0
August 1995, Vol 149, No. 8 >
Article | August 1995

Health Status of Pediatric Refugees in Buffalo, NY FREE

Sharon B. Meropol, MD
Arch Pediatr Adolesc Med. 1995;149(8):887-892. doi:10.1001/archpedi.1995.02170210061011.
Text Size: A A A
Published online
Article
References
Comments

Objective:  To characterize the health status of recent pediatric refugees.

Research Design:  Medical records of 107 pediatric refugees who underwent screening during a recent 24-month period were reviewed.

Setting:  A county hospital pediatric clinic in a metropolitan area with a population of 1189000. The majority of pediatric refugees who come to the Buffalo, NY, area receive a health screening in this clinic.

Results:  Most of the children were from Vietnam (67%), the Soviet Republics (19%), or Africa (14%). The median age was 8 years 2 months (range, 1 to 18 years). Only 39% of the children had evidence of adequate immunizations for age (39 of the children from Vietnam, two children from Africa, and one from the Soviet Republics). In 30%, physical examinations exposed conditions that required follow-up or referral to a medical or surgical specialist. Forty-two percent of the children required dental referral. Seven children were anemic; three had microcytic anemia. Of 81 children who underwent screening for hepatitis B, six (7%) were carriers, 35 (43%) were positive for hepatitis B surface antibody, and only four (5%) related a history of hepatitis exposure. Stool specimens were examined for ova and parasites in 87 children; 19 had pathogenic parasites with multiple organisms in two. Thirteen (24%) of 55 children who were tested from Vietnam, five (36%) of 14 children who were tested from Africa, and one (5%) of 18 children who were tested from the Soviet Republics had pathogenic parasites. Parasites included Ascaris lumbricoides (n=8), Necator americanus or Ancylostoma duodenale (n=5), Giardia lamblia (n=3), Trichuris trichiura (n=2), Dientamoeba fragilis (n=2), and Entamoeba histolytica (n=1). Skin testing for tuberculosis with purified protein derivative (tuberculin) was completed in 83 children, and 17 (20%) had reactive tests (21% [12/58] from Vietnam, 11% [1/9] from Africa, and 25% [4/16] from the Soviet Republics).

Conclusions:  Refugee children who come to the United States frequently have conditions that put them at risk of future morbidity and may require utilization of substantial health care resources. Some of these conditions represent public health concerns.(Arch Pediatr Adolesc Med. 1995;149:887-892)

