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Annals of Human Biology
ISSN: 0301-4460 (Print) 1464-5033 (Online) Journal homepage: http://www.tandfonline.com/loi/iahb20
Systematic health screening of refugees after
resettlement in recipient countries: a scoping
review
Anne Mette Fløe Hvass & Christian Wejse
To cite this article: Anne Mette Fløe Hvass & Christian Wejse (2017): Systematic health screening
of refugees after resettlement in recipient countries: a scoping review, Annals of Human Biology,
DOI: 10.1080/03014460.2017.1330897
To link to this article: http://dx.doi.org/10.1080/03014460.2017.1330897
Published online: 31 May 2017.
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REVIEW
Systematic health screening of refugees after resettlement in recipient countries:
a scoping review
Anne Mette Fløe Hvass
a
and Christian Wejse
a,b
a
Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark;
b
Department of Public Health, Center for Global Health,
Aarhus University, Aarhus, Denmark
ABSTRACT
Context: Health screening of refugees after settlement in a recipient country is an important tool to
find and treat diseases. Currently, there are no available reviews on refugee health screening after
resettlement.
Methods: A systematic literature search was conducted using the online Medical Literature Analysis
and Retrieval System (‘MEDLINE’) database. Data extraction and synthesis were performed according to
the PRISMA statement.
Results: The search retrieved 342 articles. Relevance screening was conducted on all abstracts/titles.
The final 53 studies included only original scientific articles on health screening of refugees conducted
after settlement in another country. The 53 studies were all from North America, Australia/New
Zealand and Europe. Because of differences in country policies, the screenings were conducted differ-
ently in the various locations. The studies demonstrated great variation in who was targeted for
screening and how screening was conducted. The disease most frequently screened for was tubercu-
losis; this was done in approximately half of the studies. Few studies included screening for mental
health and non-infectious diseases like diabetes and hypertension.
Conclusion: Health screening of refugees after resettlement is conducted according to varying local
policies and there are vast differences in which health conditions are covered in the screening and
whom the screening is available to.
ARTICLE HISTORY
Received 31 January 2017
Revised 7 April 2017
Accepted 10 May 2017
KEYWORDS
Refugee; refugee health;
screening; health screening
Introduction
Worldwide, 65.3 million people are currently forcibly dis-
placed from their homes because of war, violence or oppres-
sion. Nearly 21.3 million of these are refugees, over half of
whom are under the age of 18. Adding to this, 40.8 million
are internally displaced. Globally, 6% of the worlds displaced
people are hosted in Europe and 12% in the Americas
(UNHCR, 2015a,c,d). This refugee population is vulnerable to
communicable diseases, as they often come from countries
with a higher prevalence of infectious diseases, travel
through endemic areas and reside in crowded refugee
camps, where infections are easily spread. Also, non-commu-
nicable diseases, including mental diseases, are prevalent in
refugees, sometimes more than infectious diseases (Andersen
et al., 2016; Norredam et al., 2012,2014).
Screening is a possible tool to monitor diseases among
refugees; however, there are limited data on screening pro-
grammes in many countries receiving refugees. A survey
among national experts in 28 EU/EEA countries (K€
arki et al.,
2014) showed that only 16 countries had implemented
screening programmes. Guidelines have been implemented
in some countries, including immigration medical examina-
tions in Canada (Pottie et al., 2011), and several countries
offer health screening of children, regardless of their legal
status (Williams et al., 2016).
The WHO defines screening as the presumptive identifica-
tion of unrecognised disease or defects by means of tests,
examinations, or other procedures, that can be applied rap-
idly (WHO, n.d.). There is no general definition of what health
screenings of refugees should include and the concept is
interpreted differently in different parts of the world
(Leemreize et al., 2016). The terminology is also varied, as
some countries use the term ‘health assessment’, some
‘health screening’and others refer to it as a ‘medical
examination’.
Ensuring health screening of the refugee population also
increases equity, by levelling newly arrived refugees with the
background population in terms of prevention, understand-
ing and gaining access to healthcare.
To increase uniformity, screening strategies are made.
