Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan.
Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan.
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DOI：
10.1186/s12889-015-2429-3
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发表时间：
2015-10-31
影响因子：
4.5
通讯作者：
Burnham G
中科院分区：
文献类型：
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作者：
Doocy S;Lyles E;Roberton T;Akhu-Zaheya L;Oweis A;Burnham G
目前因冲突而流离失所的人数比二战以来的任何时候都要多。随着城市和中等收入环境中流离失所现象的增多，流离失所人口的情况也发生了变化。因此，流行病学发生了转变，不再是历史上难民人口特有的传染病。非传染性疾病 (NCD) 的高患病率对提供适当的二级和三级服务、护理的连续性、药物的获取和费用提出了挑战。鉴于难民面临的非传染性疾病负担日益增加，我们进行了这项研究，以了解非传染性疾病的流行情况，并更好地了解与约旦非难民营环境中的叙利亚难民寻求非传染性疾病相关的问题。采用多阶段聚类设计，概率与规模抽样成正比，对 1550 名难民进行了横断面调查，以获得难民营外叙利亚难民的全国代表性样本。为了获得有关慢性病的信息，受访者被问及一系列有关高血压、心血管疾病、糖尿病、慢性呼吸道疾病和关节炎的问题。使用卡方和 t 检验方法检查这些情况下寻求护理的差异，并将感兴趣的特征纳入调整后的逻辑回归模型中。在成人中，高血压患病率最高（9.7%，CI：8.8-10.6），其次是关节炎（6.8%，CI：5.9-7.6）、糖尿病（5.3%，CI：4.6-6.0）、慢性呼吸道疾病（3.1%，CI：2.4-3.8）和心血管疾病（3.7%，CI：3.2、4.3）。在 1363 例非传染性疾病病例中，84.7%（CI：81.6–87.3）在约旦接受护理；在评估的五种非传染性疾病中，关节炎病例的就医率最低，为 65%（CI：0–88，p = 0.005）。户主完成高等教育和初等教育的家庭中的个人寻求护理的几率比未受过教育的家庭低 89% (CI: 22-98) 和 88% (CI: 13-98)（分别为 p = 0.028 和 p = 0.037）。约旦北部的难民最有可能因病情寻求护理；约旦中部的难民寻求护理的几率比北部地区的难民低 68% (CI: 1–90) (p = 0.047)。约旦一半以上的叙利亚难民家庭报告称，其中一名成员患有非传染性疾病。相当一部分人没有得到护理，认为费用是主要障碍。由于资金限制持续存在，确定维持和改善约旦境内叙利亚难民获得非传染性疾病护理的途径至关重要。
There are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan. A cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian refugees outside of camps. To obtain information on chronic conditions, respondents were asked a series of questions about hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and arthritis. Differences by care-seeking for these conditions were examined using chi-square and t-test methods and characteristics of interest were included in the adjusted logistic regression model. Among adults, hypertension prevalence was the highest (9.7 %, CI: 8.8–10.6), followed by arthritis (6.8 %, CI: 5.9–7.6), diabetes (5.3 %, CI: 4.6–6.0), chronic respiratory diseases (3.1 %, CI: 2.4–3.8), and cardiovascular disease (3.7 %, CI: 3.2, 4.3). Of the 1363 NCD cases, 84.7 % (CI: 81.6–87.3) received care in Jordan; of the five NCDs assessed, arthritis cases had the lowest rates of care seeking at 65 %, (CI:0–88, p = 0.005). Individuals from households in which the head completed post-secondary and primary education, respectively, had 89 % (CI: 22–98) and 88 % (CI: 13–98) lower odds of seeking care than those with no education (p = 0.028 and p = 0.037, respectively). Refugees in North Jordan were most likely to seek care for their condition; refugees in Central Jordan had 68 % (CI: 1–90) lower odds of care-seeking than those in the North (p = 0.047). More than half of Syrian refugee households in Jordan reported a member with a NCD. A significant minority did not receive care, citing cost as the primary barrier. As funding limitations persist, identifying the means to maintain and improve access to NCD care for Syrian refugees in Jordan is essential.