REFERENCES

1 +
Report to the Congress: Refugee Resettlement Program, January 31, 1993 . Washington, DC: Office of Refugee Resettlement, Administration for Children and Families, US Dept of Health and Human Services; 1993;:3-10.
2 +
Centers for Disease Control.  Health status of Indochinese refugees . MMWR Morb Mortal Wkly Rep . 1979;;28:385-393.
3 +
Catanzaro A, Moser RJ.  Health status of refugees from Vietnam, Laos, and Cambodia . JAMA . 1982;;247:1303-1308.
4 +
Skeels MR, Nums LJ, Mann JM.  Intestinal parasitosis among Southeast Asian immigrants in New Mexico . Am J Public Health . 1982;;72:57-59.
5 +
Waldman EB, Lege SB, Oseid B, Carter JP.  Health and nutritional status of Vietnamese refugees . South Med J . 1979;;72:1300-1303.
6 +
Bicho AJ, Keenlyside RA.  Southeast Asian refugees of Rhode Island: health screening . R I Med J . 1984;;67:353-355.
7 +
McCaw BR, DeLay P.  Demographics and disease prevalence of two new refugee groups in San Francisco—the Ethiopian and Afghan refugees . West J Med . 1985;;143:271-275.
8 +
Centers for Disease Control.  Viral hepatitis type B, tuberculosis and dental care of Indochinese refugees . MMWR Morb Mortal Wkly Rep . 1980;;29:1-3.
9 +
Centers for Disease Control.  Nutritional status of Southeast Asian refugee children . MMWR Morb Mortal Wkly Rep . 1980;;29:477-479.
10 +
Barry M, Craft J, Coleman D, Coulter HO, Horwitz R.  Clinical findings in Southeast Asian refugees: child development and public health concerns . JAMA . 1983;; 249;3200-3203.
11 +
Dewey DG, Daniels J, Teo KS, Hassel E, Otow J.  Height and weight of Southeast Asian preschool children in northern California . Am J Public Health . 1986;; 76:806-808.
12 +
Tittle BS, Harris JA, Chase PA, Morrell RE, Jackson RJ, Espinoza SY.  Health screening of Indochinese refugee children . AJDC . 1982;;136:697-700.
13 +
Goldenring JM.  A high-yield workup for the new wave of immigrants . Contemp Pediatr . 1986;;3:124-128.
14 +
Parish RA.  Intestinal parasites in Southeast Asian refugee children . West J Med . 1985;;143:47-49.
15 +
Cunningham TM.  Hemoglobin E in Indochinese refugees . West J Med . 1982;; 137:186-190.
16 +
Hurst D, Tittle B, Kleman KM, Embury SH, Lubin BH.  Anemia and hemoglobinopathies in Southeast Asian refugee children . J Pediatr . 1983;;102:692-697.
17 +
Craft J, Coleman D, Coulter HO, Horwitz R, Barry M.  Hematologic abnormalities in Southeast Asian refugees . JAMA . 1983;;249:3204-3206.
18 +
Salas SD, Heifetz R, Barrett-Connor E.  Intestinal parasites in Central American immigrants in the United States . Arch Intern Med . 1990;;150:1514-1516.
19 +
Lurio J, Verson H, Karp S.  Intestinal parasites in Cambodians: comparison of diagnostic methods used in screening refugees with implications for treatment of populations with high rates of infestation . J Am Board Fam Pract . 1991;;4:71-78.
20 +
Committee on Infectious Diseases, American Academy of Pediatrics.  Active and passive immunizations: scheduling immunizations . In: Peter G, ed. Report of the Committee on Infectious Diseases . 23rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1994;:7-71.
21 +
NCHS Growth Charts, 1976 . Rockville, Md: National Center for Health Statistics, 1976;;25. Health Resources Administration No. (76) -1120.
22 +
Committee on Infectious Diseases, American Academy of Pediatrics.  Active and passive immunizations: refugees . In: Peter G, ed. Report of the Committee on Infectious Diseases . 23rd ed. Elk Grove Village, III: American Academy of Pediatrics; 1994;:66-67.
23 +
Committee on Infectious Diseases, American Academy of Pediatrics.  Tuberculosis . In: Peter G, ed. Report of the Committee on Infectious Diseases . 23rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1994;:484-485.
24 +
Children's Medical and Surgical Center of The Johns Hopkins Hospital.  Agespecific indices . In: Greene MG, ed. The Harriet Lane Handbook . 12th ed. St Louis, Mo: Mosby—Year Book Inc; 1991;:42.
25 +
