Emerging Themes in Epidemiology
Volume 16, Issue 1, 2019

Health monitoring among asylum seekers and refugees: A state-wide, cross-sectional, population-based study in Germany (Article) (Open Access)

Biddle L. , Menold N. , Bentner M. , Nöst S. , Jahn R. , Ziegler S. , Bozorgmehr K.*
  • a Social Determinants, Equity and Migration Group, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany
  • b Faculty of Arts, Humanities and Social Science, Institute of Sociology, Technische Universität Dresden, Dresden, Germany, GESIS Leibniz Institute for the Social Sciences, Mannheim, Germany
  • c Social Determinants, Equity and Migration Group, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany
  • d Social Determinants, Equity and Migration Group, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany
  • e Social Determinants, Equity and Migration Group, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany
  • f Social Determinants, Equity and Migration Group, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany
  • g Social Determinants, Equity and Migration Group, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany

Abstract

Background: Health monitoring in Germany falls short on generating timely, reliable and representative data among migrants, especially transient and marginalized groups such as asylum seekers and refugees (ASR). We aim to advance current health monitoring approaches and obtain reliable estimates on health status and access to essential healthcare services among ASR in Germany's third largest federal state, Baden-Württemberg. Methods: We conducted a state-wide, cross-sectional, population-based health monitoring survey in nine languages among ASR and their children in collective accommodation centres in 44 districts. Questionnaire items capturing health status, access to care, and sociodemographic variables were taken from established surveys and translated using a team approach. Random sampling on the level of 1938 accommodation centres with 70,634 ASR was employed to draw a balanced sample of 65 centres with a net sample of 1% of the state's ASR population. Multilingual field teams recruited eligible participants using a "door-to-door" approach. Parents completed an additional questionnaire on behalf of their children. Results: The final sample comprised 58 centres with 1843 ASR. Of the total sample expected eligible (N = 987), 41.7% (n = 412) participated in the survey. Overall, 157 households had children and received a children's questionnaire; 61% (n = 95) of these were returned. Age, sex, and nationality of the included sample were comparable to the total population of asylum applicants in Germany. Adults reported longstanding limitations (16%), bad/very bad general health (19%), pain (25%), chronic illness (40%), depression (46%), and anxiety (45%). 52% utilised primary and 37% specialist care services in the previous 12 months, while reporting unmet needs for primary (31%) and specialist care (32%). Younger and male participants had above-average health status and below-average utilisation compared to older and female ASR. Conclusions: Our health monitoring survey yielded reliable estimates on health status and health care access among ASR, revealing relevant morbidities and patterns of care. Applying rigorous epidemiological methods in linguistically diverse, transient and marginalized populations is challenging, but feasible. Integration of this approach into state- and nation-wide health monitoring strategies is needed in order to sustain this approach as a health planning tool. © 2019 The Author(s).

Author Keywords

Health status Asylum seekers Survey Refugees healthcare access Healthcare quality Healthcare planning Health monitoring

Index Keywords

anxiety patient care Germany depression household refugee health care planning demography human Multilingualism sex difference linguistics controlled study health status Aged morbidity chronic disease asylum seeker cross-sectional study male female population research Article feasibility study health care utilization major clinical study adult random sample health care quality health care access medical specialist age distribution monitoring health monitoring health care need primary health care Child health survey
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068875157&doi=10.1186%2fs12982-019-0085-2&partnerID=40&md5=07b16fea2bcf0ab470ce19284bc8f3af
DOI: 10.1186/s12982-019-0085-2
ISSN: 17427622
Original Language: English