Socioeconomic and Medical Vulnerabilities Among Syrian Refugees with Non-communicable Diseases Attending Médecins Sans Frontières Services in Irbid, Jordan.

Non-communicable diseases (NCDs) are high-prevalence health problems among Syrian refugees. In 2014, Médecins Sans Frontières (MSF) identified unmet NCD care needs and began providing free-of-charge services for Syrian refugees in Irbid, Jordan. This study aimed to describe current socioeconomic and medical vulnerabilities among MSF Irbid Syrian refugee patients and their households and raise awareness of their ongoing health needs that must be addressed. A cross-sectional survey among Syrian refugees attending MSF NCD services in Irbid Governorate, Jordan was conducted by telephone interviews in January 2021 to query sociodemographic characteristics, economic situation, self-reported NCD prevalence, and Ministry of Health (MoH) policy awareness. Descriptive analysis of indicators included proportions or means presented with 95% confidence intervals. The survey included 350 patient-participants in 350 households and 2157 household members. Mean age was 28.3 years. Only 13.5% of household members had paid or self-employed work; 44% of households had no working members. Mean monthly income was 258.3 JOD (95%CI: 243.5-273.1) per household. Mean expenditures were 320.0 JOD (95%CI: 305.1-334.9). Debt was reported by 93% of households. NCD prevalence among adults was 42% (95%CI: 40-45). Hypertension was most prevalent (31.1%, 95%CI: 28.7-33.7), followed by diabetes (21.8%, 95%CI: 19.7-24.1) and cardiovascular diseases (14.4%, 95%CI: 12.6-16.4). Only 23% of interviewees were aware of subsidized MoH rates for NCD care. Twenty-nine percent stated they will not seek MoH care, mainly due to the unaffordable price. Our findings highlight increased vulnerability among MSF Irbid Syrian refugee NCD patients and their households, including: an older population; a high percentage of unemployment and reliance on cash assistance; higher proportion of households in debt and a high number of households having to resort to extreme coping mechanisms when facing a health emergency; and a higher proportion of people with multiple comorbid NCDs and physical disability. Their awareness of subsidised MoH care was low. MoH care is expected to be unaffordable for many. These people are at increased risk of morbidity and mortality. It is vital that health actors providing care for Syrian refugees take action to reduce their risk, including implementing financial support mechanisms and free healthcare.

Rapidly adapted community health strategies to prevent treatment interruption and improve COVID-19 detection for Syrian refugees and the host population with hypertension and diabetes in Jordan.

BACKGROUND: We evaluated community health volunteer (CHV) strategies to prevent non-communicable disease (NCD) care disruption and promote coronavirus disease 2019 (COVID-19) detection among Syrian refugees and vulnerable Jordanians, as the pandemic started. METHODS: Alongside medication delivery, CHVs called patients monthly to assess stockouts and adherence, provide self-management and psychosocial support, and screen and refer for complications and COVID-19 testing. Cohort analysis was undertaken of stockouts, adherence, complications and suspected COVID-19. Multivariable models of disease control assessed predictors and non-inferiority of the strategy pre-/post-initiation. Cost-efficiency and patient/staff interviews assessed implementation. RESULTS: Overall, 1119 patients were monitored over 8 mo. The mean monthly proportion of stockouts was 4.9%. The monthly proportion non-adherent (past 5/30 d) remained below 5%; 204 (18.1%) patients had complications, with 63 requiring secondary care. Mean systolic blood pressure and random blood glucose remained stable. For hypertensive disease control, age 41-65 y (OR 0.46, 95% CI 0.2 to 0.78) and with diabetes (OR 0.73, 95% CI 0.54 to 0.98) had decreased odds, and with baseline control had increased odds (OR 3.08, 95% CI 2.31 to 4.13). Cumulative suspected COVID-19 incidence (2.3/1000 population) was suggestive of ongoing transmission. While cost-efficient (108 US${\$}$/patient/year), funding secondary care was challenging. CONCLUSIONS: During multiple crises, CHVs prevented care disruption and reinforced COVID-19 detection.

Counselling of non-communicable diseases' patients for COVID-19 vaccine uptake in Jordan: Evaluating the intervention.

