A Scoping Review of the Health of African Immigrant and Refugee Children

Migration is a growing phenomenon around the world, including within the African continent. Many migrants, especially African children, face challenges related to health and social inclusion and can face increased health risks. A systematic scoping review of available literature on the health of African migrant children across the globe was conducted to offer insight into these health risks. The review was conducted over a 15-month period from January 2019 to April 2020, yielding 6602 articles once duplicates were removed. This search included electronic databases, reference lists of articles reviewed, and searches of libraries of relevant organisations. A total of 187 studies met the inclusion criteria, of which 159 were quantitative, 22 were qualitative, and 6 used mixed methods. The findings reveal decreased health in this population in areas of nutrition, infectious diseases, mental health, birth outcomes, sexual and reproductive health, physical and developmental health, parasitic infections, oral health, respiratory health, preventative health, endocrine disorders, health care services, and haematological conditions. The findings offer insights into factors influencing the health of African immigrant and refugee children. Further studies, especially qualitative studies, are needed to determine barriers to service access after migration and to investigate other underexplored and overlooked health concerns of African migrant children, including pneumonia and child maltreatment.

To show challenges identified in assistance provision to child victims of transnational trafficking in South Africa The challenges include ensuring safety, the diverse backgrounds and needs of trafficked children, matching lifestyle previously provided by pimps/traffickers, and premature return and reintegration of the children. [183] Metsaniitty, M.; Waltimo-Siren, J.; Ranta, H.; Fieuws, S.; Thevissen, P.

2018
To compare the age prediction performances of the Willems et al. model (WM) and the newly developed model collected from dental panoramic radiographs from Somali children living in Finland Somali-specific age estimation model (SM) based on the WM resulted in a slight underestimation of age when the sex groups were analysed separately or combined, with mean error varying between 0.04 (standard deviation (SD) 1.01) and 0.05 (SD 1.04) years, mean absolute error between 0.77 and 0.80 years and root mean squared error between 1.01 and 1.04 years. To compare development and growth achievements between children of Eritrean mothers (CE) to children of Israeli mothers (CI), and assess their compliance to routine follow-up and vaccination-timeliness No statistically significant differences were found in birth anthropometric measurements. CE were more likely to fail in tests assessing fine-motor skill, linguistic and socio-emotional domains than CI, while no statistical difference was found in gross-motor achievements. 74.9% of the CE and 74.1% of the CI completed the vaccination schedule at follow-up. [208] Meyer-Weitz, A.; Oppong Asante, K.; Lukobeka, B.J.

2018
To explore refugee caregivers' perceptions of their children's access to quality health service delivery to their young children in Durban, South Africa 95% of caregivers were not satisfied with healthcare services delivery to their children due to the long waiting hours and the negative attitudes and discriminatory behaviours of healthcare workers, particularly in public healthcare facilities. To evaluate the prevalence of infectious diseases and immunisation status of children adopted from Africa 50.1% had at least one infectious disease. The most common parasitic infections were Giardia lamblia, Toxocara canis, and skin infections, notably Tinea capitis/corporis and Molluscum contagiosum.
[88] Beukeboom, C.; Arya, N. 2018 To examine the variation among ethnic populations in prevalence of anemia and vitamin D and B12 deficiencies among refugee children 15.7% were anemic (25% < 5 years, 8.7% 5-11 years, and 18.3% 12-16 years old), with Somali children having the lowest hemoglobin levels compared to those from Iraq, Afghanistan, and Myanmar. 53.5% were vitamin D deficient seen most commonly in Iraqis and Afghans. 11.2% had vitamin B12 levels < 150 pmol/L.
[115] Stevens, G.W.; Thijs, J. 2018 To investigate the associations between perceived group discrimination and several indicators of psychological well-being among Moroccan-Dutch adolescents Higher perceived group discrimination was associated with higher parent-and adolescentreported internalizing (e.g., fear, worries) and externalizing problems (e.g., anger, aggression) but not with lower personal self-esteem. To examine longitudinal changes in obesity and overweight/obesity rates among resettled refugees and identify high risk subgroups Obesity and overweight/obesity rates increased among refugees, but significant variations existed. African origin, baseline weight, and longer duration of stay in the USA were risk factors.
exceeded reference values, and most of the elements were significantly higher in zone 2 compared to zone 1.
Among the children, 12% were underweight, 33% stunted, and 4% wasted. To describe the importance of relative eosinophilia in a cohort of immigrant children (<18 years) from sub-Saharan Africa, North Africa, and Latin America Most children with parasitic infections with eosinophilia were from sub-Saharan Africa (especially West Africa) (99, 56.3%), followed by North Africa (54, 30.7%) and Latin America (25, 13.0%). The findings suggest that relative eosinophilia is frequently associated with helminthic infection in immigrant children from tropical and subtropical areas.
[162] Esler, A.N.; Hall-Lande, J.; Hewitt, A. 2017 To examine differences across racial/ethnic groups in Autism Spectrum Disorder (ASD) symptoms, cognitive and adaptive skills, and related behaviors in children from the Somali diaspora Somali children were more likely to have ASD with intellectual disability than children from all other racial/ ethnic groups. [111] Meyer, S.R.; Steinhaus, M.; Bangirana, C.; Onyango-Mangen, P.; Stark, L.

2017
To explore the relationship between caregiver depression and adolescent mental health in two refugee settlements in Uganda Caregiver depression, gender, and exposure to violence were all associated with higher symptoms of adolescent depression in both sites and the full sample. [70]

2016
To assess the nutritional status of primary school Sudanese pupils and explore its correlates 31% of respondents suffer from underweight and 6.75% from overweight. Participants' average daily intake of calories and fiber was significantly lower than that of the dietary requirement intakes (DRI) (1, 397.89 kcal versus 2,000 kcal, p=<0.01), some vitamins and iron was significantly higher than that of the DRI (p=<0.01). [66] Wandel, M.; Terragni, L.; Nguyen, C.; Lyngstad, J.; Amundsen, M.; de Paoli, M.

