Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan.

INTRODUCTION: The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings. METHODS: A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. RESULTS: Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications. DISCUSSION: Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs.

Causes and differentials of childhood mortality in Iraq.

BACKGROUND: Limited information is available in Iraq regarding the causes of under-five mortality. The vital registration system is deficient in its coverage, particularly from rural areas where access to health services is limited and most deaths occur at home, i.e. outside the health system, and hence the cause of death goes unreported. Knowledge of patterns and trends in causes of under-five mortality is essential for decision-makers in assessing programmatic needs, prioritizing interventions, and monitoring progress. The aim of this study was to identify causes of under-five children deaths using a simplified verbal autopsy questionnaire.The objective was to define the leading symptoms and cause of death among Iraqi children from all regions of Iraq during 1994-1999. METHODS: To determine the cause structure of child deaths, a simplified verbal autopsy questionnaire was used in interviews conducted in the Iraqi Child & Maternal Mortality Survey (ICMMS) 1999 national sample. All the mothers/caregivers of the deceased children were asked open-ended questions about the symptoms within the two weeks preceding death; they could mention more than one symptom. RESULTS: The leading cause of death among under-five children was found to be childhood illnesses in 81.2%, followed by sudden death in 8.9% and accidents in 3.3%. Among under-five children dying of illnesses, cough and difficulty in breathing were the main symptoms preceding death in 34.0%, followed by diarrhea in 24.4%. Among neonates the leading cause was cough/and or difficulty in breathing in 42.3%, followed by sudden death in 11.9%, congenital abnormalities in 10.3% and prematurity in 10.2%. Diarrhea was the leading cause of death among infants in 49.8%, followed by cough and/or difficulty in breathing in 26.6%. Among children 12-59 months diarrhea was the leading cause of death in 43.4%, followed by accidents, injuries, and poisoning in 19.3%, then cough/difficulty in breathing in 14.8%. CONCLUSION: In Iraq Under-five child mortality is one of the highest in the Middle East region; deaths during the neonatal period accounted for more than half of under-five children deaths highlighting an urgent need to introduce health interventions to improve essential neonatal care. Priority needs to be given to the prevention, early and effective treatment of neonatal conditions, diarrheal diseases, acute respiratory infections, and accidents. This study points to the need for further standardized assessments of under-5 mortality in Iraq.

Anemia among adolescents.

OBJECTIVE: To determine the prevalence of anemia in a group of apparently healthy school adolescents selected from 2 distinct socio-economic areas (SEAs) in Baghdad; and to assess the importance of diet and some other factors which could be relevant in the epidemiology of anemia in adolescents. METHODS: A random sample of 1051 adolescents were included in the present study, 46% of them (487 adolescents) were from Al-Mansoor area for high socio-economic area (HSEA) and 54% of them (564 adolescents) were from Al-Horya area for low socio-economic area (LSEA) in Baghdad, Iraq. Collection of data was carried out during the period between November 1996 until the end of April 1997. Hemoglobin concentration and packed cell volume levels were determined. Dietary intake of iron, calories, protein and Vitamin C were estimated. RESULTS: The prevalence of anemia among adolescents in HSEA was 12.9% compared with 17.6% in LSEA. Hemoglobin concentration in males was significantly correlated with age and dietary iron intake while in females it was correlated significantly with years of education of father and mother, number of pads and age at menarche. CONCLUSION: Anemia among adolescents was found to be a health problem of moderate severity.