BACKGROUND: People with noncommunicable diseases (NCDs) are at a significantly higher risk of worst outcomes if infected with COVID-19 and thus amongst the main target population for vaccination. Despite prioritizing them for vaccination, the number of vaccinated patients with comorbidities stalled post vaccine introduction. Despite that the government along with partners ran a national awareness campaign to ramp up vaccination coverage, the coverage remained suboptimal. Thus, a one-to-one health counselling initiative was implemented to explore the acceptance of COVID-19 vaccines by the NCDs patients and address the main issues surrounding vaccine hesitancy. This study evaluates the impact of this intervention by analyzing the change in COVID-19 vaccine acceptance. METHODS: In this analytical observational study, a random sample of 57,794 people living with NCDs were approached. Out of them, 12,144 received one-to-one counselling by a group of trained health professionals. The counselled group's vaccine acceptance was assessed on a Likert scale from 1 to 5 pre- and post- counselling. Moreover, a random sample was followed up 2 months after initial counselling to measure their vaccine acceptance and update their vaccination status. RESULTS: 44.5% of total respondents were already registered in the vaccination platform. On a scale from 1 to 5, the overall mean confidence significantly increased by 1.63 from 2.48 pre-counselling to 4.11 post-counselling. Two-months post counselling, a random sample was contacted again and had a mean vaccine confidence of 3.71, which is significantly higher than pre-counselling confidence level despite a significant decrease to post-counselling results. DISCUSSION: Implementing an intervention that targets all key factors impacting health decisions, such as health literacy, risk appraisal and response efficacy, helps reach an adaptive response and increase vaccine confidence. Scholars should be cautious when implementing an intervention since it could lead to maladaptive defensive responses. One-to-one interventions are more effective in population when addressing new interventions and vaccines.

Prevalence of and risk factors for depression among female Syrian refugees and Jordanians with chronic disease: a pilot study.

BACKGROUND: Chronic disease and depression are primary contributors to morbidity among displaced and local populations. AIMS: This study aims to address the prevalence for and risk factors of comorbid depression among Jordanian and Syrian women with known chronic disease. METHODS: To provide evidence for mental health intervention planning, we conducted a cross-sectional survey to investigate determinants of depression among female Syrian refugees and Jordanians with chronic disease living in Amman. A total of 272 female Syrian refugees and Jordanians with chronic disease were recruited from 4 clinics across Amman from June to August 2017. We compared demographic and health characteristics and depression level and identified predictors of depression via multivariable ordinal regression. RESULTS: Moderate to high levels of depression were reported in 55.9% of the participants, with a prevalence of 41.1% among Jordanians and 70.6% among Syrians. Syrians with chronic disease had 2.73 times greater odds of higher levels of depression than their Jordanian peers. After adjusting for age, income, spouse employment status, gastrointestinal or genitourinary disorder status, and perceived self-efficacy, Syrians were not at significantly greater odds of reporting higher levels of depression. Risk factors for higher depression levels included having an unemployed spouse, diagnosis of gastrointestinal or genitourinary disorder and low perceived self-efficacy. CONCLUSION: Depression is frequently comorbid with chronic physical conditions and has a deleterious impact on health status. Mental health interventions and chronic disease management tailored to differences among local and displaced communities may reduce disease burden and disability.

Exploring the bidirectional relationship between chronic disease and depression among female Syrian refugees and Jordanians: a qualitative analysis.

BACKGROUND: Nearly 700 000 Syrian refugees currently reside in Jordan. Chronic disease and neuropsychiatric conditions are leading contributors of morbidity among refugee and host communities. The bidirectional relationship between depression and chronic disease is not well studied among displaced Syrian or Jordanian women. AIMS: This qualitative study explores the bidirectional relationship between chronic illness and comorbid depression, as well as related themes, among Jordanian and Syrian women with known chronic disease-populations that receive medical care through distinct and evolving health care structures-to assist providers and policy makers in creating culturally sensitive interventions. METHODS: Forty Jordanian women and Syrian refugees with chronic disease were interviewed at four clinical settings in Amman, Jordan. Data collection occurred from June-August 2017. Content analysis was completed with Dedoose, a qualitative coding software. RESULTS: The majority of Syrian women endorsed a relationship between their chronic disease and depression. Some women felt too depressed to take medication for chronic conditions, while others felt depression contributed to chronic illnesses. Syrian women reported less perceived social support than Jordanian women. Although some Syrians were unable to afford medications, they reported fewer negative health care experiences than Jordanians. Both populations endorsed female-specific hardships impacting their mental health, including the demands of motherhood, household duties, and marital strife. CONCLUSION: This study explores the intersection of depression and chronic disease among Syrian and Jordanian women. By documenting stressors and experiences accessing health care, mental health and chronic disease interventions can be integrated and tailored to these populations.

Perceptions of use of a case-based, integrated national electronic public health surveillance system in Jordan.

Collection of real-time, standardized data remains a challenge for public health surveillance systems. The use of mobile information technology may facilitate this. A national case-based public health surveillance system was introduced in Jordan in 2015 using mobile tablets and an online framework. After training on the system, users were surveyed about their perceptions of it. Of 596 participants attending the training, 580 (97.3%) completed the survey. The majority of users were nurses (58.5%). Overall perceptions of the system were highly positive across 5 areas of functionality (standardized case definitions, clinical guidance on signs and symptoms, risk factors and laboratory guidance, SMS and Email alerts for notifiable diseases, one-hour reporting of information via an online framework). In all areas, over 80% of participants thought the system would help their work and would save time in identifying notifiable diseases and reporting this information centrally. Further work is encouraged to evaluate the system and consider the application of cloud-based models in other settings.