Several countries have operational systems ensuring screen-
ing for infectious diseases in specific populations. Screening
strategies may be cost-effective and reduce the burden of
disease caused by infections such as tuberculosis and hepa-
titis. Still it is being debated how, where and for whom
screening should be implemented to be most effective
(Pareek et al., 2011; Rossi et al., 2013). Screening strategies
may also be used as a tool to improve the situation of a vul-
nerable population and could be considered as part of rou-
tine healthcare in most of the immigrant sub-groups (Barnett
et al., 2013)
CONTACT Anne Mette F. Hvass anhvas@rm.dk Department of Infectious Diseases, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200
Aarhus N, Denmark
ß2017 Informa UK Limited, trading as Taylor & Francis Group
ANNALS OF HUMAN BIOLOGY, 2017
https://doi.org/10.1080/03014460.2017.1330897
A crucial part of being a refugee is to be recognised as a
refugee through the Refuge Status Determination (RSD). This
legal or administrative process is led by the United Nations
High Commissioner of Refugees (UNHCR) or a government to
determine whether a person (an asylum seeker) seeking
international protection is considered a refugee under inter-
national, regional or national law (UNHCR, n.d.). If the RSD
recognise the person as a refugee, he or she is a refugee
with legal refugee status (Table 1). This review only focuses
on refugees having obtained legal status as a refugee.
The merit of screening is closely linked to the availability
of disease-specific treatment programmes. This creates an
ethical dilemma if screening is done at a time when treat-
ment cannot be provided. Often, treatment is not possible
until the refugee has arrived in a new host country with a
functioning health system. In many countries, asylum seekers
(waiting for residence permits) only have limited access to
healthcare until receiving legal status as a refugee and
obtaining a residence permit. Acquiring legal status as a refu-
gee ensures access to health services equivalent to that of
the host population, stated by the 1951 refugee convention
(United Nations, 1951). Thus, screening after receiving legal
status as a refugee creates a better opportunity for screening
and for starting treatment.
Currently, no published reviews have evaluated the stud-
ies on refugee health screening programmes after resettle-
ment. This scoping review of health screening of resettled
refugees, was aimed to summarise the current literature on
health screenings implemented after resettlement, regarding
the content of the screenings and how they may differ across
countries. This is done to compliment previous disease-spe-
cific and geographically focused reviews in the field (Dang &
Tribble, 2014; Greenaway et al., 2015; Klinkenberg et al.,
2009), in order to provide information to practitioners,
researchers and decision-makers.
Health screenings performed before departure to a new
home country or before obtaining legal refugee status are
beyond the scope of this review.
Methods
The scoping review was conducted using the Arksey and
O’Malley (2005) framework. The main focus of the review was
health screening of newly-arrived refugees and, therefore,
only data concerning the screening process was extracted
from articles that included a variety of data on healthcare
assessments.
Data was extracted through a three-step selection process.
At the first step, we used PubMed to search the online
Medical Literature Analysis and Retrieval System (‘MEDLINE’)
database with a combination of the following search terms:
(‘Mass Screening’[Mesh terms] OR ‘Mass Screening’[All
fields]) AND (‘Refugees’[Mesh terms] OR ‘Asylum Seeker’[All
fields] OR ‘Asylum Seekers’[All fields] OR ‘refugee’[All fields]).
The MeSH Word ‘Mass Screening’also covers the entry term
‘Screening’and is defined as ‘Organised periodic procedures
performed on large groups of people for the purpose of
detecting disease’. The scope of the review was to find stud-
ies including participants with legal refugee status. The term
asylum seeker was added to the literature search to ensure
identifying studies categorised as regarding asylum seekers,
but actually including information on refugees.
The only limit applied was ‘(Humans’). We added no limit
regarding language, as screening programmes may be
regarded as country-specific and the papers may only be
available in the nation’s own language. We also performed a
manual search for references of published articles.
At the second step, titles and abstracts were reviewed
using pre-defined screening criteria. If the required informa-
tion was not available in the abstract, full text articles were
further reviewed to gather this information. At the third
step, an exclusion criterion was used to narrow the scope
of the research question, including only studies that con-
tained data on health screening studies after resettlement
in a new home country. Random sampling was made from
the excluded papers to validate the exclusion criteria
(Figure 1).
