Impact of enhanced health interventions for United States–bound refugees: Evaluating best practices in migration health

Author/s: Tarissa Mitchell, Deborah Lee, Michelle Weinberg, Christina Phares, Nicola James, Kittisak Amornpaisarnloet, Lalita Aumpipat, Gretchen Cooley, Anita Davies, Valerie Daw Tin Shwe, Vasil Gajdadziev, Olga Gorbacheva, Chutharat Khwan-Niam, Alexander Klosovsky, Waritorn Madilokkowit, Diana Martin, Naing Zaw Htun Myint, Thi Ngoc Yen Nguyen, Thomas Nutman, Elise O’Connell, Luis Ortega, Sugunya Prayadsab, Chetdanai Srimanee, Wasant Supakunatom, Vattanachai Vesessmith, William Stauffer
Language: English
Publication Type: Scientific Report (Journal)(External)

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With an unprecedented number of displaced persons worldwide, strategies for improving the health of migrating populations are critical. United States–bound refugees undergo a required overseas medical examination to identify inadmissible conditions (e.g., tuberculosis) 2–6 months before resettlement, but it is limited in scope and may miss important, preventable infectious, chronic, or nutritional causes of morbidity. We sought to evaluate the feasibility and health impact of diagnosis and management of such conditions before travel. We offered voluntary testing for intestinal parasites, anemia, and hepatitis B virus infection, to U.S.-bound refugees from three Thailand–Burma border camps. Treatment and preventive measures (e.g., anemia and parasite treatment, vaccination) were initiated before resettlement. United States refugee health partners received overseas results and provided post-arrival medical examination findings. During July 9, 2012 to November 29, 2013, 2,004 refugees aged 0.5–89 years enrolled. Among 463 participants screened for seven intestinal parasites overseas and after arrival, helminthic infections decreased from 67% to 12%. Among 118 with positive Strongyloides-specific antibody responses, the median fluorescent intensity decreased by an average of 81% after treatment. The prevalence of moderate-to-severe anemia (hemoglobin < 10 g/dL) was halved from 14% at baseline to 7% at departure (McNemar P = 0.001). All 191 (10%) hepatitis B–infected participants received counseling and evaluation; uninfected participants were offered vaccination. This evaluation demonstrates that targeted screening, treatment, and prevention services can be conducted during the migration process to improve the health of refugees before resettlement. With more than 250 million migrants globally, this model may offer insights into healthier migration strategies.


IOM Contributors:  • Lalita Aumpipat (Bangkok) • Chutharat Khwan-Niam (Maesot) • Sugunya Prayadsab (Bangkok) • Anita Davies (Accra) • Alexander Klosovsky (Washington, DC) • Chetdanai Srimanee (Amman) • Vasil Gajdadziev (Nairobi) • Naing Zaw Htun Myint (Nairobi) • Wasant Supakunatom (Maesot) • Olga Gorbacheva (Geneva) • Thi Ngoc Yen Nguyen (Ho Chi Minh) 

The American Society of Tropical Medicine and Hygiene