2016
To explore infant feeding practices among Somali-born mothers in Norway, and the ways in which they navigate among different information sources The mothers had positive attitudes to breastfeeding but were unfamiliar with the concept of exclusive breastfeeding. Early introduction of water and infant formula was a common practice that interfered with exclusive breastfeeding.
[124] Iyakaremye, I.; Mukagatare, C. 2016 To explore the situation of sexual abuse of Congolese adolescent girls in Kigeme camp and to suggest remedial strategies The findings show that rape, unwanted physical touching, sexual exploitation, commercial sex, early marriage, and girl trafficking are the main forms of sexual abuse. [

2016
To describe breastfeeding and general feeding practices and the nutrition status among children from birth to 6 months of age in the Saharawi refugee camps located in Algeria 13.8, 8.2, and 16.5% of the infants were stunted, wasted, and underweight, respectively. Approximately 65% initiated breastfeeding within 1 h after birth and 11.7 and 21.6% were exclusively or predominantly breastfed less than 6 months. [48]

2016
To obtain baseline information about oral health, oral health behaviours, and knowledge about prevention of oral diseases in newly arrived Somali children 78-82% of the children in the three groups had never visited a dental clinic in Somalia. Toothache was reported by 18-28% of the children. About half the children had poor oral hygiene while 25-33% reported daily intake of sugary snacks. Malocclusion affected 40% of the 7-11-year-olds and 50% of the 12-17year-olds. [113] Jensen, T.K.; Fjermestad, K.W.; Granly, L.; Wilhelmsen, N.H.

2015
To examine life experiences and mental health among unaccompanied asylum seekers (from Asia and Africa) aged 16 years and younger, who were newly arrived, and still in an asylumseeking process and thus in temporary residency Participants from Asian countries had experienced an average of 1.1 more stressful life events than participants from African countries.

2015
The aim of this study was to examine differences in distribution of neonatal jaundice by migration indicators 3.7%% African infants had neonatal jaundice compared to 6.4% Norwegian infants (p<0.007). African infants were more often transferred to a neonatal intensive care unit (NICU) compared to Norwegian infants (31.8 vs. 11.6%, p=0.013). [110] Wilchek-Aviad, Y. 2015 To look at the connection between meaning in life and suicide among youth born to immigrants from a developing country, in Ethiopiacompared to native-born Israeli youth A significant negative correlation between meaning in life and suicidal tendencies was found for Ethiopian youths (r=-0.61, p<0.001). Higher suicidal tendencies, anxiety, and depression were found among immigrants compared to native-born Israelis, with immigrant boys displaying more anxiety than girls.
[179] Amin, M.; Perez, A.; Nyachhyon, P. 2015 To assess parental awareness of their child's dental status and the relationship between parental awareness and children's dental attendance 52% of the children never had a dental visit. Dental status of 44% of children was rated as good by parents; among them, 56% had dental decay. Parental assessments did not coincide with the clinical assessments of 62 % of children. Immigrant adolescents were divided in two acculturation profiles, ethnic and integrated-national, with adolescents belonging to the latter showing higher self-esteem, life satisfaction, and sociocultural competence than the former. To explore the differences in the perceived HRQoL between children with asthma from Moroccan and Dutch descent and their parents Moroccan children differed significantly on the DUX-25 overall score (p = 0.002) and the subscales physical (p = 0.006) ( Table 1, lower part), emotional (p=0.003), and home functioning (p = 0.006) also indicating a better health related quality of life compared to Dutch children.

2015
To investigate the salivary microbiota of the Saharawi population how they are influenced by the intake of specific nutrients A remarkable change in the metabolic potential of the microbiota occured following the diet change, with increased potential for amino acid, vitamin and co-factor metabolism. High concentrations of acetone and 2-butanone were noted during treatment with the Italianstyle gluten-free diet, which suggested metabolic dysfunction in the Saharawi celiac children. [167] Thul, C.M.; Eisenberg, M.E.; Larson, N.I.; Neumark-Sztainer, D.

2015
To assess the levels and types of physical activity among a populationbased sample of Somali and other non-Hispanic black and white adolescents living in Minnesota Somali girls had lower mean moderate-to-vigorous-physicalactivity (MVPA) hours than their peers; however, no differences were found for Somali boys. Involvement in most activities was similar for Somali and other groups, but some differences were observed. For example, Somali youth were more likely to play soccer than their samesex other black peers (boys: 52.4 vs. 20.4%; girls: 34.6 vs. 14.6%; p<. 05). Most immigrant HIV-infected children living in NL were born in SSA (47%). Children born in SSA were diagnosed and initiated cART at an older age (3.7 years, IQR:0.9-9.0) (p < 0.001), than children born in NL ((1.2 years, inter quartile range (IQR):0.3-3.7). Despite initial differences in CD4+ T-cell counts and HIV viral load, there was no difference in immunological reconstitution during and after the first 5 years of cART between the 2 groups (p < 0.05). [175] Quach, A.; Laemmle-Ruff, I.L.; Polizzi, T.; Paxton, G.A.