The heterogeneity in terms of study design, aim and out-
come measures of the included studies did not allow for a
meta-analysis. Instead the studies were reviewed systematic-
ally and presented under different sub-categories according
to the country of resettlement and the evidence of system-
atic health screening after settlement in a new country was
summarised and discussed.
Results
The literature search yielded 342 articles, which were
screened by title and abstract. Of these, 166 were excluded
because they were not studies on health screening of
Table 1. Definitions.
Term Definition Legal refugee status Reference
Internally Displaced People (IDP) IDPs have been forced to flee, but have not
crossed a border to find safety. Unlike refugees,
they are still in their native country.
No unhcr.org/internally-displaced-
people.html
Asylum seeker/Asylee/Refugee claimant Someone whose request for sanctuary has yet to
be processed.
No unhcr.org/asylum-seekers.html
ccrweb.ca/en/glossary
Refugee People fleeing conflict or persecution, who have
been granted refugee status from a government
or UNHCR. They are defined and protected by
international law.
Yes unhcr.org/refugees.html
Refugee recognised by UNHCR Refugees, granted refugee status under UNHCR
mandate.
Yes unhcr.org/4ce531e09.pdf
Government assisted refugee Canadian term. Refugees from Convention
Refugees Abroad Class, e.g. referred by UNHCR.
Yes cic.gc.ca/english/refugees/index.asp
2A. M. F. HVASS AND C. WEJSE
refugees, but letters, editorials, reviews, etc. The remaining
176 were assessed for eligibility, and hereof 123 did not
meet the inclusion criteria and were excluded. Fifty-three
articles met the criteria and contained data from cross-sec-
tional surveys. All the 53 papers were available in full-text
and were included in the review. Forty-nine papers were in
English, two in Danish and one in French.
Australia and New Zealand
Australia
We identified nine studies where Australia was the country
of resettlement (Chaves et al., 2009; Francis et al., 2012;
Hoad & Thambiran, 2012; Johnston et al., 2012; Kelly et al.,
2002; Marks et al., 2001; Martin & Mak, 2006; Nicol et al.,
2015; Paxton et al., 2012)(Table 2). The studies were con-
ducted between 2001–2015. The sample size varied from
100–24 625 refugees. In six studies, all refugees arriving
within a defined time span in a specific area were offered
a health screening. In two studies only refugees seeking
medical care were offered screening (for other conditions
than what brought them to the physician). One study did
not define who were offered screening. The refugees were
primarily from Asia, predominantly Burma. The studies
were heterogeneous in terms of diseases covered by the
screening; most studies screened for several diseases. In
seven studies refugees were screened for TB. Screening for
hepatitis and schistosomiasis was done in five studies.
Screening for STDs (Sexually Transmitted Diseases), malaria,
helminithes and vitamin D deficiency was done in four
studies. Screening for dental problems, anaemia and HIV
was done in two studies. PTSD, Helicobacter Pylori and
vitamin B12 deficiency were each addressed in one study.
Seven studies reported data on screening of adults and
seven reported data on screening of children—some stud-
ies screened both adults and children.
New Zealand
Two studies were conducted in New Zealand (Poole &
Galpin, 2011; Rungan et al., 2013)(Table 3). Both were cross-
sectional studies conducted in a refugee resettlement centre,
where refugees coming to New Zealand stayed for the first 6
weeks. One was a study of all refugees recognised by the
UNHCR arriving in New Zealand in 2008–2009 (750 refugees),
where all underwent a screening process concerning a his-
tory of torture. The other study was a retrospective audit on
the outcomes of health screening and referrals in 343 chil-
dren below 5 years of age. The children came from various
countries, with a majority (40%) coming from Myanmar. The
screening covered tuberculosis, hepatitis B, hepatitis C, HIV,
syphilis, parasites, helminithes, schistosomiasis, vaccination
status, anaemia and vitamin D deficiency, although not all
children were screened for all these diseases. All refugee chil-
dren arriving in New Zealand between 2007–2011 were
examined and included in the study, providing a participa-
tion rate of 100%.
