Migration Health

Healthy Migrants in Healthy Communities

donate

Determinants and Findings

65.jpg
unitedto.jpg
Tuberculosis and Migration
1-1.png
1-2.png
1-3.png
65.jpg
unitedto.jpg
2-1.png
(Intelligence Council on Global Trends 2030, December 2012 issue)
7.4 billion population >1 billion migrants 250 million international           760 million internal Urbanization: >50% Feminization: 50% Under 20 years of age: 33M
“International migration is set to grow even faster than in the past quarter-century”
2-2.png
The Context
65.jpg
unitedto.jpg
3-1.png
250 Million International Migrants...
65.jpg
unitedto.jpg
- Decrease in number of TB cases (42% since 1990)
The 2015 WHO TB report shows that the Millennium Development Goals (MDGs) have been achieved globally:
- Decrease in new TB and relapse TB cases by an average of 1.5% since 2000
Note: The MDG targets were to decrease incidence of TB cases by 2015 (MDG target 6c) and that prevalence and mortality rates should be halved compared with their levels in 1990.
-Between 2000 and 2014, TB treatment alone saved 35 million lives among HIV-negative people; TB treatment and antiretroviral therapy saved an additional 8 million lives among HIV-positive people.
- Decrease in TB mortality rate (47% since 1990)
Tuberculosis: a global issue
65.jpg
unitedto.jpg
- About 1.5 million deaths due to TB (including 390,000 deaths among HIV-positive people and 190,000 from MDR-TB) in 2014
But globally, TB remains a global threat
- Approximately 6 million new cases of TB were reported in 2014
- India, Indonesia and China had the largest numbers of cases (23%, 10% and 10% of the global total, respectively)
- TB ranks alongside HIV as a leading cause of death worldwide
Tuberculosis: a global issue
TB burden is concentrated in developing and low income countries / regions
- Of the 480,000 cases of multidrug-resistant TB (MDR-TB) estimated to have occurred in 2014, only about a quarter of these – 123,000 – were detected and reported
- Around 58% of cases occur in the South-East Asia and Western Pacific regions
- The African Region has 28% of the world’s TB cases, but the most severe burden relative to population (281 incident cases per 100,000 population on average, more than double the global average of 133)
- Majority (74%) of TB/HIV cases were in the African Region
65.jpg
unitedto.jpg
The largest migrant source countries overlap with the highest TB-burden countries; India, Russian Federation, Bangladesh, China, Pakistan, Philippines, Afghanistan, Indonesia. In low-burden and immigration countries, TB is often observed in foreign-born groups of population for both existing infection, or reactivation of latent TB.
Tuberculosis: a global issue
6-1.png
65.jpg
unitedto.jpg
The migration process and TB in individuals
There are risks involved with TB infection at ALL POINTS of the migration process.
7-1.png
65.jpg
unitedto.jpg
The migration process and TB in individuals
Risk factors for TB at origin:
7-1.png
1. Burden of TB in the community of origin
2. Health care system available to the community of origin
3. Access to care
4. Initial SES
5. Education/ knowledge/ beliefs
6. Political (in)stability
7. Conflict
circle.png
65.jpg
unitedto.jpg
The migration process and TB in individuals
Risk factors for TB during transit:
7-1.png
1. Physical travel conditions:
- overcrowding
- food shortages
- violence
- poor ventilation
2. Interrupted treatments/ no continuity of care
3. Potential distrust for public personnel; fear of getting caught,     deportation, etc.
4. Women are particularly vulnerable -     reproductive health, sexual health (ex.     rape)
circle.png
65.jpg
unitedto.jpg
The migration process and TB in individuals
Risk factors for TB at destination:
7-1.png
1. Integration into social systems:
- access to adequate housing, jobs, health care
2. Poor working conditions (overcrowding, poor ventilation,     overexposure to small particles)
3. Low wages
4. No benefits- no insurance/ sick leave
5. Delayed presentation for treatment
6. Poor nutrition
circle.png
7. Language and cultural barriers
8. Stigma-related fears
65.jpg
unitedto.jpg
The migration process and TB in individuals
Risk factors for TB during return:
7-1.png
1. Availability and accessibility of health care services
2. Stigma and family pressure
3. Distress/ psychological issues
circle.png
65.jpg
unitedto.jpg
Migration and health in receiving countries
1. There is an increased incidence of TB in foreign-born populations of low burden countries
- a decrease in TB in the native born
- an increase in the immigration of people from countries where TB is endemic
Countries of Origin of Foreign-Born Cases of Tuberculosis(TB) Diagnosed in the United States
12-1.png
12-2.png
12-3.png
65.jpg
unitedto.jpg
Migration and health in receiving countries
2. An increase in the cost of medical care for foreign-born TB cases
- lack of insurance?
- TB resistance?
- no continuity of care? - increased chance of TB resistance?
13-1.png
65.jpg
unitedto.jpg
A clarification: migrant myths vs. reality
14-1.png
65.jpg
unitedto.jpg
South Africa’s temporary mining community: occupational conditions and TB
- high rates of TB transmission
Context:
- many miners are migrant laborers from neighboring countries, especially from Lesotho, Mozambique, and Swaziland
- high HIV prevalence and subsequently, high TB prevalence
- high exposure to silica from the mines- occupational hazard
- high risk of drug resistance
15-1.png
15-2.png
65.jpg
unitedto.jpg
Addressing ALL underlying determinants
The legal, social, cultural, economic, behavioral, and communication barriers involved with the entire migration process put migrants at a greater risk of disease. In addition to strategies and programs in place to decrease global TB transmission, we also need to address other migration-influenced factors that affect health.
16-1.png
65.jpg
unitedto.jpg
17-1.png
65.jpg
unitedto.jpg
Screening pathway to increase detection
18-1.png
65.jpg
unitedto.jpg
Overseas screening programmes
- ensure early case detection and access to treatment in vulnerable populations
19-1.png
Screening migrants can:
- includes referral to relevant health systems as necessary
65.jpg
unitedto.jpg
1. Screen migrants for active TB prior to resettlement and immigration.
IOM TB Services Migration Health Assessments
2. Provide a comprehensive range of TB-related services, including physical examination, radiological investigation, the tuberculin skin test, sputum smear and culture, drug susceptibility testing (DST) and DOT, in line with partner government protocols.
3. Provide TB treatment either directly or through a referral system, in partnership with national tuberculosis programmes (NTPs).
65.jpg
unitedto.jpg
Screening example: IOM’s Migration Health Assessment Programmes
21-1.png
65.jpg
unitedto.jpg
IOM Health Assessment Exams: How the data can be used to present TB detection
22-1.png
65.jpg
unitedto.jpg
IOM Pre-Migration TB Screening – Selected Outcomes
25-1.png
25-2.png