2015
To report on oral health in refugeebackground children in Australia, and to assess their follow-up at dental services Compared to Australian-born children of African background, African-born children were more likely to be referred for further dental care (adjusted PR 1.33, 95% CI [1.02 -1.73]) although there was no statistically significant difference in caries prevalence.
[214] Corriveau-Bourque, C.; Bruce, A.A. 2015 To measure the prevalence of sickle cell disease and thalassemia in the Northern Alberta pediatric population and to determine the clinical outcomes.
25% of patients born abroad originated from Africa. African participants had sickle cell diagnoses of HbSS, HbS/B+thalassemia, or HbSC To investigate African unaccompanied refugee minors (URMs) living in Austria for posttraumatic stress disorder (PTSD) prevalence and related symptoms and coping strategies The study revealed lower PTSD rates than measured among URMs in previous studies. Girls were more likely to develop PTSD. PTSD was significantly correlated with single war-related traumatic events. The depression score for the sample was above the clinical cut-off value. The results obtained in this study confirm the significance of nontherapeutic male circumcision among the African immigrant population in Spain. Half (49.1%) of the families who had the circumcision performed in Europe did so at home. 26 of the children in the study were circumcised at home, with 22 thereof from Gambia and the rest from Ghana, Mali, Guinea-Conakry, and Morocco.
[69] Tyler, L.; Kirby, R.; Rogers, C. 2014 To highlight and compare immigrant Sudanese women's infant feeding choices and patterns before and after moving to a regional city in Queensland, Australia The study indicated a trend for immigrant women's breastfeeding duration to decline when they moved to another country. This research suggests that the reasons for this decline are complex. The authors conclude that a lack of social support, language difficulties, and wanting to fit in with particular Western practices are contributing factors.
[209] Soriano, E.; Ruiz, D.; Higginbottom, G. 2014 To analyze how the health promotion concept is integrated into the ethos of the Moroccan population through the positions set forth with respect to adherence to the Healthy Child Program Moroccan mothers maintained the belief that it is pointless to go to health professionals; the women perceived themselves as responsible for child care and health, and for that reason assumed some options of the host society whenever they considered it to be good for the child and did not clash with ideas, values, and uses of their culture. [65] Shah, A.Y.; Suchdev, P.S.; Mitchell, T.; Shetty, S.; Warner, C.; Oladele, A.; Reines, S.

2014
To compare bidimensional psychological acculturation orientation of Moroccan immigrant boys in pretrial detention with those of Moroccan boys in the general population Parents with sons in pretrial detention were more likely to be divorced than parents from the general population (14 vs. 4%, respectively). Boys in pretrial detention had dropped out of school much more often than boys from the general population (22 vs. 4%, respectively). Integrated boys were found to be almost five times as likely to belong to the pretrial detention group than separated boys (OR 4.7, CI [2.0, 11.2], p < .00), whereas no significant differences occurred between ambivalently acculturated and separated boys (OR 1.9, CI [0.5, 6.9], p .34).
[141] Juarez, S.P.; Revuelta-Eugercios, B.A. 2014 To compare the main indicators related to birth weight and gestational age (LBW, macrosomia, preterm and post-term) for immigrants and Spaniards Sub-Saharan immigrants to Spain showed higher risks in all perinatal outcomes studied (LBW, macrosomia, preterm and post-term births) [

2013
To present the survey estimates of death rates and malnutrition prevalence, and the age and sex breakdown of the suspected measles cases, and discuss the implications of the findings The under-5 death rate was 1.8 per 10,000 person-days. More than twothirds of all deaths were reported were associated with diarrhoea (25%), cough or other breathing difficulties (24%), or with fever (19%). Measles accounted for 17% of all deaths; this was due to a measles outbreak. Trends of decreasing death rates and malnutrition prevalence with length of stay in Bulo Bacte were observed. Immigrant bilingual children with SCD seem to display a rate of cognitive impairment similar to their monolingual counterparts but a more pronounced and precocious onset of language difficulties. [164]

2013
The study describes the characteristics of childhood TB in Israel and examines treatment outcomes Of all childhood TB cases, 236 (56.7%) were born in countries with high prevalence of TB; 214 (51.5% of all children) were Israeli citizens who were Ethiopian-born. In 2010, the incidence of childhood TB if at least one of their parents was Ethiopian-born was 7.5 cases per 100,000 children. To determine whether Somali girls living in a US community are following the recommendations for HPV vaccination Somali girls to be generally accepting of initiating the HPV vaccine series but less likely to complete the series as compared with white non-Hispanic girls of the same age. [186] Patel, A.R.; Zietlow, J.; Jacobson, R.M.; Poland, G.A.; Juhn, Y.J.

2013
To assess the prevalence of asthma and other atopic conditions in Somali immigrants and to determine the humoral immune response to the measles, mumps, and rubella (MMR) vaccine viruses in Somali immigrants with asthma Study results may not support the hygiene hypothesis. Of the subjects, 10 (16%) had asthma and 22 (35%) had other atopic conditions. There was no difference in the rubella (p=0.150) and measles (p=0.715) virus-specific IgG levels between the subjects with and without asthma. Mumps virus-specific IgG antibody levels were lower in those with asthma than in those without asthma (mean±SE 2.08±0.28 vs. 3.06±0.14, p=0.005).
[109] Walsh, S.D.; Edelstein, A.; Vota, D. 2012 To explore the relationship between ethnic identity (Israeli and Ethiopian) and parental support with suicide ideation and alcohol use There is a significant relationship between suicide ideation and parental support. Positive Ethiopian heritage identity is associated with lower levels of suicidal ideation and alcohol use. Positive ethnic identity is an important protective factor against suicidal and risk behaviors. [77] Mescher-Benbeneck, M.; Garwick, A.W. 2012 To explore the dietary factors that contribute to bone health among first generation Somali girls and to determine the social and cultural contexts that shape these health behaviors Cultural tradition, developmental stage, acculturation, and environment were major factors contributing to the intake of calcium and vitamin D-rich foods. To examine the specificity of these putative mental health risks to the immigration experience. The level and predictors of emotional problems among preadolescent Ethiopians living in immigrant families in Toronto, Canada Youth reported higher levels of emotional problems (M=10.09, SD=2.56) than their parents (M=9.46, SD=2.10). Predictors differed for parents and youth ratings. Contrary to immigration stress theory, parental perceptions of prejudice did not predict emotional problems. Perceived discrimination was a significant predictor of selfrated emotional problems.