Williams BC, Miller CA.  Preventive health care for young children: findings from a 10-country study and directions for United States policy . Pediatrics . 1992;; 89( (suppl) ):983-998.
26 +
Bergstein JM.  Conditions associated with hematuria . In: Behrman RE, ed. Nelson Textbook of Pediatrics . 14th ed. Philadelphia, Pa: WB Saunders Co; 1992;: 1326.
27 +
Olness K, Yip R, Indritz A, Torjesen E.  Height and weight status of Indochinese refugee children: an anthropometric study of 1650 children . AJDC . 1984;; 138:544-547.
28 +
Baldwin LM, Sutherland S.  Growth patterns of first-generation Southeast Asian infants . AJDC . 1988;;142:526-531.
29 +
Munger RG, Gomez-Marin O, Prineas RJ, Sinaiko AR.  Elevated blood pressure among Southeast Asian refugee children in Minnesota . Am J Epidemiol . 1991;; 133:1257-1265.
30 +
Goldenring JM, Castle GF.  Prevalence of disease in Southeast Asian teenagers: results of screening medical examination at a residential vocational training facility . J Adolesc Health Care . 1983;;4:266-269.
31 +
Bernier RH, Sampliner R, Gerety R, Tabor E, Hamilton F, Nathanson N.  Hepatitis B infection in households of chronic carriers of hepatitis B surface antigen: factors associated with prevalence of infection . Am J Epidemiol . 1982;; 116:199-211.
32 +
Hurie MB, Mast EE, Davis JP.  Horizontal transmission of hepatitis B virus infection to United States—born children of Hmong refugees . Pediatrics . 1992;; 89:269-273.
33 +
Franks AL, Berg CJ, Kane MA, et al.  Hepatitis virus infection among children born in the United States to Southeast Asian refugees . N Engl J Med . 1989;; 321:1301-1305.
34 +
Leichtner AM, Leclair J, Goldmann DA, Schumacher RT, Gewolb IH, Katz AJ.  Horizontal nonparenteral spread of hepatitis B among children . Ann Intern Med . 1981;;94:346-349.
35 +
Vernon TM, Wright RA, Kohler PF, Merrill DA.  Hepatitis A and B in the family unit: nonparenteral transmission by asymptomatic children . JAMA . 1976;;235: 2829-2831.
36 +
Pon EW, Ren H, Margolis H, Zhao Z, Schatz, GC, Diwan A.  Hepatitis B virus infection in Honolulu students . Pediatrics . 1993;;92:574-578.
37 +
Kashiwagi S, Hayashi J, Ikematsu H, et al.  Transmission of hepatitis B virus among siblings . Am J Epidemiol . 1984;;120:617-625.
38 +
McMahon BJ, Alward WLM, Hall DB, et al.  Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state . J Infect Dis . 1985;;151:599-603.
39 +
Barrett-Connor E.  Natural history of intestinal parasites in asymptomatic adults . J Fam Pract . 1984;;19:635-639.
40 +
Borchardt KA, Ortega H, Mahood JD, et al.  Intestinal parasites in Southeast Asian refugees . West J Med . 1991;;135:93-96.
41 +
Centers for Disease Control.  Survey of intestinal parasites—Illinois . MMWR Morb Mortal Wkly Rep . 1979;;28:346-347.
42 +
Powell KE, Brown ED, Farer LS.  Tuberculosis among Indochinese refugees in the United States . JAMA . 1983;;249:1455-1460.
43 +
Centers for Disease Control.  Tuberculosis among Indochinese refugees—United States, 1979 . MMWR Morb Mortal Wkly Rep . 1980;;29:383-390.
44 +
Starke JR, Jacobs RF, Jereb J.  Resurgence of tuberculosis in children . J Pediatr . 1992;;120:839-855.
45 +
Advisory Committee for the Elimination of Tuberculosis.  Tuberculosis among foreign-born persons entering the United States: recommendations of the Advisory Committee for the Elimination of Tuberculosis . MMWR Morb Mortal Wkly Rep . 1990;;39:1-21.
46 +
Centers for Disease Control.  Drug resistance among Indochinese refugees with tuberculosis . MMWR Morb Mortal Wkly Rep . 1981;;30:273-275.
47 +
Melby PC, Kreutzer RD, McMahon-Pratt D, Gam AA, Neva FA.  Cutaneous leishmaniasis: review of 59 cases seen at the National Institutes of Health . Clin Infect Dis . 1992;;15:924-937.
48 +
Emanuel B, Aronson N, Shulman S.  Malaria in children in Chicago , Pediatrics . 1993;;92:83-85.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Report to the Congress: Refugee Resettlement Program, January 31, 1993 . Washington, DC: Office of Refugee Resettlement, Administration for Children and Families, US Dept of Health and Human Services; 1993;:3-10.
