ChronicdiseaseprevalenceandutilizationofhealthservicesinSyrianrefugeeslivinginŞanlıurfaMEHMETAKMAN,MD, MPH, PROF OFFAMİLY MEDİCİNE

DUYGUALTIPARMAKKARAÇİZMELİ , MD, FAMİLY PYHSİCİAN

MARMARAUNIVERSİTY SCHOOL OFMEDİCİNE

REFUGEEHEALTHBY DOROTH Y L ANG E I R I S H IMM IG R AN T S TO U S 1 9 TH C E N TUR Y

REFUGEECRISIS

TURKEY(2016)

>2million Syrian refugees

24camps in10provinces

258000living incamps

2million outside camps

0-4yrs ofage:300000

0-11month infants:60000

<65years:100000

Physically/mentally handicapped:150000

Peoplewithspecific needs

• impairment• injuries• chronic disease

onethirdofpeoplewithspecific needsexperiencingmorethanonecondition.Chronic disease 15.6%;over 65increases to 54%.

Source:handicap international:file:///C:/Users/asus/Downloads/HiddenVictimsApril2014.pdf

Peoplewithspecificneeds

Background&AimØAsfarasrefugee health isconcerned,there ismuch more emphasis oncommunicable diseases rather than non-communicable diseases.

ØTheaimofourworkistodetecttheprevalenceofchronicdiseasesamongSyrianrefugeesandtofindoututilizationofhealthservicesinthispopulation.

ØAsasecondaryobjective,thedifficultiesinreachinghealthservicesinthecontextofchronicdiseasesandtheservicesprimarilyneedareexplored.

MethodØCross-sectional study,

ØPopulation:theindividualsaged18 andoverliving inKurtuluşdistrict ofUrfa,where ishighlypopulatedbySyrianmigrants

ØSampling and datacollecton: Simpletwo stage cluster sampling (30X7)*.ØWerandomlyselected30streetsfromthisdistrictandenrolledpeopleover18yearsofagelivingin7randomlyselectedhomesfromtheselectedstreets.

ØIfthehouseolderwasnotathome,thenthewifeofthehouseholder,ortheoldestindividualinthehouseholdwhocouldanswerthequestion,wasinterviewed.

ØIf nobody found atselected household for atleast 3consecutive visits (one out ofoffice hours),thenthis households was markeds asno response.

ØAsameansofgatheringinformation,aquestionnairewaspreparedbyresearchersafterliteraturesearch.Questionnairewasappliedtohouseholdersfacetoface.

*developed by EPİ(expanded programonimmunization)for immunization coverage.http://www.ph.ucla.edu/epi/rapidsurvey.html

MethodØ Questionnairehas4parts:I. Individualcharacteristicsoftheeachperson

livinginthehouseholdII. AccesstohealthcareIII. ExistingchronicconditionsIV. Healthprovidercharacteristics

Ø Datacollectionteam:researcher+2interpreters(Arabic-95%/Kurdish - 5%)Ø ResearchisfundedbyScientificResearchProjectsUnitofMarmaraUniversityandapprovedbyMarmaraUniversityEthicalcommitteeofobservational studies.

*Doocy SetalBMCPublic Health 2015;**Handicap international 2014

Chronic Conditions included inthe survey

Hypertension*

Diabetes*

Cardiovascular disease*

Chronic respiratory disease*

Arthritis*

Mental disorders**

Cancer**

Disability**

Results:Backgroundvariables&prevalence

Characteristics

Female n(%)Male n(%)

293 (47.5)324(54.5)

Age, mean±sdFemaleMale

35.6±14.335.5±14.335.7±14.3

≥65yrs,n(%) 23(3.7)

Place lived inSyria,%CitycenterSuburb

8315

Thestudyincluded617 cases(≥18yrs)from 210households andthechronic disease prevalence isfoundtobe15.2% (n=94CI:12.6-18.2).

Characteristics

Educational status,n(%)<primary schoolprimary schoolSecondary schoolUniversity

5 (0.8)424(68.7)75(12.1)113(18.3)

Type ofhome n(%)Apartment flatroom inahouseHouseAbondaned building

70 (33.9)37(17.6)96(45.7)7(3.3)

Chronic Disease Prevalenceaccording to age and gender

15,2% 15,0% 15,4%

8,7%

21,1%

53,30%

65,20%

0%

10%

20%

30%

40%

50%

60%

70%

CD prevalance

allparticipantsfemale

male

>18 and <40yrs>40 yrs

>60 yrs

>65 yrs

List ofChronic Condition percentages andtheir distributrion according to gender

Chronic ConditionWhole population

%(n)

Female

%(n)

Male

%(n)Hypertension 4.7(29) 5.5(16) 4.0(13)