2012
To identify psychosocial barriers to providing and obtaining preventive dental care for preschool children among African recent immigrants Early childhood caries (ECC) were associated with barriers to parental prevention knowledge and selfefficacy for early detection as well as barriers to access. [203] Oilinki, T.; Otonkoski, T.; Ilonen, J.; Knip, M.; Miettinen, P. J.

2012
To investigate the effect of racism, own-group ethnic density, diversity, and deprivation on adolescent trajectories in psychological wellbeing Ghanians/Nigerians had significantly more experiences of racism than their white peers at ages 11-13 years (p<0.01) and 14-16 years (p<0.001).
Other Africans had significantly more experiences of racism than their white peers at ages 11-13 years (p<0.001) and 14-16 years (p<0.01). All groups (controls, one-time offenders, and re-offenders) showed substantial problems. Single parenthood (OR 6.0) and financial problems (OR 3.9) distinguished one-time offenders from controls. Reading problems (OR 3.8), having an older brother (OR 5.5), and a parent having Dutch friends (OR 4.3) distinguished re-offenders from one-time offenders. The control group reported high levels of emotional problems (33.3%). To investigate the effect of indicators of acculturation among Somali refugee women's birth outcomes Factors selected to reflect acculturation did not yield statistically significant relationships with preterm and low birth weight infants in this study. However, the magnitude of observed increases in risk factors contributing to poor birth outcomes are of concern in Somali refugee women, and the value of early and regular prenatal care was confirmed. [194] Paxton, G.A.; Rice, J.; Davie, G.; Carapetis, J.R.; Skull, S.A.

2011
To provide data on immunisation status of recently arrived East African children and adolescents in Australia 97% of the African immigrant children had either an incomplete or uncertain immunisation status. Low numbers of participants had serological immunity against hepatitis B (33%), diphtheria (45%), and tetanus (61%), and a higher number of children had immunity to measles (90%), rebella (77%), and tetanus (61%). Four percent of written vaccination records were available.
[166] Thul C.M.; LaVoi, N.M. 2011 To explore the experiences with and beliefs about physical activity of East African adolescent female participants and suggestions for promoting active living Deductive and inductive content analysis revealed that East African girls desired to be physically active and perceived a wide range of physical activities to be culturally relevant and desirable, yet faced an array of personal, social, environmental, and cultural barriers to active living.
[78] Dharod, J.M.; Croom, J.E. 2010 To estimate the prevalence of child hunger and its relationship to dietary intake and body mass index (BMI) among Somali refugee children Underweight or BMI < 5th percentile was significantly higher in children who experienced hunger. In terms of dietary intake, compared to food secure or mild to moderate food insecure households, intake of green leafy vegetables was significantly lower while intake of eggs was higher among children experiencing hunger.

2009
To analyse the differences between low birth weight (LBW) and preterm birth (PB) according to the mother's nationality in newborns in Spain In comparison with Spanish ones, the lowest risk of PB was observed in North African children (ORa= 0.77 CI95% 0.74-0.80).
[45] To report on an unusually high occurrence of profound biotinidase deficiency (BTD) within a single ethnic population and an overall high occurrence of combined partial and profound BTD in Minnesota Of the 5 subjects with profound BTD, four of them were of Somali ethnic background. With four cases of profound BTD, the incidence among infants of Somali ethnic background is 1/1395. Of the 26 subjects identified through newborn screening as having partial BTD, none were of Somali ethnic background. [46] Åsander, A.S.; Björkman, A.; Belfrage, E.; Faxelid, E.

2009
To explore the frequency of HIVinfected African parents' disclosure of their status to their children and custody planning for their children's future to identify support needs among these families In Sweden, the majority of HIVinfected parents are of African origin, and despite the introduction of anti-retroviral (ARV) medication, there has been no tendency for disclosures to children to increase. The fear of a double stigma-that of being both immigrant and HIV infected-is likely the main barrier to disclosure of HIV infection. [81] Renzaho, A.M.N; Swinburn, B.; Burns, C.

2008
To examine the association between acculturation and obesity and its risk factors among African migrant children in Australia The further African children moved from traditional lifestyles, the less physically active they become and the more fatty foods they eat, which results in obesity.
[184] Obeng, C.S. 2008 To examine dental health issues for African immigrant families of preschoolers living in the United States The authors of this study found that 82% of the parents felt that it was unnecessary for a child to be taken to a dentist at an early age since their chances of contracting diseases at the dentist's office at that age were high. In addition, 48% of the parents had never taken their children to have their teeth checked by a dentist, and 61% of the parents reported that their children brushed their teeth once per day. [151] Gaspar

2007
To study the relation between acculturation and problem behavior in Moroccan adolescents Girls with an ambivalent acculturation pattern showed more problems than the other girls on parent-and adolescent reported internalizing and externalizing behavior. For boys, no effects of acculturation on problem behavior were found. The high number of conflicts between parents and their ambivalently acculturated daughters partly explained the relation between acculturation and problem behavior. Verkade, H.J.

2007
To assess the nutritional condition and growth of asylum seekers' children upon arrival and follow-up in the Netherlands.
The proportion of children who were obese/overweight increased in those seeking asylum in the Netherlands following their migration.

