[Open Access] Travel health risk perceptions of Chinese international students in Australia – Implications for COVID-19

Travel health risk perceptions of Chinese international students in Australia – Implications for COVID-19

Tara Maa, Anita HeywoodaC., Raina MacIntyreb
aSchool of Public Health and Community Medicine, UNSW Australia, Kensington, NSW, 2052 Australia
bBiosecurity Program, The Kirby Institute, UNSW Australia, Kensington, NSW, 2052 Australia

Abstract

Background

International students frequently return to their country of origin to visit friends and relatives (VFR), and are at increased risk of travel-associated infections. Little is known of their travel health seeking behaviours. China is the biggest source of international students studying in Australia and the unprecedented epidemic of COVID-19 in China makes this an important area of research.

Methods

Focus groups of Chinese international students were conducted to explore travel health-related knowledge, attitudes and practices. Eligible participants were studying in Sydney, and had travelled to China and Hong Kong to visit friends and relatives in the preceding 18 months. A variety of topics were explored, using a focus group guide. Thematic analysis was undertaken on the transcripts using nVivo software. The list of codes and themes were not pre-determined but developed through content analysis.

Results

Two focus groups were held with a total of 28 participants. Risk perception about VFR travel was generally low among Chinese international students. Pre-travel healthcare was not sought. Students strongly relied on the Internet, social media, parents and friends in China for travel health advice.

Conclusion

This research provides insights into Chinese international students as VFR travellers. It confirms students could be a risk population for importations of infections such as COVID-19 because of low risk perception and lack of seeking travel health advice. This can inform health promotion strategies for students.

Read the full paper here

[open access] Covid-19: how a virus is turning the world upside down

Covid-19: how a virus is turning the world upside down

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1336 (Published 03 April 2020)
Cite this as: BMJ 2020;369:m1336

Ilona Kickbusch, director1,  

Gabriel M Leung, dean of medicine2,  

Zulfiqar A Bhutta, co-director3,  

Malebona Precious Matsoso, director of health regulatory science platform4,  

Chikwe Ihekweazu, director general5,  

Kamran Abbasi, executive editor6

1Global Health Programme, Graduate Institute of International and Development Studies, Geneva, Switzerland

2Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China

3Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada

4Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa

5Nigeria Centre for Disease Control, Abuja, Nigeria

6The BMJ, London, UK

Correspondence to: I Kickbusch kickbusch@bluewin.ch

“Covid-19 has taught us that health is the basis of wealth, that global health is no longer defined by Western nations and must also be guided by Africa and Asia, and that international solidarity is an essential response and a superior approach to isolationism. We may emerge from this with a healthier respect for the environment and our common humanity. All citizens, governments, businesses, and organisations must heed these lessons. Covid-19 is the virus that is turning the world upside down. It will destroy the world as we know it; in the process we may learn to hold it together.”

Read the full article here

[Open Access] COVID-19 control in low-income settings and displaced populations: what can realistically be done?

COVID-19 control in low-income settings and displaced populations: what can realistically be done?

Maysoon Dahab1, Kevin van Zandvoort2, Stefan Flasche2, Abdihamid Warsame2, Paul B. Spiegel3, Ronald J Waldman4 5, Francesco Checchi2 *

1  Conflict & Health Research Group, King’s College London, London, UK

2 Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

3 Centre for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

4 Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA

5 Doctors of the World USA, New York, NY, USA

* Corresponding author: Francesco.checchi@lshtm.ac.uk

Background

“While modelling predictions1 suggest that uncontrolled or even partially mitigated COVID-19 epidemics in high-income countries could lead to substantial excess mortality, the virus’ impact on people living in low-income settings or affected by humanitarian crises could potentially be even more severe. Three mechanisms could determine this: (i) higher transmissibility due to larger household sizes2, intense social mixing3 between the young and elderly4, overcrowding in urban slums and displaced people’s camps, inadequate water and sanitation, and specific cultural and faith practices such as mass prayer gatherings, large weddings and funerals during which super-spreading events might propagate transmission disproportionately5; (ii) higher infection-to-case ratios and progression to severe disease due to the virus’ interaction with highly prevalent co-morbidities, including non-communicable diseases (NCDs; prevalence of hypertension and diabetes is often higher in low- than high-income settings, with a far lower treatment coverage6), undernutrition, tuberculosis7 and HIV; and (iii) higher case-fatality due to a dire lack of intensive care capacity, especially outside large cities. Moreover, extreme pressure on curative health services could result in indirect impacts resulting from disrupted care for health problems other than COVID-19.8 While these risk factors could be counterbalanced by younger age distributions and hot temperatures, on balance we believe that, given current evidence and plausible reasoning, drastic action is required immediately to protect the world’s most fragile populations from this unfolding threat.”

