[Show abstract][Hide abstract] ABSTRACT: Populations displaced by conflict face numerous threats to their psychological well-being; consequently, the prevalence of mental health problems, including anxiety, depression, and post-traumatic stress disorder can be elevated as compared to populations who have not experienced forced displacement.
Little is known about the mental health needs of displaced Iraqis. The factors associated with a need for psychological services among patients at seven clinics served by two NGOs that are known sources of care for the displaced Iraqi population in Amman, Jordan were explored.
The survey was conducted in January and February 2008 and included a random sample of care seekers from seven clinics selected using interval sampling. Interviews on the health needs of displaced Iraqis and their access to services, including mental health services lasting approximately 20 minutes were conducted.
Of the 664 survey participants, 49% (95% CI = 45-53%) of respondents reported needing mental health services and 5% (95% CI = 3-8%) of those in need had access to services. The length of time spent in Jordan (adjusted OR = 1.08; 95% CI = 1.00-1.11) was associated with the need for mental health services and the adjusted odds of requiring psychological services was 39% less for individuals from outside of Baghdad as compared to Baghdad residents (OR = 0.61; 95% CI = 0.38-0.98). Responders citing violence as a factor were twice as likely to be from Baghdad (OR = 2.28; 95% CI = 1.03-6.91), while interviewees reporting displacement as a cause for needing mental health services were twice as likely to be female (OR = 2.14; 95% CI = 1.12-4.18). In individuals 35-44 years of age (OR = 0.36; 95% CI = 0.14-0.87) the need for mental health services due to displacement decreased by 64%, while being a part of a female-headed household decreased the need by 81% (OR = 0.19; 95% CI = 0.06-0.57%).
More attention should be given to expanding the local Jordanian health system capacity for the provision of mental service. Targeted social and psychiatric interventions that are culturally sensitive and aligned with Inter-Agency Standing Committee recommendations should be developed to compliment and expand the existing mental health service capacity in Jordan.
Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 08/2009; 24(4):312-20.
[Show abstract][Hide abstract] ABSTRACT: Minority groups in the US have comparatively poorer access to a range of health care services. Access can be considered a function of opportunity and use and can vary with the level of segregation within a county. We hypothesized that with varying levels of segregation, increasing the proportion of the minority population within a county was accompanied by decreasing levels of access to surgical care.
A cross-sectional analysis was performed on data from the 2004 Area Resource File. Each county in the US was categorized into one of three levels: most, moderately, or least segregated, using the Isolation Index. Multivariable linear regression analysis was performed to examine the association between access to surgical services and proportion of minority population with varying levels of segregation adjusting for socioeconomic and health characteristics.
In the most segregated counties, each percentage point increase in Hispanic or African-American population was associated with a statistically significant decrease in outpatient surgery volume (p < 0.0001), ambulatory surgical facilities (p < 0.0001), and number of general surgeons (p < 0.0001). In the least segregated counties, these associations showed no statistical significance. A significant increase (p < 0.0001) in the volume of emergency medical visits was associated with increasing proportions of African-American and Hispanic populations within the most segregated counties.
In the most segregated counties, an increase in the African-American or Hispanic population was associated with a decrease in the availability and use of surgical services and an increase in emergency visits after adjustment for socioeconomic and health characteristics.
Journal of the American College of Surgeons 06/2009; 208(6):1017-22. · 4.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: To assess the health care needs, perceptions of quality of care, and health care seeking behaviors of Iraqi nationals seeking health care at Caritas and Jordan Red Crescent health clinics in Amman, Jordan.
Background: Many Iraqis fled due to the 2003 US invasion. Approximately 1.8 million refugees have sought refuge in Jordan and Syria. It is estimated that approximately 700,000 Iraqi nationals are living in Jordan. Because the Iraqis are highly mobile, difficult to reach, and have tenuous access to social services, little is known about their needs. Heightened financial concerns, concerns about their legal status in Jordan, and their fear of deportation are potential barriers preventing them from seeking health care.
Data: Interviewer administered survey
Methods: A surveys of patients seeking care Caritas and Jordan Red Crescent clinics in Amman, Jordan was conducted in January and February 2008. The Arabic questionnaire was administered by Iraqi physician interviewers, and most respondents were Iraqis. Respondents were selected using systematic randomization with the sampling interval dependant on clinic utilization data.
Results: Most clinic attendees were originally from Baghdad with more females seeking care. Overall, perceptions of clinic quality were positive. Staff, waiting time, and medication access and quality were cited as problems at specific clinics. Free services and medication availability were the strongest incentives for clinic utilization. There was a substantial need for mental health services. Though few Iraqis are registered with UNHCR overall, the survey showed that almost all clinic attendees had valid registration. There is some misinformation about UNHCR registration being required to attend clinics, or to receive free services. Results also provide information about patient access and barriers to care.
Recommendations and policy implications: Whereas our survey indicates that some services to meet the health needs of Iraqi nationals in Amman exist, additional and expanded services are needed. Emphasis should be placed on providing emergency and mental health services. The lack of appropriate information regarding clinic utilization eligibility needs to be addressed.
136st APHA Annual Meeting and Exposition 2008; 10/2008
[Show abstract][Hide abstract] ABSTRACT: Studies have been done to characterize primary "urgent" health needs in displaced populations; few studies have explored specifically family planning (FP) needs.
To investigates the hypothesis that there exists an unmet need for FP among Iraqi nationals in Amman, Jordan.
Married Iraqi individuals attending seven nongovernmental organization clinics were asked a subset of survey questions to ascertain FP health needs and access.
16.1 percent (n = 76) of respondents reported need for FP services, of which 16 percent (n = 397) report having access to FP counseling, and 43 percent (n = 33) had access to contraceptives. After 30 years of age, need for FP decreased yearly 12 percent (OR = 0.88, CI = 0.84-0.92, p = 0.00). After one year of living in Amman, Jordan, the odds of needing FP services increases yearly 13 percent (OR = 1.13, CI = 1.05-1.22, p = 0.001). In addition, if the respondent has one or more children younger than 5 years in the same household, the odds of needing FP services increases by 85 percent (OR = 1.85, CI = 1.0-3.44, p = 0.05).
This study illustrates a clear unmet need in FP services among Iraqis in Amman, Jordan, especially among the long-term displaced.
American journal of disaster medicine 01/2008; 3(5):295-300.