Rosenblum, S. 2007
To examine the experience of immigrant Jewish Ethiopian youth in Israel and its impact on their identity formation and determine which aspects contribute to the experience of being a Jewish Ethiopian youth in Israel.
Despite the stress and challenges of integration in Israeli society families are central to youth's sense of belonging. Schools need to establish definite disciplinary boundaries between adults and children for immigrant youths. [

2006
To examine (i) whether the recently observed African-White differences in birth weights in Lisbon are replicated at a national level, (ii) temporal shifts in the birth weight distributions of babies of Portuguese and African mothers, and (iii) the factors influencing any changes in birth weights in these groups Among African births there was an increase in births to teenage mothers and a decline to mothers from advantaged socioeconomic backgrounds. African (3297, SD 441 g) babies were not different but the percentage of small preterm births was higher among African (4.7%) than among Portuguese (2.9%) births. The left shift of the birth weight distributions was independent of maternal age, parity, and social factors among Portuguese babies, but among African babies the decrease appeared to be associated with socioeconomic advantage.

2006
To evaluate the usefulness and feasibility of methods to assess the prevalence of food insecurity and child hunger, and to examine associations between child hunger and measures of socioeconomic status and measures of acculturation in Liberian refugees and asylum seekers 85% of households were food insecure, and 42% experienced child hunger. Hunger was more likely to be indicated in households using foods stamps, with lower income, and lower education. Hunger was also more likely to be indicated in households where the primary shopper experienced difficulty shopping and with language. [190] Chemtob, D.; Weiler-Ravell, D.; Leventhal, A.; Bibi, H.

2006
To analyze the specific impact of our screening procedures on active TB among children in Israel Most cases (81.8%) were foreign born, predominantly (88.2%) immigrants from Ethiopia and, therefore, huge differences existed in TB incidence rates according to countries of origin. TB was more frequently diagnosed among young children (aged 0-4 years) of Ethiopian origin (39.9%) compared to those from the former Soviet Union (17.5%) (P = 0.067). TB was diagnosed within 3 years of arrival most (83.6%) of the Ethiopian children. [82] Renzaho, A.M.; Gibbons, C.; Swinburn, B.; Jolley, D.; Burns, C.

2006
To assess the anthropometric status of 337 sub-Saharan African children aged between 3-12 years who migrated to Australia Obesity and overweight are very prevalent in SSA migrant children and undernutrition, especially wasting, was also not uncommon in this target group. The prevalence rates for overweight and obesity were 18.4% (95%CI: 14 -23%) and 8.6% (95%CI: 6% -12%) respectively. The prevalence rates for the indicators of undernutrition were: wasting 4.3% (95%CI: 1.6%-9.1%), underweight 1.2% (95%CI: 0.3%-3.0%), and stunting 0.3 (95%CI: 0.0%-1.6%). Of the 94 children with malaria from Africa, 80% had P. falciparum, 11% P. ovale, 5% P. malariae, 4% P.vivax. P. falciparum affected a larger proportion of children from Africa relative to other immigrant regions of origin. Of the 121 cases analyzed, 93 of the patients originated from Africa. Ten children with serious complications had P. falciparum infection (P = 0.03), and presented within one month of arrival from their respective endemic country. All of these patients arrived from Africa.

2005
To assess the level of iron deficiency anemia and vitamin A deficiency in populations dependent on long-term international food aid and humanitarian assistance The research illustrates evidence of high level of micronutrient malnutrition (iron and vit A) and moderate-to-high levels of protein energy malnutrition were seen in several of the camps. [148] Johnson, E.B.; Reed, S.D.; Hitti, J.; Batra, M.

2005
To compare maternal and neonatal morbidity among Somali immigrants, US-born blacks and whites in Washington state Somali women more commonly had caesarean deliveries associated with fetal distress and failed induction of labor. They were 9 times more likely than both control groups to deliver after 42 weeks gestation, and 4 times more likely than US-born black women and 8 times more likely than white women to have oligohydramnios. Newborns of Somali women were at increased risk for prolonged hospitalization, lower 5-minute Apgar scores, assisted ventilation, and meconium aspiration. [211] Cooke, R.; Murray, S.; Carapetis, J.; Rice, J.; Mulholland, N.; Skull, S.

2004
To analyze the demographics and utilization of health services by pediatric refugees from East Africa and to assess the implications for service planning and provision Availability of interpreters and information on health services were the main factors hindering access to care. These data have informed future service planning at the Clinic.

2004
To investigate differentials in mortality between children from former Mozambican refugee and host South African households in a rural sub-district in the north-east of South Africa This study demonstrates higher childhood, but not infant, mortality rates among children from former Mozambican refugee households compared with those from host South African households in rural South Africa. The lack of legal status and lower wealth of many former Mozambican refugees may partly explain this disparity. [174] Cote, S.; Geltman, P.; Nunn, M.; Lituri, K.; Henshaw, M.; Garcia, Raul I.

2004
To describe the prevalence of caries experience and untreated decay among newly arrived refugee children stratified by their region of origin and compared with US children African refugee children had significantly lower dental caries experience as well as fewer untreated caries as compared with similarly aged Eastern European refugee children. They were also less likely to have ever been to a dentist. Possible reasons for these findings may include differences in exposure to natural fluoride in the drinking water, dietary differences, access to professional care, and cultural beliefs and practices. [56] Depoortere, E.; Guthmann, J.P.; Sipilanyambe, N.; Nkandu, E.; Fermon, F.; Balkan, S.; Legros, D.

2004
To measure patient adherence to Artemisinin-based combination therapy (ACT) in children up to age 5 years under routine conditions of prescription in a refugee settlement We found 21.2% of the patients to be certainly non-adherent, 39.4% probably non-adherent, and 39.4% (95% CI [31.6-47.6]) probably adherent. Insufficient explanation by the dispenser was identified as an important reason for non-adherence.