Read the full paper here

[Open Access] Targeting COVID-19 interventions towards migrants in humanitarian settings

COMMENT | Lancet Infectious Diseases | VOLUME 20, ISSUE 6, P645-646, JUNE 01, 202

Targeting COVID-19 interventions towards migrants in humanitarian settings

Published:April 21, 2020DOI: https://doi.org/10.1016/S1473-3099(20)30292-9

“Millions of refugees and migrants reside in countries devastated by protracted conflicts with weakened health systems, and in countries where they are forced to live in substandard conditions in camps and compounds, and high-density slum settings.1 Although many such settings have yet to feel the full impact of coronavirus disease 2019 (COVID-19), the pandemic is now having an unprecedented impact on mobility, in terms of border and migration management, as well as on the health, social, and economic situation of migrant populations globally. An urgent coordinated effort is now needed to align these populations with national and global COVID-19 responses.”

Read more here.

Risk behind bars: Coronavirus and immigration detention

Risk behind bars: Coronavirus and immigration detention

BY RANIT MISHORI

“….an outbreak in a facility threatens the outside community as well. An outbreak in a detention facility endangers all who come in contact with migrants, from immigration enforcement staff to workers at detention facilities, asylum officers, lawyers, and judges. All those people come in contact with the detainees and go home to their families at night.”

Read the full article here

[open access] Responding to the COVID-19 pandemic in complex humanitarian crises

Responding to the COVID-19 pandemic in complex humanitarian crises

International Journal for Equity in Health volume 19, Article number: 41 (2020) Cite this article

Over 168 million people across 50 countries are estimated to need humanitarian assistance in 2020 [1]. Response to epidemics in complex humanitarian crises—such as the recent cholera epidemic in Yemen and the Ebola epidemic in the Democratic Republic of Congo—is a global health challenge of increasing scale [2]. The thousands of Yemeni and Congolese who have died in these years-long epidemics demonstrate the difficulty of combatting even well-known pathogens in humanitarian settings. The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may represent a still greater threat to those in complex humanitarian crises, which lack the infrastructure, support, and health systems to mount a comprehensive response. Poor governance, public distrust, and political violence may further undermine interventions in these settings.

Sequential screening for depression in humanitarian emergencies: a validation study of the Patient Health Questionnaire among Syrian refugees

This study utilized data from a cross-sectional survey done with Syrian refugees in a camp in Greece. The goal was to determine if a sequential screening process would be able to accurately assess the number of patients with major depressive disorder (MDD) in the population. While the initial data was collected through the eight-item Patient Health Questionnaire (PHQ-8), this validation study simulated the use of the two-item Patient Health Questionnaire (PHQ-2) as well. The PHQ-2 was used to first screen the data of patients who scored less than 2 on the PHQ-2, who were then ruled out for MDD symptoms. The other patients’ answers were then used in the PHQ-8. The findings were analyzed to see if the two-part process would be able to accurately and efficiently determine who would be most at risk for symptoms of MDD. 

The conclusion of this study was that “The benefits of the sequential screening approach for the classification of MDD presented here are twofold: preserving classification accuracy relative to the PHQ-2 alone while reducing the response burden of the PHQ-8. This sequential screening approach is a pragmatic strategy for streamlining MDD surveillance in humanitarian emergencies.” 

Migration Health Evidence Portal for COVID-19

This evidence portal is a repository of research publications and high-yield evidence briefs on COVID-19 and its intersection with migration health.

The scientific literature and knowledge base on the epidemic rapidly expand daily. Tremendous efforts are being made by the global community of clinicians, researchers and journal editors to advance scientific evidence to guide policy and decision making at the field level. However, there is a need to build evidence platforms to share and distill key findings emergent from this growing body of scientific literature that is relevant to migration, health, and human mobility to ultimately assist evidence-informed decision making from a migration lens.

