Jill Benson

Low vitamin B12 levels among newly-arrived refugees from Bhutan, Iran and Afghanistan: a multicentre Australian study

Background Vitamin B12 deficiency is prevalent in many countries of origin of refugees. Using a threshold of 5% above which a prevalence of low Vitamin B12 is indicative of a population health problem, we hypothesised that Vitamin B12 deficiency exceeds this threshold among newly-arrived refugees resettling in Australia, and is higher among women due to their increased risk of food insecurity. This paper reports Vitamin B12 levels in a large cohort of newly arrived refugees in five Australian states and territories. Methods In a cross-sectional descriptive study, we collected Vitamin B12, folate and haematological indices on all refugees (n = 916; response rate 94% of eligible population) who had been in Australia for less than one year, and attended one of the collaborating health services between July 2010 and July 2011. Results 16.5% of participants had Vitamin B12 deficiency (<150 pmol/L). One-third of participants from Iran and Bhutan, and one-quarter of participants from Afghanistan had Vitamin B12 deficiency. Contrary to our hypothesis, low Vitamin B12 levels were more prevalent in males than females. A higher prevalence of low Vitamin B12 was also reported in older age groups in some countries. The sensitivity of macrocytosis in detecting Vitamin B12 deficiency was only 4.6%. Conclusion Vitamin B12 deficiency is an important population health issue in newly-arrived refugees from many countries. All newly-arrived refugees should be tested for Vitamin B12 deficiency. Ongoing research should investigate causes, treatment, and ways to mitigate food insecurity, and the contribution of such measures to enhancing the health of the refugee communities.

The Impact of Culture and Ethnicity on Women's Perceived Role in Society and Their Attendant Health Beliefs:

Cultural background and ethnicity need to be at the forefront of a doctors mind when thinking about the way women present and deal with health issues for themselves and their families. Despite the obvious fact that women make up about half the population, their health needs may be different to the expectations and processes of the model of care used by the majority of health professionals. Some of these differences are likely to be due to social structures but womens personal history and health beliefs in general will impact on their health care in ways that may lead them even further from achieving healthy outcomes. In general practices where a large proportion of the population is from different cultures, interacting with women with complex health care needs requires an awareness of the underlying beliefs of both doctor and patient. To understand a womans health issues in her new country, the doctor must acknowledge that she may face discrimination at three levels: as a woman, as a migrant and as an ethnic minority.

Extreme heat and cultural and linguistic minorities in Australia: perceptions of stakeholders

BackgroundDespite acclimatisation to hot weather, many individuals in Australia are adversely affected by extreme heat each summer, placing added pressure on the health sector. In terms of public health, it is therefore important to identify vulnerable groups, particularly in the face of a warming climate. International evidence points to a disparity in heat-susceptibility in certain minority groups, although it is unknown if this occurs in Australia. With cultural diversity increasing, the aim of this study was to explore how migrants from different cultural backgrounds and climate experiences manage periods of extreme heat in Australia.MethodsA qualitative study was undertaken across three Australian cities, involving interviews and focus groups with key informants including stakeholders involved in multicultural service provision and community members. Thematic analysis and a framework approach were used to analyse the data.ResultsWhilst migrants and refugees generally adapt well upon resettlement, there are sociocultural barriers encountered by some that hinder environmental adaptation to periods of extreme heat in Australia. These barriers include socioeconomic disadvantage and poor housing, language barriers to the access of information, isolation, health issues, cultural factors and lack of acclimatisation. Most often mentioned as being at risk were new arrivals, people in new and emerging communities, and older migrants.ConclusionsWith increasing diversity within populations, it is important that the health sector is aware that during periods of extreme heat there may be disparities in the adaptive capacity of minority groups, underpinned by sociocultural and language-based vulnerabilities in migrants and refugees. These factors need to be considered by policymakers when formulating and disseminating heat health strategies.

Prevalence of Helicobacter pylori infection in newly arrived refugees attending the Migrant Health Service, South Australia

To determine the prevalence of Helicobacter pylori infection in the refugee population attending the Migrant Health Service, South Australia, identify demographic factors associated with infection and compare prevalence of infection in refugees with that of the nonrefugee population in Australia.

Newly arrived refugee children with Helicobacter pylori are thinner than their non-infected counterparts

The hypothesis of this study was that those refugee children with Helicobacter pylori are thinner than their non-infected counterparts. This cross-sectional study investigated the height and weight of newly arrived refugee children up to age 19 years, who were screened for H. pylori using a stool antigen test at the Migrant Health Service in Adelaide between August 2010 and October 2013. Of 460 children, 21% were infected with H. pylori. After adjusting for vitamin B12 and iron levels, ethnicity, age and sex, the odds of being thin in the 10- to 19-year-old age group was 4.28-fold higher (95% CI 1.48-12.4) if they were H. pylori positive compared with those who were H. pylori negative. The difference between the two groups is statistically significant (P=0.01). Screening and treatment for H. pylori in the general population in developed countries is not recommended unless there are symptoms such as dyspepsia or risk of peptic ulcer, duodenal ulcer or gastric cancer. Given the findings of this study, a recommendation could be made that newly arrived refugee children who are thin should be tested for H. pylori. Thinness in children may influence their cognitive ability, school performance, physical endurance and hence their ability to successfully settle into their new country.

A New Era in Mental Health Care in Vanuatu

Inequity in health-care delivery for those with mental illness is widespread throughout low- and middle-income countries. In the Pacific Island countries there are many barriers to addressing the growing mental health burden. In an effort to address this problem, the WHO is coordinating the Pacific Islands Mental Health Network involving 18 countries in the Pacific region with the financial support of New Zealand Aid (NZAid). JB and DP have developed and presented mental health training to health professionals, community leaders, and social service personnel in an environment in Vanuatu that is very different from that of their usual Australian-based general practices. They discuss evidence for their work, an outline of the programme, some difficulties working across different cultures, and the enthusiasm with which the training has been greeted. Vanuatu is now well on its way to addressing the inequity of access to mental health care with a culturally appropriate and self-sustaining mental health workforce.

A culturally sensitive consultation model

Abstract Cultural sensitivity is not only about those patients who come from a different country to that of the practitioner, but also includes those with other differences such as family background, education, religion, belief system or socio-political outlook. If the patient feels their beliefs, values and practices are understood and respected by the practitioner, there is an increased likelihood a good relationship will be established and the patient will trust the doctor and the clinical procedures. To be more culturally sensitive in consultations, three additional variables – ethnocentrism, health literacy and transcultural perceptions of illness – need to be taken into account. It is near impossible for doctors to undertake education for themselves on the evergrowing variety of cultural factors that can influence the interaction with patients. Some practical ways of communicating are outlined in the use of the Cultural Awareness Tool and Narrative Therapy.

Age determination in refugee children: A narrative history tool for use in holistic age assessment.

To present the rationale for using a narrative history tool as part of a holistic age assessment of accompanied refugee children with age uncertainty by exploring cultural narratives of age.

A holistic approach to age estimation in refugee children

Many refugee children arriving in Australia have an inaccurately documented date of birth (DOB). A medical assessment of a childs age is often requested when there is a concern that their documented DOB is incorrect. This studys aim was to assess the accuracy a holistic age assessment tool (AAT) in estimating the age of refugee children newly settled in Australia.