2004
To compare birthweights and frequencies of preterm birth for North African and Belgian infants Infants of North African immigrants were heavier at birth and were less likely to be born low birthweight or preterm, compared to infants of Belgian women. North African women were more likely to live with a partner while pregnant. After adjusting for sociodemographic and maternal factors, the estimated difference in mean birth weight between North African and Belgian women was about 74 g (p=0.05) among all births.
[44] Hallgren, J.; Petrini, B.; Wahlgren, C.F. 2004 To describe the mycological and clinical data in children diagnosed with tinea capitis in a hospital setting in Stockholm The study showed a striking predominance of scalp infection caused by T. violaceum among children of eastern African extraction. Why children of African extraction seem to be at higher risk of infection with these fungi than others remains unclear. Children of immigrants tend to be infected with dermatophyte species common in their country of origin, irrespective of how long they have lived in their adopted country. [159] Kamer, A.; Zohar, A.H.; Youngmann, R.; Diamond, G.W.; Inbar, D.; Senecky, Y.

2004
To estimate the prevalence of pervasive developmental disorder (PDD) among immigrants to Israel and Israeli natives Among immigrants, the rate of PDD in Ethiopian-born children was lower than that of those born in other countries. The rate of PDD in immigrant Ethiopian children was much lower than in native Israeli children of Ethiopian extraction.

2004
To assess the effect of a highly nutrient-dense spread fortified with vitamins and minerals, with or without antiparasitic metronidazole treatment, in correcting retarded linear growth and reducing anemia in stunted children Fortified spread (FS), and not unfortified spread (US), induces catch-up growth in stunted children whose diets are poor in micronutrients. Our trial provides support for delivering multiple micronutrients to reverse stunting and reduce anemia in children up to age 6 years. Linear growth of children fed FS was 30% faster at 3 months than in US and control groups, after which height-for-age z scores increased only slightly in the Increase in hemoglobin concentrations in the FS group at 6 mo was twofold that in the US and control groups (37 ± 40, 19±15, and 16±17 g/L, respectively; P<0.0001), and anemia was reduced by nearly 90%.
[29] Javaloy, J.; Ferrer, C.; Vidal, M.T.; Alio, J.L. 2003 To ascertain the prevalence of acute trachoma as a supposed endemic disease among infants in the Saharan refugee camps of Tindouf (Algeria) and to evaluate the efficacy of treatment with a single dose of azithromycin Chlamydia trachomatis was suspected in 2.47% of the children, papillary hypertrophy being the most frequently seen clinical sign. Scarring changes secondary to trachoma were detected in 11.7% of the children. Only four cases (0.8%) were positive to the immunoassay test and 12 cases (2.27%) were positive by polymerase chain reaction (PCR). After treatment a second PCR was performed on positive children and they were negative of chlamydia DNA amplification. [130] Stevens, G.W.; Pels, T.; Bengi-Arslan, L.; Verhulst, F.C.; Vollebergh, W.A.; Crijnen, A.A.

2003
To compare emotional and behavioral problems of Moroccan immigrant children to those of Dutch native children and Turkish immigrant children Moroccan parents reported as many problems as Dutch parents, but less problems than Turkish parents. Teachers stated substantially more externalizing problems were reported for Moroccan pupils compared to Dutch and Turkish pupils. Moroccan adolescents themselves reported less problems than Dutch and Turkish adolescents.

2003
To investigate periodontal status and oral hygiene practices among recent new immigrants from Quara, Ethiopia the aim to maintain and promote their periodontal health 55.7% of 13-to 17-year-olds had a community periodontal index score of 2 indicating calculus.
[101] Renzaho, A.; Renzaho, C. 2003 To evaluate the public health and nutritional situation of refugee children in Katale camp, Eastern Zaire, after two years of nutritional and health intervention from 1994 to 1996 Public health interventions in Katale camp 1994 to 1996 reduced mortality and morbidity rates dramatically. This was not reflected in the malnutrition rates for children under five years, which remained stable after an initial fall despite two years of nutritional intervention.

2003
To determine the growth patterns of immigrant children after changes in their nutritional habits The 7-to 11-y-old Israeli-born boys were heavier (P<0.03) and had higher mean arm muscle circumference transthyretin, and magnesium (P<0.0001) and lower albumin (P<0.0001) and triceps skinfold thickness (P<0.005) than did the corresponding caravandwelling boys. Israeli girls were heavier (P<0.006) and had higher wt/ht ratio (P<0.02), MAMC, transthyretin, calcium, and magnesium (P<0.0001) and lower albumin (P<0.05) and TSF (P <0.0001) than did the Ethiopianborn girls of the same age range. There was a significant difference in weight, wt/ht ratio, TFS, MAMC, transthyretin, calcium, and magnesium (P <0.0001) between the Ethiopian-and Israeli-born boarding schoolboys. [63]

2001
To determine the prevalence of childhood SCD in Ireland and to predict requirements for a comprehensive care and assessment programme All 20 children with SCD were from Africa (12 from Nigeria, 4 from Congo, 3 from Angola and one from Zaire). Their Hb level was 6.4-9.7 g/dL with a median of 7.7 g/dL and all consistently fail to express the Duffy red cell antigen (Fya/Fyb). [61] Geltman, P.L.; Radin, M.; Zhang, Z.; Cochran, J.; Meyers, A.F.

2001
To analyze growth and identify related medical conditions among refugee children in Massachusetts Of the African refugee children screened for ova and parasites, 50% tested positive. Infection with pathogenic parasites was associated with increased risk of low heightfor-age z scores (OR=2.4; 95% CI=1.6-3.4). Of African refugee children screened for TB via the purified protein derivative (PPD) tuberculin skin test, 25% tested positive. A positive PPD result was associated with lowered likelihood of having height-for-age z scores less than −2 (OR=0.6; 95% CI=0.3, 0.9). Of the African refugees who were screened for dental abnormalities, 72% tested positive. To estimate incidence of and determine risk factors for poor pregnancy outcomes and to calculate the contribution of mortality from neonatal and maternal deaths to overall mortality in a refugee camp The fetal death rate was 45.6 per 1000 births, the neonatal mortality rate was 29.3 per 1000 live births, and 22.4% of all live births were low birth weight. Compared with women without poor pregnancy outcomes, those with poor pregnancy outcomes were more likely to report prior high socioeconomic status and having 3 or more episodes of malaria during pregnancy. [140] Essen, B.; Hanson, B.S.; Ostergren, P.O.; Lindquist, P. G.; Gudmundsson, S.