The portal contains:

Research Publications on COVID-19 and Migration Health

This section reflects the output of the publication mapping exercise involving the quantitative assessment of a set of published scientific articles (i.e., bibliometric analysis) on COVID-19 with reference to migrants, migration, and human mobility. Bibliometric analysis provides an important snapshot of a specific field of interest/domain. The baseline information from bibliometric analysis helps identify research gaps that future studies can investigate. The bibliometric analysis conducted by IOM and MHADRI on international migration and health is one example.

Key messages

  • As of 30 March 2020, the publications related to COVID-19 totaled 21,779 (no restriction set in terms of language and subject area). From this, a total of 43 publications were relevant to migration health and human mobility.
  • Most of the studies investigated the cases and disease transmission dynamics of COVID-19 in the context of national and international population movement, with most studies undertaken in China. The distribution of research to date indicates the role of travel and migration in the importation of the virus.
  • Research on the epidemiology of the disease among migrant groups such as migrant workers, internally displaced persons (IDPs), refugees and asylum seekers is lacking. Evidence with attribution to migrant groups within clinical datasets are seldom reported.
  • Despite multiple studies from high-income countries (HICs) using mathematical modelling to predict spread, and model social distancing, border closures and impacts on health care system capacities, there were only a few studies that model outbreak in low-to-middle-income countries (LMICs) contexts. None hitherto have focused on camps and camp-like situations.
  • There is a real need to strengthen the current knowledge base on the epidemiology and social determinants of COVID-19 and examine health-related outcomes in specific migrant groups, especially migrant workers.
  • Investigations on COVID-19 and migration health should not be limited to the role of movement/mobility in the dynamic importation of cases in a pandemic; a more inclusive research strategy that integrates the relevant interests of migrant populations should be considered.
  • Advocating for the right to health of migrants and migrant inclusion within the global, regional, national and sub-national pandemic preparedness and response plans is of critical importance.
  • The most productive authors and institutions come from Hong Kong, whose geographical proximity to and socio-economic ties with China were likely contributing factors in their early contributions to the field.

Network map of common keywords

The network map below shows an overview of the common keywords that appear in the title, abstract, and keywords of the relevant publications retrieved on the topic of COVID-19 and migration health. Network maps of keywords reveal key topics in a research area or domain as well as the relationship (co-occurrence) between common keywords. It is a relative indicator of important research areas that are drawing attention in the field. 

  • The large circles in the figure represent the most frequently occurring author keywords in the research publications (N=43) such as ‘pneumonia’ (n=26), ‘epidemic’ (n=22), ‘travel’ (n=19), ‘quarantine’ (n=18), ‘outbreak’ (n=15), and ‘disease transmission’ (n=14). 
  • The lines connecting the circles represent the co-occurring keywords. The distance between two keywords approximates how strongly the words are related based on the number of their co-occurrences (i.e., the more publications in which two keywords co-occur, the stronger the relation between them). Thus, the strongly related words appear closer together on the map. 
  • Each distinct color represents a cluster of keywords that are strongly related to each other. In the figure, ‘pneumonia’, ‘travel’, and ‘disease transmission’ are strongly related to ‘virology’, ‘animals’, ‘nonhuman’, ‘zoonosis’, ‘fever’, ‘genetics’, and ‘pandemic’ (red cluster). The keyword ‘epidemic’ is strongly related to ‘outbreak’, ‘quarantine’, ‘mass screening’, ‘air travel’, ‘travel medicine’, ‘global health’, ‘infection control’, and ‘risk assessment’ – these keywords are shown to be closer together forming the green cluster. 
  • These topics on COVID-19 and migration health can be classified into the following thematic areas: disease epidemiology (i.e., travel, disease transmission, virology, animals, nonhuman, zoonosis, genetics, pandemic); clinical management (i.e., pneumonia and fever); and public health intervention (i.e., quarantine, control, etc.).

Note: See the full paper for the Methodology and Limitations of this analysis.