2 +
Centers for Disease Control.  Health status of Indochinese refugees . MMWR Morb Mortal Wkly Rep . 1979;;28:385-393.
3 +
Catanzaro A, Moser RJ.  Health status of refugees from Vietnam, Laos, and Cambodia . JAMA . 1982;;247:1303-1308.
4 +
Skeels MR, Nums LJ, Mann JM.  Intestinal parasitosis among Southeast Asian immigrants in New Mexico . Am J Public Health . 1982;;72:57-59.
5 +
Waldman EB, Lege SB, Oseid B, Carter JP.  Health and nutritional status of Vietnamese refugees . South Med J . 1979;;72:1300-1303.
6 +
Bicho AJ, Keenlyside RA.  Southeast Asian refugees of Rhode Island: health screening . R I Med J . 1984;;67:353-355.
7 +
McCaw BR, DeLay P.  Demographics and disease prevalence of two new refugee groups in San Francisco—the Ethiopian and Afghan refugees . West J Med . 1985;;143:271-275.
8 +
Centers for Disease Control.  Viral hepatitis type B, tuberculosis and dental care of Indochinese refugees . MMWR Morb Mortal Wkly Rep . 1980;;29:1-3.
9 +
Centers for Disease Control.  Nutritional status of Southeast Asian refugee children . MMWR Morb Mortal Wkly Rep . 1980;;29:477-479.
10 +
Barry M, Craft J, Coleman D, Coulter HO, Horwitz R.  Clinical findings in Southeast Asian refugees: child development and public health concerns . JAMA . 1983;; 249;3200-3203.
11 +
Dewey DG, Daniels J, Teo KS, Hassel E, Otow J.  Height and weight of Southeast Asian preschool children in northern California . Am J Public Health . 1986;; 76:806-808.
12 +
Tittle BS, Harris JA, Chase PA, Morrell RE, Jackson RJ, Espinoza SY.  Health screening of Indochinese refugee children . AJDC . 1982;;136:697-700.
13 +
Goldenring JM.  A high-yield workup for the new wave of immigrants . Contemp Pediatr . 1986;;3:124-128.
14 +
Parish RA.  Intestinal parasites in Southeast Asian refugee children . West J Med . 1985;;143:47-49.
15 +
Cunningham TM.  Hemoglobin E in Indochinese refugees . West J Med . 1982;; 137:186-190.
16 +
Hurst D, Tittle B, Kleman KM, Embury SH, Lubin BH.  Anemia and hemoglobinopathies in Southeast Asian refugee children . J Pediatr . 1983;;102:692-697.
17 +
Craft J, Coleman D, Coulter HO, Horwitz R, Barry M.  Hematologic abnormalities in Southeast Asian refugees . JAMA . 1983;;249:3204-3206.
18 +
Salas SD, Heifetz R, Barrett-Connor E.  Intestinal parasites in Central American immigrants in the United States . Arch Intern Med . 1990;;150:1514-1516.
19 +
Lurio J, Verson H, Karp S.  Intestinal parasites in Cambodians: comparison of diagnostic methods used in screening refugees with implications for treatment of populations with high rates of infestation . J Am Board Fam Pract . 1991;;4:71-78.
20 +
Committee on Infectious Diseases, American Academy of Pediatrics.  Active and passive immunizations: scheduling immunizations . In: Peter G, ed. Report of the Committee on Infectious Diseases . 23rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1994;:7-71.
21 +
NCHS Growth Charts, 1976 . Rockville, Md: National Center for Health Statistics, 1976;;25. Health Resources Administration No. (76) -1120.
22 +
Committee on Infectious Diseases, American Academy of Pediatrics.  Active and passive immunizations: refugees . In: Peter G, ed. Report of the Committee on Infectious Diseases . 23rd ed. Elk Grove Village, III: American Academy of Pediatrics; 1994;:66-67.
23 +
Committee on Infectious Diseases, American Academy of Pediatrics.  Tuberculosis . In: Peter G, ed. Report of the Committee on Infectious Diseases . 23rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1994;:484-485.
24 +
Children's Medical and Surgical Center of The Johns Hopkins Hospital.  Agespecific indices . In: Greene MG, ed. The Harriet Lane Handbook . 12th ed. St Louis, Mo: Mosby—Year Book Inc; 1991;:42.
25 +
Williams BC, Miller CA.  Preventive health care for young children: findings from a 10-country study and directions for United States policy . Pediatrics . 1992;; 89( (suppl) ):983-998.