Records idenfied through
database searching
(n = 325)
ScreeningIncluded Eligibility Identication
Addional records idenfied
through other sources
(n = 17)
Records aer duplicates removed
(n = 342)
Records screened
(n = 342)
Records excluded
(n = 166)
Full-text arcles assessed
for eligibility
(n = 176)
Full-text arcles excluded,
with reasons
(n = 123)
Studies included in
qualitave synthesis
(n = 53)
Studies included in
quantave synthesis
(meta-analysis)
(n = 0)
Figure 1. PRISMA flow diagram.
ANNALS OF HUMAN BIOLOGY 3
United States of America and Canada
United States of America
Twenty-nine cross-sectional studies were identified in which
the US was the country of resettlement (Buchwald et al.,
1995a,b; Catanzaro & Moser, 1982; Chai et al., 2013; Cuffe et al.,
2014; Entzel et al., 2003; Geltman et al., 2000,2001; Goldenring
et al., 1982; Huntington et al., 2010; Johnson-Agbakwu et al.,
2014; Lifson, 2002; LoBue & Moser, 2004; Maroushek et al.,
2005; Miller et al., 2000; Peterson et al., 2001; Proue et al.,
2010; Sarfaty et al., 1983; Savin et al, 2005; Scott et al., 2015;
Simpson et al., 2013; Stauffer et al., 2006; Sutherland et al.,
1983; Tobin et al., 2015; Trepka et al., 2005; Truong et al., 1995;
Ugwu et al., 2008; Yun et al., 2016; Zabel et al., 2008)(Table 4).
The screening of refugees arriving in the US consists of
two steps: The first step is before departure and the second
step is a voluntary screening after arrival in the US. As this
review focuses on screening after resettlement, only articles
including data from the second step (also referred to as ‘the
domestic screening’) were included.
In 16 of the 29 articles, the refugees came from various
countries and continents. Six studies only included data on ref-
ugees from Asian countries. One study consisted of refugees
from Central America and Mexico. In eight studies the refugees
came from the same country (Bosnia, Bhutan, Cuba, Somalia,
Liberia, Burma). Twenty-three studies included results from
children and nineteen studies included results from adults
(some both). One study did not specify the age of the refugees
screened.
In 22 studies, all refugees coming to the area of resettle-
ment were offered screening (‘domestic screening’). In four
studies only people seeking medical care were offered screen-
ing. Three studies did not define who was offered screening.
There were between 31–12 505 participants in the studies.
The participation rate varied between 10–100% and in 22
studies participation rate was not stated.
Of the 29 studies, 12 reported results for tuberculosis
screening and 11 reported results for parasite screening.
Eight different studies reported on screening for helminithes
and hepatitis. Seven studies screened for mental health prob-
lems/Post Traumatic Stress Disorder (PTSD), five studies for
anaemia and five studies for blood lead and vaccination sta-
tus. Four studies reported on malaria screening, two studies
on screening for HIV and STDs and only one study reported
on screening for schistosomiasis, vitamin D, vitamin B12 and
dental problems.
Canada
Five studies were conducted in Canada (Denburg et al., 2008;
Gyorkos, 1989;Pottieetal.,2007; Redditt & Graziano, 2015a,b)
(Table 5). Two of them were conducted on the same cohort of
1063 resettled refugees, who visited a primary care clinic
between 2011–2014. In this study, only patients seeking med-
ical care were offered screening and the screening tests per-
formed were not consistently offered to the entire population.
Both children and adults were examined. Patients were tested
forHIV,hepatitis,schistosomiasis,STDs,parasites,helminthes,
anaemia, diabetes and high blood pressure; moreover, a gen-
eral medical examination was performed. Testing for cervix can-
cer was offered to the women. The refugees originated from
Table 2. Studies where Australia was the country of resettlement.
