The Health of Resettled Refugee Children: a Modified Systematic Review 2001-2009

Abstract

Background: New Zealand regularly accepts refugee children and their families for resettlement. Refugees as a population have been reported previously as having high health needs in resettlement. A search for current evidence specifically about resettled refugee child health to inform primary health care nursing practice found limited information. The main evidence to guide practice was Refugee Health Care: A Handbook for Health Professionals (2001a) which provided a useful overview of refugee health care but had limited information about children and as it was published in 2001 was potentially out of date. Question and approach: What does the published research report about the health of resettled refugee children? A modified systematic review process was used due to the broadness of the research question. Search strategy: A two phase search strategy of six electronic databases using key words Refugee, Health, Child, Infant, Baby, Resettle was conducted in January and February 2010. Selection criteria: Primary research studies that were eligible for review inclusion had a study population of refugee children aged 12 years or younger who had resettled in a third country, focused on any aspect of health and were published between 2001-2009. Refugee children not resettled, that is displaced, in camps or immigration detention were excluded as were studies that had an exclusive study population of children aged 13 years or older. Data collection: The abstracts of 194 studies were read and assessed against the inclusion/exclusion criteria and 145 were excluded. The full text was obtained for the remaining 49 studies that were read and assessed against the inclusion/exclusion criteria and 25 studies excluded. The remaining 24 studies were critically appraised using the RAPid appraisal tool from the Joanna Briggs Institute by the researcher and the second reviewer at the Joanna Briggs Institute. Nine were excluded following this appraisal. Results: Of the 15 studies in the review nine focused on physical health, four focused on psychological health and two on health service use. The studies were mainly descriptive and concerned with establishing the population prevalence of infectious or deficiency diseases found in refugee children on arrival or in the first months of resettlement. The synthesis updated three health issues that were elevated blood lead levels that increased after arrival in the USA, an 82% rate of H pylori infection in African refugee children in Australia and the widespread prevalence of low vitamin D levels in refugee children in New Zealand and Australia. Conclusions: Refugee children as a population have special physical health needs at least in early resettlement. There is limited research on the health of resettled refugee children except in early resettlement. Limited comparisons could be made between the review findings and other populations of New Zealand children. These comparisons indicate that resettled refugee children as a population have a higher incidence of the health issues that were identified by the review than the general child population in New Zealand. A review limitation was the exclusion of nine studies because of design issues identified in critical appraisal with RAPid. Although the review findings had little to say about the socio-economic determinants of health of resettled refugee children they are able to inform primary health care nurse practice from a population health and an individual care perspective.