26 +
Bergstein JM.  Conditions associated with hematuria . In: Behrman RE, ed. Nelson Textbook of Pediatrics . 14th ed. Philadelphia, Pa: WB Saunders Co; 1992;: 1326.
27 +
Olness K, Yip R, Indritz A, Torjesen E.  Height and weight status of Indochinese refugee children: an anthropometric study of 1650 children . AJDC . 1984;; 138:544-547.
28 +
Baldwin LM, Sutherland S.  Growth patterns of first-generation Southeast Asian infants . AJDC . 1988;;142:526-531.
29 +
Munger RG, Gomez-Marin O, Prineas RJ, Sinaiko AR.  Elevated blood pressure among Southeast Asian refugee children in Minnesota . Am J Epidemiol . 1991;; 133:1257-1265.
30 +
Goldenring JM, Castle GF.  Prevalence of disease in Southeast Asian teenagers: results of screening medical examination at a residential vocational training facility . J Adolesc Health Care . 1983;;4:266-269.
31 +
Bernier RH, Sampliner R, Gerety R, Tabor E, Hamilton F, Nathanson N.  Hepatitis B infection in households of chronic carriers of hepatitis B surface antigen: factors associated with prevalence of infection . Am J Epidemiol . 1982;; 116:199-211.
32 +
Hurie MB, Mast EE, Davis JP.  Horizontal transmission of hepatitis B virus infection to United States—born children of Hmong refugees . Pediatrics . 1992;; 89:269-273.
33 +
Franks AL, Berg CJ, Kane MA, et al.  Hepatitis virus infection among children born in the United States to Southeast Asian refugees . N Engl J Med . 1989;; 321:1301-1305.
34 +
Leichtner AM, Leclair J, Goldmann DA, Schumacher RT, Gewolb IH, Katz AJ.  Horizontal nonparenteral spread of hepatitis B among children . Ann Intern Med . 1981;;94:346-349.
35 +
Vernon TM, Wright RA, Kohler PF, Merrill DA.  Hepatitis A and B in the family unit: nonparenteral transmission by asymptomatic children . JAMA . 1976;;235: 2829-2831.
36 +
Pon EW, Ren H, Margolis H, Zhao Z, Schatz, GC, Diwan A.  Hepatitis B virus infection in Honolulu students . Pediatrics . 1993;;92:574-578.
37 +
Kashiwagi S, Hayashi J, Ikematsu H, et al.  Transmission of hepatitis B virus among siblings . Am J Epidemiol . 1984;;120:617-625.
38 +
McMahon BJ, Alward WLM, Hall DB, et al.  Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state . J Infect Dis . 1985;;151:599-603.
39 +
Barrett-Connor E.  Natural history of intestinal parasites in asymptomatic adults . J Fam Pract . 1984;;19:635-639.
40 +
Borchardt KA, Ortega H, Mahood JD, et al.  Intestinal parasites in Southeast Asian refugees . West J Med . 1991;;135:93-96.
41 +
Centers for Disease Control.  Survey of intestinal parasites—Illinois . MMWR Morb Mortal Wkly Rep . 1979;;28:346-347.
42 +
Powell KE, Brown ED, Farer LS.  Tuberculosis among Indochinese refugees in the United States . JAMA . 1983;;249:1455-1460.
43 +
Centers for Disease Control.  Tuberculosis among Indochinese refugees—United States, 1979 . MMWR Morb Mortal Wkly Rep . 1980;;29:383-390.
44 +
Starke JR, Jacobs RF, Jereb J.  Resurgence of tuberculosis in children . J Pediatr . 1992;;120:839-855.
45 +
Advisory Committee for the Elimination of Tuberculosis.  Tuberculosis among foreign-born persons entering the United States: recommendations of the Advisory Committee for the Elimination of Tuberculosis . MMWR Morb Mortal Wkly Rep . 1990;;39:1-21.
46 +
Centers for Disease Control.  Drug resistance among Indochinese refugees with tuberculosis . MMWR Morb Mortal Wkly Rep . 1981;;30:273-275.
47 +
Melby PC, Kreutzer RD, McMahon-Pratt D, Gam AA, Neva FA.  Cutaneous leishmaniasis: review of 59 cases seen at the National Institutes of Health . Clin Infect Dis . 1992;;15:924-937.
48 +
Emanuel B, Aronson N, Shulman S.  Malaria in children in Chicago , Pediatrics . 1993;;92:83-85.

Correspondence

Submit a Letter
CME
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Clear Answers | Save For Later
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2013 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems