High diabetes risk among asylum seekers in The Netherlands.

AIMS: To map the prevalence and incidence of recorded diabetes among asylum seekers according to demographic factors and length of stay in the host country. METHODS: We used a nationwide database from the Community Health Services for Asylum Seekers. The study population included all asylum seekers aged 20-79 years who arrived in the Netherlands between 2000 and 2008. Case allocation was based on International Classification of Primary Care codes. A general practice registry was used to obtain reference data. Standardized prevalence and incidence ratios were calculated and their association with length of stay was explored with Cox regression. RESULTS: The study included 59 380 asylum seekers among whom there were 1227 recorded cases of diabetes. The prevalence of recorded diabetes was higher among asylum seekers compared with the reference population for both men (standardized prevalence ratio=1.85, 95% CI 1.71-1.91) and women (standardized prevalence ratio=2.26, 95% CI 2.08-2.45). The highest standardized prevalence ratios were found for asylum seekers from Somalia, Sudan and Sri Lanka. The standardized prevalence ratio was higher in asylum seekers aged ≥ 30 years. Incidence rates were higher compared with the reference population for all length-of-stay intervals. CONCLUSIONS: Asylum seekers from the majority of countries of origin were at higher risk of diabetes compared with the general population in the Netherlands. Asylum seekers from Somalia were particularly at risk. This emerging public health issue requires attention from policy-makers and care providers.

The first contacts between healthcare providers and newly-arrived asylum seekers: a qualitative study about which issues need to be addressed.

OBJECTIVES: Asylum seekers have been recognized as having unique and complex health needs which require attention upon arrival in the host country. Not much is known about what issues to address in first contacts with asylum seekers. The purpose of this study is to give insight in the specific issues that healthcare providers need to address in the first contacts with newly arrived asylum seekers. STUDY DESIGN: A qualitative study using different types of data in 2007 and 2008. METHODS: Questionnaires (n = 89) were used as input for seven group interviews with Dutch care providers (n = 46) working with asylum seekers in the Netherlands, were qualitatively analysed, using a framework method. RESULTS: Healthcare providers identified four issues they aimed to address in first contacts with asylum seekers: (1) assessing the current health condition; (2) health risk assessment; (3) providing information about the healthcare system of the host country; and (4) health education. CONCLUSION: The first contacts between healthcare providers and asylum seekers serve different goals, especially assessing health problems and risks, and providing health information. These issues may, however, be addressed differently by different healthcare providers, across different host countries, dependent on the way healthcare and medical insurance for asylum seekers are organized.

Mortality and causes of death among asylum seekers in the Netherlands, 2002-2005.

BACKGROUND: The world's growing population of asylum seekers faces different health risks from the populations of their host countries because of risk factors before and after migration. There is a current lack of insight into their health status. METHODS: A unique notification system was designed to monitor mortality in Dutch asylum seeker centres (2002-2005). RESULTS: Standardised for age and sex, overall mortality among asylum seekers shows no difference from the Dutch population. However, it differs between subpopulations by sex, age and region of origin and by cause of death. Mortality among asylum seekers is higher than among the Dutch reference population at younger ages and lower at ages above 40. The most common causes of death among asylum seekers are cancer, cardiovascular diseases and external causes. Increased mortality was found from infectious diseases (males, standardised mortality ratio (SMR)=5.44 (95% CI 3.22 to 8.59); females, SMR=7.53 (95% CI 4.22 to 12.43)), external causes (males, SMR=1.95 (95% CI 0.52 to 2.46); females SMR=1.60 (95% CI 0.87 to 2.68)) and congenital anomalies in females (SMR 2.42; 95% CI 1.16 to 4.45). Considerable differences were found between regions of origin. Maternal mortality was increased (rate ratio 10.08; 95% CI 8.02 to 12.83) as a result of deaths among African women. CONCLUSION: Certain subgroups of asylum seekers (classified by age, sex and region of origin) are at increased risk of certain causes of death compared with the host population. Policies and services for asylum seekers should address both causes for which asylum seekers are at increased risk and causes with large absolute mortality, taking into account differences between subgroups.

Induced abortions and teenage births among asylum seekers in The Netherlands: analysis of national surveillance data.

BACKGROUND: Asylum seekers are assumed to be a vulnerable group with respect to sexual and reproductive health. The objective of this study was to quantify induced abortion and teenage birth indicators for this group. METHODS: The population comprised all female asylum seekers aged 15-49 in The Netherlands between September 2004 and August 2005. Information was collected about induced abortions from notification forms and electronic patient files. The central agency for the reception of asylum seekers provided population and birth data. RESULTS: Among asylum seekers the abortion rate (14.4/1000 women) and teenage birth rate (49.1/1000) were higher than average in The Netherlands (8.6/1000 and 5.8/1000). Great differences were found between subgroups. High abortion rates were seen among women who were pregnant on arrival or got pregnant in the first months after arrival at the reception facilities. Abortion and teenage birth rates were particularly high among asylum seekers aged 15-19 from specific parts of Africa and Asia. Abortion ratios were high among asylum seekers aged 30-49 from parts of Europe and Asia. Decreases in the abortion rate and teenage birth rate were observed as the length of stay increased. CONCLUSION: Abortions and teenage births were more common among asylum seekers than among the overall population of The Netherlands. Increased rates were a consequence of subgroups being at high risk. Abortion and teenage birth rates were very high among women who were pregnant on arrival or got pregnant in the first few months after arrival, but decreased as the length of stay increased.