Asylum seekers’ and Refugees’ Changing Health (ARCH) study protocol: an observational study in Lebanon and Denmark to assess health implications of long-distance migration on communicable and non-communicable diseases and mental health

Abstract

IntroductionBy end of 2018, the European Union countries hosted approximately 2.5 million refugees and Lebanon alone hosted more than 1 million. The majority of refugees worldwide came from Syria. The prevailing study design in published studies on asylum seekers’ and refugees’ health leaves a number of fundamental research questions unanswerable. In the Asylum seekers’ and Refugees’ Changing Health (ARCH) study, we examine the health of a homogeneous group of refugees and asylum seekers in two very different host countries with very different migration histories. We aim to study the health impact of the migration process, living conditions, access to healthcare, gene–environment interactions and the health transition.Methods and analysisARCH is an international multisite study of the health of adult (>18 years old) Syrian refugees and asylum seekers in Lebanon and Denmark. Using a standardised framework, we collect information on mental and physical health using validated scales and biological samples. We aim to include 220 participants in Danish asylum centres and 1100 participants in Lebanese refugee camps and settlements. We will use propensity score weights to control for confounding and multiple imputation to handle missing data.Ethics and disseminationEthical approval has been obtained in Lebanon and Denmark. In the short term, we will present the cross-sectional association between long-distance migration and the results of the throat and wound swab, blood and faeces samples and mental health screenings. In the longer term, we are planning to follow the refugees in Denmark with collection of dried blood spots, mental health screenings and semistructured qualitative interviews on the participant’s health and access to healthcare in the time lived in Denmark. Here, we present an overview of the background for the ARCH study as well as a thorough description of the methodology.

Pregnancy complications among refugee women: A systematic review

“…The present study found a lower prevalence of preeclampsia among refugee women than native women. One possible explanation for this is the “healthy migrant effect”, where people of refugee/migrant status have more favorable health outcomes compared with the native population in the host countries 33,34 . Reasons for this may be an average younger age in the refugee population at time of giving birth, which is known to lower the risk of developing preeclampsia.…”

“…In some of the studies, no clear definition of refugees is provided, and thus no clear distinction between refugees and migrants. This is problematic as “migrants” is a very heterogeneous term 9,34 . Many factors, such as the reason for migration and the migration process itself, are important to consider, and these can differ substantially between refugees and other types of migrants.…”

“…This is problematic as "migrants" is a very heterogeneous term. 9,34 Many factors, such as the reason for migration and the migration process itself, are important to consider, and these can differ substantially between refugees and other types of migrants. This can cause a distorted result, as women of refugee status may be of higher risk of the adverse pregnancy outcomes and pregnancy-related infections compared with migrant women.…”

“…One possible explanation for this is the "healthy migrant effect", where people of refugee/migrant status have more favorable health outcomes compared with the native population in the host countries. 33,34 Reasons for this may be an average younger age in the refugee population at time of giving birth, which is known to lower the risk of developing preeclampsia. Another reason may be that refugees have a lower BMI during pregnancy compared with native women.…”

High prevalence of methicillin-resistant Staphylococcus aureus, Giardia, and Blastocystis in asymptomatic Syrian asylum seekers in Denmark during 2016 through 2018

“…The study was part of the “Asylum seekers’ and Refugees’ Changing Health” (ARCH) project which is described in detail in the study protocol ( Eiset et al., 2020 ). Briefly, adult Syrian asylum seekers were included shortly after arriving in Denmark during 2016 through 2018 using a cross-sectional design with one-stage cluster sampling, setting the design effect to one due to random allocation to the asylum centres [22].…”