Infectious and non communicable health conditions among newly arrived Eritrean migrants and refugees at arrival and post integration in Switzerland
Summary In the recent past years, due to the unprecedented refugee influx worldwide, the awareness of migration has started to get momentum globally. Several key discussion themes had been raised so far by politicians, economists, international organizations, humanitarian activists, public health expertise, as well as researchers. Particularly in the European context, the continuous upsurge of migrants is of great concern. Majority of immigrants from the south heading towards north are from the sub Saharan African countries (SSA) where largest portion of them are in the category of low and middle income countries (LMIC) Hence, migrants and refugees from this region are highly anticipated to have an earlier exposure to the endemic infectious diseases (IDs) before even they kick off their migration tour. Moreover, due to economical impoverishment, the health system of most LMIC is incapable to provide even basic health care services. Adding to this, the exhausting journey along the Sahara desert and the stressful Mediterranean Sea voyage, expose refugees and migrants to destitute health statues. Even transit countries, being in an unstable condition, are not equipped to support them. That is why several refugees and migrants arriving in Europe disembark with several infectious diseases (IDs) non communicable diseases (NCDs) mental health (MH) as well maternal and child health related complications. Several international organizations, such as the WHO European region, international organization of migration (IOM) and European center for disease prevention and control (ECDC) and others non governmental organization (NGOs) have reported many easily treatable diseases on arrival and post arrival. In Switzerland, similar to other countries in Europe, the number of refugees and migrants is on the rise. The reports from the federal office of statistic, federal secretary of migration, and international Red Cross of the country shows majority of the recently arriving refugees from the south are from Eritrea. Currently, migrants and refugees from Eritrea account for more than 32% of the immigrants in the country, making them on top of the table for the last 10 years in a row. Despite the large number of Eritrean refugees and migrants in the country, to our knowledge, the health condition of this population is not fully documented. Like most SSA, the health condition among the Eritreans is anticipated to be poor on arrival. But, apart from few case reported studies, there is no systematic screening procedure conducted. Hence, using novel approach, we intended to systematically screen newly arrived, asymptomatic, feeling healthy, Eritrean refugees and migrants at base line and follow them for two years cohort. In this cross sectional base line study, we recruited voluntary participants from both males and females. Invitation letter (written in both English and Tigrigna, local language from Eritrea) was sent by post, using addresses retrieved from the registries' of social assistants' bureau. The study was conducted in two cantons in the north west Switzerland, the Basel Stadt and Basel Landschaft. At the base line, among the screened IDs, schistosomiasis was reported in more than half of the asymptomatic refugees and migrants. Malaria was screened in 6% Other IDs such as Giardia lamblia and Hymenelopis nana were also reported. As to NCDs and their risk factors, majority of participants had vitamin D deficiency. Hence, a onetime intramuscular supplementation of vitamin D3 was important and significantly improved serum vitamin D level. Since most of our study participants were young (median age of 25 years) several of the NCDs risk factors were within the normal range of scale according to the WHO recommended measures. In regarding to the mental health situation, nearly half reported symptoms of post traumatic stress disorder (PTSD) This finding is similar to several studies conducted within Europe and outside Europe. This implies how demanding and frightening journey refugees and migrants had to overcome to reach their destination target in Europe. But the one year follow up has showed an improvement toward their PTSD score in the post migration statues. Though it is vital to investigate the poor mental health condition of immigrants using a qualitative assessment tool, findings from our study foresees the need of proper screening and handling. Some studies argue that, it is also possible the mental health of these immigrants to get worsened during the post arrival, due to the anticipated delay of processing and inaccessibility to health care facilities. Hence, basic screening protocols on arrival, particularly for refugees and migrants from IDs endemic countries and/or transiting through one of them, can be suggested to reduce the sequel of asymptomatic chronic infections. Similarly, since the trend of the disregard NCDs and their risk factors among young immigrants is more likely to shift, boosting the consciousness is essential. This could be through intervention such as, engaging immigrants into behavioral change practices, for example outdoor exposure, physical activities and applying healthy diet menus as well. In general, our immigrants health study Switzerland (IHSS) has depicted the need of an extensive and broader study to understand the health disparities of migrants during pre migration, along the migration path way and in post migration. Only cross sectional designed studies might fail to investigate and understand the roots, causes, progresses and epidemiology of the diseases. Similarly, health care services and demands of refugees and migrants may not be in depth represented through quantitative approach alone. Hence, an integrated, holistic approach, embarrassing IDs, NCDs, mental health as well as maternity, childcare and family planning need to be implemented. As migration health is a complex theme to address discretely, collaborative efforts from regional and international organizations, including policy makers, NGOs, researchers and social workers and medical professionals and others need to join hand for the better health care services access to immigrants. This joint effort toward establishing a sustainable, equitable and affordable (SEA) health care access would greatly minimize the unnecessary public health expenses, reduce the efficient utilization gap by immigrants, and would be a tool to establish an efficient surveillance system. Hence, a more healthier, productive and efficient immigrant community could successful be integrated into the host countries.