Cardiovascular disease 2.1(13) 1.4(4) 2.8(9)

Diabetes 2.3(14) 2.4(7) 2.2(7)

Chronic respiratory disease 2.4(15) 2.4(7) 2.8(8)

Disability 2.1(13) 1.4(4) 2.8(9)Arhtritis 1.6(10) 1.7(5) 1.5(5)

Mental disorders 1(6) 0.7(2) 1.2(4)Cancer 0.2(1) 0.3(1) 0.0(0)

Results:Accessto health careTotally agree agree disagree Totally

disagree Noidea

% n % n % n % n % n

Icanaccess healthcare 5.2 11 34.8 73 55.2 116 1.9 4 2.9 6

Icanaccess familyphysican

1.9 4 11.9 25 79.5 167 3.3 7 3.3 7

Icanaccess specialist 1.4 3 10.0 21 79.5 167 5.2 11 3.8 8

Icanafford health carecosts

1 2 7.6 16 71.4 150 17.1 36 2.9 6

Icanafford medicinecosts

1.4 3 9.5 20 65.2 137 21 44 2.9 6

Iamwell informed 1.4 3 31.9 67 47.1 99 14.8 31 4.8 10

*answers ofinterviewed househols member (n=210)

Results:Patients having chronicconditions

n=42,%47.2

n=14.%15.7

n=9,%10.1

n=9,%10.1

n=9,%10.1

0% 10% 20% 30% 40% 50%

<1mo

1-2mobefore

3-6mobefore

6mo- 1year

<1year

lasttimeappliedtoahealthcenter n=65%76.5

n=13.%.5.3

n=2,%2.4 n=1,%1.20%

10%20%30%40%50%60%70%80%90%

statehospital

privateclinic primarycare emergency

firstcontactofcare

Results:Accessto medication%

n=37,%45.7

n=28,%34.6

n=16,%19.8

0%5%

10%15%20%25%30%35%40%45%50%

Nomoneyoutofpocket fullyoutofpocket partiallyoutofpocket

Prescription reimbursement

ResultsDİSTRİBUTİONOFCDOCCURANCEACCORDİNG TO REFUGEE HEALTH CENTERVİSİT

x2=6.25 Refugee healthcenter visit

totalp<0.01 + -

ChronicDisease

+ %(n) 48,9(45) 51,1(47) 100(92)

- %(n) 36,3(183) 63,7(321) 100(504)

DİSTRİBUTİONOFCDACCORDİNG TOEDUCATİON STATUS

x2=1171p<0.01

Primaryschool and

lower

Secondaryschool andhigher

total

ChronicDisease

+ %(n) 80,9(76) 19,1(18) 100(94)

- %(n) 67,5(353) 32,5(170) 100(523)

Discussion

ØInourstudytheprevalenceofchronicdiseasewasrelativelylowerthantheratesreportedintheliterature.

ØInUskudar districtofIstanbul43.7%ofthepeopleover40haveatleastonechronicconditionwhereasinourstudyitis21.7%.

ØDossy Setal.alsofoundoutlowerprevalenceofchronicconditionamongsyrian refugeescomparedtohostpopulationinLebanon.

ØSurvivalofthefittest?ØBarriersfordisclosure?

Discussion &ConclusionØImmigrantshavealmostneverreceivedprimaryhealthcareduetotheirchronicdiseases,anditseemsthattheyreceivehealthservicespredominantlyfromthehospitals.ØEffectiveness ofrefugee heath centers?ØMigrant-specific,exclusive approach vsMigrant-sensitive,inclusive approach◦ specific health and preventive interventions are required vs adapting theexistingroutinehealthandpreventiveservices

ØItisrecommendedtoinvestigatethereasonsforlowprevalenceandverylowutilizationoftheprimaryhealthcareservices.Ø Contrast :perception oflow accessibility vs free ofcharge health services bothpc and hospitals (National disaster funds)

References1.Razum O.Spallek J.Addressinghealth-relatedinterventionstoimmigrants: migrant-specific ordiversity-sensitive?Int JPublicHealth(2014)59:893–895.DOI10.1007/s00038-014-0584-4

2.KarahanÖ.,AkmanM.,Şimşek S.,Özçelik E(2016).multimorbidity prevalance among peopleover 40living Uskudar district ofIstanbul.MarmaraUniversity department ofFamily medicine.Family medicine thesis

3.Doocy,Shannon,etal."Prevalence and care-seeking for chronic diseases among Syrianrefugees inJordan." BMCPublic Health 15.1(2015):1097.

4.Doocy,Shannon,etal." Prevalence,care-seeking,andhealthserviceutilizationfornon-communicablediseasesamongSyrianrefugeesandhostcommunitiesinLebanon Conflict andHealth2016

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