Neurological disorders in complex humanitarian emergencies and natural disasters

Mateen, Farrah J.

doi:10.1002/ana.22135

Cited by 26 publications

(31 citation statements)

References 99 publications

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“…There has been limited reporting of neurological disorders among displaced persons. Most data derive from infectious disease outbreaks, including mortality surveillance of meningococcal meningitis, and disease-specific campaigns involving poliomyelitis and leprosy [2]. Active monitoring of the range of diagnoses, demographic characteristics, vulnerabilities, and health service utilization of refugees with neurological disorders is limited despite the fact that armed conflict, climate change, and economic migration pose important and increasingly global challenges and may have significant effects on the incidence and burden of neurological disease.…”

Section: Introductionmentioning

confidence: 99%

Neurological disorders in Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System

Mateen

Carone

Nyce³

et al. 2011

J Neurol

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The United Nations High Commissioner for Refugees (UNHCR) recognizes 43.7 million forcibly displaced persons and asylum seekers due to conflict and persecution worldwide. Neurological disorders have rarely been described in displaced persons but likely pose a significant burden of disease. We describe the disease spectrum and health service utilization of Iraqi refugees and asylum seekers with neurological disorders using an information system developed by the UNHCR. Neurological disorders were actively monitored among the 7,642 UNHCR-registered Iraqi refugees and asylum seekers who received health and humanitarian assistance using a pilot, centralized, database called the Refugee Assistance Information System (RAIS) in the Kingdom of Jordan in 2010. There were 122 neurological diagnoses reported in 1,328 refugees (mean age 41 years, 49% female, 10% disabled, 43% with pending resettlement applications) in 2,659 health visits, accounting for 17% of all refugees who sought health assistance in RAIS. Referral to a neurologist occurred in 178 cases (13.4%). The most frequent ICD-10 neurological diagnoses were dorsalgia (back pain) (29.7% of individuals with neurological disorders), headache (13.1%), and epilepsy (12.6%). Approximately 1 in 20 Iraqi refugees with a neurological diagnosis self-reported a history of torture, which was higher than Iraqi refugees without a history of torture [66/1,328 versus 196/6,314, odds ratio (OR) = 1.63, 95% confidence interval (CI) 1.21-2.18]. Neurological disease affects a high proportion of Iraqi refugees, including victims of torture and the disabled. Refugees require dedicated care for treatment of neurological disease with a focus on pain disorders and epilepsy.

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Section: Introductionmentioning

confidence: 99%

Neurological disorders in Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System

Mateen

Carone

Nyce³

et al. 2011

J Neurol

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“…1 Limited information is available on neurologic diseases in refugee camps, and is mainly focused on meningococcal meningitis outbreaks during the 1990s. [2][3][4][5] Compiled surveillance data would be valuable for setting health care policy related to the prevention, management, and reduction of neurologic diseases in refugee camps on a global basis. Here, we present the burden of health care visits per reportable neurologic disease by country level from refugee camps supported by the United Nations High Commissioner for Refugees (UNHCR).…”

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confidence: 99%

Reportable neurologic diseases in refugee camps in 19 countries

et al. 2012

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“…Neurological manifestations are important contributors to morbidity and mortality during the acute phase of humanitarian emergencies as well as in the subsequent months and years [3]. Outbreaks of optic and peripheral neuropathy, for which the identification of a definitive cause is challenging, have been reported in association with dietary inadequacies [4], [5].…”

Section: Introductionmentioning

confidence: 99%

“…Outbreaks of optic and peripheral neuropathy, for which the identification of a definitive cause is challenging, have been reported in association with dietary inadequacies [4], [5]. Despite numerous reports of both cholera [6] and peripheral neuropathy [3] among internally displaced persons (IDPs), the epidemiological features of their concurrent outbreaks and their impact on mortality have not been previously described.…”

Section: Introductionmentioning

confidence: 99%

Concurrent Outbreaks of Cholera and Peripheral Neuropathy Associated with High Mortality among Persons Internally Displaced by a Volcanic Eruption

Rosewell

Clark²,

Mabong³

et al. 2013

PLoS ONE

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BackgroundIn October 2004, Manam Island volcano in Papua New Guinea erupted, causing over 10 000 villagers to flee to internally displaced person (IDP) camps, including 550 from Dugulaba village. Following violence over land access in March 2010, the IDPs fled the camps, and four months later concurrent outbreaks of acute watery diarrhea and unusual neurological complaints were reported in this population.Materials and MethodsA retrospective case-control study was conducted to identify the risk factors for peripheral neuropathy. Rectal swabs were collected from cases of acute watery diarrhea. Hair and serum metals and metalloids were analyzed by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS).ResultsThere were 17 deaths among the 550 village inhabitants during the outbreak period at a crude mortality rate 21-fold that of a humanitarian crisis. Vibrio cholerae O1 El Tor Ogawa was confirmed among the population. Access to community-level rehydration was crucial to mortality. Peripheral neuropathy was diagnosed among cases with neurological symptoms. A balanced diet was significantly protective against neuropathy. A dose-response relationship was seen between peripheral neuropathy and a decreasing number of micronutrient- rich foods in the diet. Deficiencies in copper, iron, selenium and zinc were identified among the cases of peripheral neuropathy.ConclusionsCholera likely caused the mostly preventable excess mortality. Peripheral neuropathy was not caused by cholera, but cholera may worsen existing nutritional deficiencies. The peripheral neuropathy was likely caused by complex micronutrient deficiencies linked to non-diversified diets that potentially increased the vulnerability of this population, however a new zinc-associated neuropathy could not be ruled out. Reoccurrence can be prevented by addressing the root cause of displacement and ensuring access to arable land and timely resettlement.

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Neurological disorders in complex humanitarian emergencies and natural disasters

Cited by 26 publications

References 99 publications

Neurological disorders in Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System

Neurological disorders in Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System

Reportable neurologic diseases in refugee camps in 19 countries

Concurrent Outbreaks of Cholera and Peripheral Neuropathy Associated with High Mortality among Persons Internally Displaced by a Volcanic Eruption

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