2000
To investigate whether the maternal country of origin affected the risk for perinatal mortality and to determine its relationship to risk factors Women of foreign origin, especially from sub-Saharan Africa, have a higher risk of perinatal mortality than native Swedish women. The differences in mortality could not be explained by risk factors. The results suggest that women and newborns from sub-Saharan Africa should be given more intense surveillance on all levels of perinatal care in order to reduce perinatal mortality. [127] Berman, H. 1999 To explore how two groups of children who grew up amid violence "make sense" of their experience Themes of normalcy, peace, and contentment, prior to war, were common amongst refugee children. They believed that their lives would remain that way forever. As they stated repeatedly, there was no reason to believe otherwise. None of the refugee children had any preparation for the changes which ensued. Although they had only vague understandings as to what the fighting was about or who the warring factions were, they had very clear memories as to the actual events, what they saw and what they heard.
[106] Peltzer, K. 1999 To determine the extent of trauma and mental health problems The traumatic event in all the 56 children happened more than six months previously. Twelve children (20%) were suffering from chronic PTSD; their age range was from six to 14 years with a mean of 11.2 years (Q1= 8.3; Q,= 12.9). [105] Paardekooper, B.; de Jong, J.T.; Hermanns, J.M.

1999
To study the psychosocial effects of the war situation and subsequent flight on South Sudanese children who were compared to a group of Ugandan children who did not have these experiences of war and flight Compared to Ugandan children, the Sudanese reported significantly more PTSD-like complaints, behavioural problems, and depressive symptoms. The many psychological complaints from the Sudanese children could be caused by traumatic events they experienced as well as by their difficult daily circumstances.
[132] Zlot, A. 1999 To address body image among Ethiopian-Israeli teenage girls Ethiopian-Israeli girls found a balance between adopting Western concepts of beauty and preserving their Ethiopian traditions. Ethiopian-Israeli girls did not differentiate between the body, mind, and sprit; the girls maintained a holistic perception of the body. Different body parts were also assigned symbolic meaning.
[207] Nudelman, A. 1999 To explore to what extent traditional Ethiopian culture influences health practices of immigrant adolescents, in what circumstances are they more likely to adopt Western patterns of response as reflected by those of the Israeli culture.
Several situations of illness were presented, with an analysis of the differential behaviour patterns of Ethiopian immigrant pupils in Israeli youth villages. A similar process was evident among the different cases. In the first stage, there was a tendency to act according to the accepted mode of behaviour in Israel, and to go to the clinic for medical treatment.
[171] Roville-Sausse, F. 1998 To determine the influence of ethnic, cultural, and socioeconomic differences on the growth of children, particularly in the younger preschool years

1997
To assess the incidence of type 1 diabetes in under 20 years of age in the Netherlands, among Moroccan children in the Netherlands, correcting for determining the incidence in the period 1988-1990 In all age categories, the incidence of type 1 diabetes is higher in Moroccan children than in the Dutch children.

1997
To report an epidemiologic investigation of this cholera outbreak and document the challenges of providing adequate treatment and prevention in these circumstances Of the 173 patients whose records were reviewed following admission to the intravenous tent, 28% of patients were <6 years old. Twentyfour (60%) of the 40 persons whose deaths were reviewed were children under 4 years of age, compared to 29 (17%) of the 173 selected patients who were children (RR=4.5, [CI] 2.6-7.9). Fever was especially common among children. [54] Wolday, D.; Kibreab, T.; Bukenya, D.; Hodes, R.

1995
To assess the susceptibility in vivo of P. falciparum to chloroquine and pyrimethamine-sulfadoxine in Goma refugee camp in Zaire.
Children with malnutrition were more likely to have higher parasite densities and slower clearance of parasites than children without malnutrition and the prevalence and degree of resistance in vivo were more pronounced in malnourished children. In the chloroquine treatment group, 62% of all P. falciparum infections among normally nourished children were resistant in vivo, compared to 77% of infections among the malnourished children. In those treated with pyrimethaminesulfadoxine, 58% of all infections in normal children were resistant, compared to 86% of the infections in children with malnutrition. [49] Irova, T.I.; Burtonboy, G.; Ninane, J. 1995 To report experience of "vertically"acquired pediatric HIV infection, the mother-to-child transmission rate, and the clinical spectrum of HIV infection in our population of children, most of whose families came from Central Africa The findings are consistent with other studies from Africa and present evidence for a higher mother-to-infants transmission rate of HIV-1 in children born to HIV+ mothers in Africa than in industrialized countries. [129]

1993
To screen a representative number of Ethiopian immigrants for ectoparasites a few days after their arrival in Israel The infestation rate of head lice among Ethiopian children varied between 65-100% in the various age-groups compared to Israeli children whose infestation rate ranged between 0 and 18%. Children 6-11 years old were the most infested group and no differences between girls and boys were found. Among Ethiopians, more children than adults were infested with head lice (P<0.05). [177] Sgan-Cohen, H. D.; Steinberg, D.; Zusman, S.P.; Sela, M.N.

