreign-born populations is a major public health concern for Australia, Canada, New Zealand, United Kingdom, and the United States, large immigrant- and refugee-receiving countries that comprise the Immigration and Refugee Health Working Group (IRHWG). Identifying and comparing immigration and distribution of foreign-born tuberculosis cases are important for developing targeted and collaborative interventions. 

Methods. Data stratified by year and country of birth from 2005 to 2009 were received from these five countries. Immigration totals, tuberculosis case totals, and multidrug-resistant tuberculosis (MDR TB) case totals from source countries were analyzed and compared to reveal similarities and differences for each member of the group. Results. Between 2005 and 2009, there were a combined 31,785,002 arrivals, 77,905 tuberculosis cases, and 888 MDR TB cases notified at the federal level in the IRHWG countries. India, China, Vietnam, and the Philippines accounted for 41.4% of the total foreign-born tuberculosis cases and 42.7% of the foreign-born MDR tuberculosis cases to IRHWG. 

Interpretation. Collaborative efforts across a small number of countries have the potential to yield sizeable gains in tuberculosis control for these large immigrant- and refugee-receiving countries.

[PAPER] Cross-border collaboration for improved tuberculosis prevention and care: policies, tools and experiences (2017)

Cross-border collaboration for improved tuberculosis prevention and care: policies, tools and experiences [Open Access]

Dara M, Sulis G, Centis G, D’Ambrosio L, de Vries G, Douglas P, Garcia D, Jansen N, Zuroweste E, Migliori GB

Int J Tuberc Lung Dis. 2017 Jul 1;21(7):727-736.

https://doi.org/10.5588/ijtld.16.0940

 

Abstract

As tuberculosis (TB) spreads beyond borders with people movements, several interventions ensuring the continuity of care are essential, although difficult to put in place in the absence of well-defined agreements allowing data sharing and easy referral of patients to appropriate health facilities. This article first sets out general principles for cross-border collaboration and continuity of care. It then presents a series of case studies. Policies and practices on cross-border collaboration in selected low-incidence countries (Australia, Italy, Norway, The Netherlands, the United Kingdom and the United States) are described and critically appraised. Details of the World Health Organization’s (WHO’s) European Respiratory Society TB Consilium for transborder migration and those of the Health Network’s TBNet activities are described. With increasing population movement, including migrants and travellers, it is time to build on good practices and existing tools and to remove legal, financial and social barriers to ensure early diagnosis, full treatment and continuity of care across our world. Data sharing between the sending and the receiving countries is of utmost importance and must be conducted in line with privacy protection rules. Successful implementation of these interventions is key to being on track with the WHO’s End TB strategy targets for 2030.

[PAPER] Capacity strengthening through pre-migration tuberculosis screening programmes: IRHWG experiences (2017)

 

Abstract

Effective tuberculosis (TB) prevention and care for migrants requires population health-based approaches that treat the relationship between migration and health as a progressive, interactive process influenced by many variables and addressed as far upstream in the process as possible. By including capacity building in source countries, pre-migration medical screening has the potential to become an integral component of public health promotion, as well as infection and disease prevention, in migrant-receiving nations, while simultaneously increasing capabilities in countries of origin. This article describes the collaborative experiences of five countries (Australia, Canada, New Zealand, United Kingdom and the United States of America, members of the Immigration and Refugee Health Working Group [IRHWG]), with similar pre-migration screening programmes for TB that are mandated. Qualitative examples of capacity building through IRHWG programmes are provided. Combined, the IRHWG member countries screen approximately 2 million persons overseas every year. Large-scale pre-entry screening programmes undertaken by IRHWG countries require building additional capacity for health care providers, radiology facilities and laboratories. This has resulted in significant improvements in laboratory and treatment capacity, providing availability of these facilities for national public health programmes. As long as global health disparities and disease prevalence differentials exist, national public health programmes and policies in migrant-receiving nations will continue to be challenged to manage the diseases prevalent in these migrating populations. National TB programmes and regulatory systems alone will not be able to achieve TB elimination. The management of health issues resulting from population mobility will require integration of national and global health initiatives which, as demonstrated here, can be supported through the capacity-building endeavours of pre-migration screening programmes.