Resisting Borders: A Virtual Conference on Refugee & Migrant Health, Mobility, Human Rights & Responsibilities (June 2020)

Originally posted online: https://resistingbordersconference.wpcomstaging.com/call-for-abstracts/

CALL FOR PAPERS

RESISTING BORDERS II: REFUGEE AND MIGRANT HEALTH AND RESPONSIBILITIES

Caring on the Landscape of Displacement:

Mapping Moral Experience in Health Services for Migrants

June 15th, 16th, 17th and 18th 2020, 7 am – 9 am Eastern Standard Time

First convened in 2017, Resisting Borders: Refugee and Migrant Health and Responsibilities is a no travel, online, no fee conference aimed at discussing ethical issues surrounding responsibilities for the health of refugees, asylum-seekers, and other migrant and displaced people.

We are now inviting contributions for a second conference to be held in June 15th, 16th, 17th and 18th 2020, 7 am – 9 am Eastern Standard Time, as a satellite to the World Congress of Bioethics.

As before, we will convene for a few hours during each of the four days. The theme of the 2020 Resisting Borders conference will be Caring on the Landscape of Displacement: Mapping Moral Experience in Health Services for Migrants.

Submissions on any topic concerning migrant health and responsibility are welcome, but we are especially interested in contributions – be they academic research presentations, or narratives – that reflect the moral experience of professionals (e.g. scholars, practitioners, advocates, or policy-makers) whose work concerns the care of migrants at any point of their journey and settlement, as well as the ethical issues that arise in providing this care. We are also interested in experiences of those engaging with the care of migrants indirectly through the development of policy, journalism, or artistic creations. Presentations might, for example, address ethical issues regarding constraints in the provision of health or other services, the identification of remains, involvement in medical exams linked to the processing of asylum claims, provision of care in detention facilities or other morally compromised/compromising settings, problems of dual or confused loyalties.

The organizers will assemble selected essays and artistic submissions for publication, in addition to an online and traveling art and storytelling exhibition.

Submission before March 31rst , 2020.

Please send abstracts of no longer than 500 words via our abstract submission page.

Please include the following information:

  • Name and affiliation of presenter
  • Title of presentation
  • Type of presentation: experiential; research; artistic
  • Email address

Call for Papers: Psychosocial Perspectives on Migration and Health


Call for Papers: Psychosocial Perspectives on Migration and Health

Department of Psychosocial Studies, Birkbeck, University of London.

1st May 2020

Seminar convenors: Anna Shadrina (Birkbeck) and Ayelen Hamity (IoE-UCL)

Seminar sponsorship: Birkbeck/Wellcome Trust ISSF

This session seeks to provide a psychosocial reflection into migration and health. Migration is traditionally associated with the loss of cultural capital, social networks and professional identities which have to be re-established in a new place, causing feelings of disconnectedness and loneliness, and physical distress. Against the tendency to individualise and depoliticise suffering and distress associated with migration; we explore migration as a collective phenomenon and a constitutive force of our contemporary world.

We set out by interrogating the very foundations from which the category ‘migration’ emerges by challenging the notion of place as static. Places do not exist outside of the histories of human movement which differentiate them. It is by thinking through the transhistorical quality of human movement and its relation to place that we may approach the contemporary paradox of an increasingly interconnected world being met with oftentimes violent attempts at strengthening borders.

From this perspective, the migrant is not conceptualised as an anomaly or an alien, but it is rather place which may be alienating to those who move, those who stay, as well as those who have never thought of leaving. This conceptual provocation does not minimise the psychological and physical distress that may be associated with human movement, but it does de-pathologize ‘the migrant’ and forces us to think politically and empathetically about the distinctive psychosocial experiences associated with migration.

The seminar will address migration from a range of perspectives as a desirable and undesirable experience, and how it intersects with gender, race, class, age and health. The session seeks to think about migration and health as both the experiences that disconnect from others and can serve as a source for solidarity and social change. We welcome (but not exclusively) submissions that explore:

• Migration and mental health as an issue of social inequality;

•  Notions about ‘the responsible patient’ and how/whether they change as people move;

• ‘Moral panics’ and ‘new’ diseases associated with human movement;

•  Medical tourism.

Please send 250-word abstracts to the convenors Anna Shadrina (a.shadryna@bbk.ac.uk) and Ayelen Hamity (ayelenhamity@gmail.com) by Friday 27th Match 2020.