1992
To determine the prevalence of dental caries, fluoride supplementation, and fluorosis, and to establish the dietary patterns, the microbial content of saliva, salivary flow rates, and pH levels in recent immigrants from rural Ethiopia Salivary pH levels were generally similar between the Ethiopian group and the controls. Salivary flow was significantly higher for the Ethiopians (1.93 mL/min) than for controls (1.16 mL/min). Low levels of caries in this population can be attributed to an almost sugar-free diet and high salivary flow, but not to the composition of oral microflora. [196] Porter, J.D.; Gastellu-Etchegorry, M.; Navarre, I.; Lungu, G.; Moren, A.

1990
To review the measles surveillance in the camps, discuss the reason for outbreaks, and identify continued need for an effective single dose measles vaccine for children less than nine months of age Children were being inappropriately vaccinated, either being vaccinated at less than six months of age (2-29%), or failing to receive a second dose if vaccinated at six months (0-25%). Measles outbreaks again indicate the need to improve vaccine coverage with the existing Schwarz vaccine, and also highlight the urgent need for an effective single dose measles vaccine for children less than nine months of age.
[176] Sarnat, H.; Cohen, S.; Gat, H. 1987 To measure the changing pattern of dental caries, periodontal health status, and tooth cleaning behaviour among a cohort of Ethiopian immigrants to Israel between the years 1999-2005 The results showed a nearly sixfold difference in caries prevalence between the Ethiopian and the Israeli group (1.5/9.6). No differences could be seen clinically between the Ethiopians who immigrated more than 1 year ago and those who arrived within the last year. Radiographically, a significant difference was found between the two Ethiopian subgroups. Those who arrived more than 1 year ago had nearly three times more initial caries. Oral hygiene was poorer in the Ethiopian group than in the Israeli group; little difference was found in gingival health.
[144] Yudkin, P.L.; Harlap, S.; Baras, M. 1983 To examine a group of births in West Jerusalem in 1975-1976 and to test whether ethnic group differences in birthweight were then apparent and, if so, whether they could be accounted for by differences in maternal body size or by other social or demographic factors Birthweight was higher if the mother had immigrated to Israel after the age of 10 years than if she had immigrated at a younger age, or had been born in Israel. [99] Taylor, W.R. 1983 To feed the undernourished and protect the nutritionally vulnerable groups by providing them with supplementary food and to establish procedures for continuous surveillance of nutritional status of individuals and population groups Out of 1006 children who attended at least one of two daily sessions, 53% exceeded the discharge level and 26% were in the category 80%-84% of the reference median weight for height. The prevalence of acute malnutrition in the camp population at Daray Ma'an was 34.7 to 35.3%. The small intracluster variation in the sample indicates that acute malnutrition was distributed uniformly throughout the camp.

1981
To assess growth in relation to country of birth, time of parental residence in Scotland, child order in family, social class, living conditions, and dietary factors For standardised height against age, differences in height for ethnic groups was consistent over all ages.
No significant differences were noted between boys and girls of any ethnic group. For mean standardised height analysed by ethnic group, the mean for the African group was significantly higher (p<O.Ol) than the mean for the Asian group. For mean bone age for ethnic group, the African mean was significantly higher (p<0.01) than other group means. For weight according to Tuxford's Index analysed by ethnic group (children 0-3 years), Africans had the largest mean and was significantly higher compared to Scottish, Asian, and Chinese children (p<0.01).
[60] The most frequently occurring abnormality was the sickle cell trait in African children and the next commonest was the Beta-Thalassaemia trait in Asian and Chinese children. No purely Scottish child was found to have a haemoglobinopathy. Findings suggest the need for a hemoglobinopathy clinic as essential part of the routine paediatric service in the UK.
[53] Asch, A.J. 1976 To describe the epidemiology of malaria diagnosed at a tertiary care pediatric center in the multicultural city of Toronto Of the P. falciparum infections, 32% were from Ghana, 28% were from Nigeria, and 7% were from Ivory Coast -the top 3 countries of origin for people infected by P. falciparum are all African countries. None of the top 3 countries of origin for P. vivax are African countries. One case of 2% paracitenia was identified in an 8-year-old girl from Nigeria. [59] Thompson, R.G.; Hutchison, J.G.; Johnston, N.M.

1972
Not clearly stated The Kenyan population comprised roughly equal numbers of boys and girls with ages between 4 and 17 years, and their carriage of helminths was similar. These children have a much lower carriage rate (16%) than the Asian or American populations, and hookworm, hymenolepis, ascaris, and trichuris each contribute a substantial percentage to the total. The Ugandans show an even lower carriage rate (7%) than the Kenyans and due to this as well as the small size of the population examined (67 children), some species of worms are probably not represented. [142] Legg, S.; Davies, A.M.; Prywes, R.; Sterk, V.V.; Weiskopf, P.

1970
To analyze some demographic and socioethnic attributes of women who delivered underweight babies in Jerusalem in 1964-67 Between the different ethnic groups of Jews, the crude rate of low birth weight was lowest for North African children. When adjusted for differences in maternal age, birth order, and education, North African children faced a significant deficiency of low birth weight. In North African infants, maternal age had no significant effect on low birth weight. In the Asian and North African immigrant mothers, education is of low significance in contrast to the Israeli-born and western immigrant groups.
[212] Bennett, F.J.; Jelliffe, D.B. 1965 To determine the possibility of eliciting exactly what health services immigrant mothers made use of for their babies and to determine patterns of usage of services to the health of the baby and urbanization status of the parents 20 of the 60 children were Child Welfare Clinic attendees. 13 of the 57 children (with an adequate history) were taken to Mulago hospital during this period and seven to the Catholic hospital. 27 babies had medicine bought for them, usually from the nearest shop but occasionally from a chemist. Many children received treatment in a variety of places often depending on the severity of the illness and financial resources/permission from the father. Reasons for hospital attendance seemed often to be the mothers' estimation of the seriousness of the illness (determined by the child's temperature and crying). Proximity of the clinic was the most important factor in determining its use.