Paper
Who was the screening
available to? Age Health provider
Screening for ID
and/or NCD n
Nicol et al. (2015) Refugees seeking medical
care (various reasons)
Children Paediatric hospital healthcare clinic NCD 105
Francis et al. (2012) Not defined Children Paediatric refugee health clinic NCD 100
Johnston et al. (2012) All newly-arrived
refugees
a
Children and adults Refugee Primary Health Care Service IDþNCD 187
Paxton et al. (2012) All newly-arrived
refugees
a
Children and adults General practitioner in primary care ID þNCD 1 136
Chaves el al. (2009) Refugees seeking medical
care (various reasons)
Adults Infectious Diseases Outpatient Clinic,
Tertiary Hospital/primary care
doctor
ID þNCD 156
Martin and Mak (2006) All newly-arrived
refugees
a
Adults and children Migrant health Unit (established by
The Department of Health)
ID 2 781
Kelly et al. (2002) All newly-arrived
refugees
a
Children and adults Emergency room physician in the air-
port/General Practitioner at refugee
reception centre
ID 1 863
Marks et al. (2001) All newly-arrived
refugees
a
Children and adults Refugee Screening Unit/Chest Clinic ID 24 652
Hoad and Thambiran (2012) All newly-arrived
refugees
a
Adults Clinic specialised in refugee health
(Government Program)
ID 2 610
ID: Infectious Diseases; NCD: Non-Communicable Diseases.
a
Arriving within a defined timespan in a given area.
Table 3. Studies where New Zealand was the country of resettlement.
Paper Who was the screening available to? Age Healthcare provider
Screening for ID
and/or NCD n
Poole and Galpin (2011) All newly-arrived refugees
a
Children and adults National Refugee Resettlement Centre NCD 750
Rungan et al. (2013) All newly-arrived refugees
a
Children National Refugee Resettlement Centre ID þNCD 343
ID: Infectious Diseases; NCD: Non Communicable Diseases.
a
Arriving within a defined timespan in a given area.
4A. M. F. HVASS AND C. WEJSE
various continents, primarily from Hungary, North Korea and
Nigeria.
In two studies the refugees underwent screening accord-
ing to a screening protocol ensuring all participants were
screened for the same diseases. In one study this included
testing 112 adult refugees for tuberculosis, HIV, hepatitis, par-
asites, vaccination status and cervix cancer. Most of the refu-
gees came from Sub-Saharan Africa. In the other 68, ‘Karen’
refugees from Myanmar (adults and children) were tested for
tuberculosis, HIV, hepatitis, parasites, vaccination status,
haemoglobin, vaccination status, syphilis (adults only) and
blood lead levels (children only).
The fifth study included information on screening 567
Southeast Asian refugees (adults and children) for parasites
and helminithes.
In these five studies, participation rate was unknown, as
the total number of refugees in the study area was not
stated in any of the papers.
Table 4. Studies where the US was the country of resettlement.
Paper
Who was the screening
available to? Age Healthcare provider
Screening for ID
and/or NCD n
Yun et al. (2016) All newly arrived refugees
a
Children Public Health Department/
Refugee Health Programme/
Department of Family and
Community Medicine
ID þNCD 8 148
Scott et al. (2015) All newly arrived refugees
a
Children and adults Health Department/Medical
University/Hospital
(Surveillance data)
ID 6 175
Johnson-Agbakwu et al. (2014) Refugees seeking medical
care (Obstetric and gynae-
cological care)
Adults Refugee Women’s Health Clinic NCD 112
Cuffe et al. (2014) All newly-arrived refugees
a
Adults County Clinic NCD 49
Tobin et al. (2015) Refugees seeking medical
care (Giving birth)
Adults Tertiary Medical Centre NCD 126
Simpson et al. (2013) All newly-arrived refugees
and immigrants
a
Children and adults Public Health Clinic from ID 541
Chai et al. (2013) All newly-arrived refugees
a
Children and adults Health Department ID 781
Proue et al. (2010) All newly-arrived refugees
a
Children Health Department/Refugee
Health Programme
NCD 1 256
Huntington et al. (2010) All newly-arrived refugees
a
Children and adults Community Health Centre NCD 157
Zabel et al. (2008) All newly-arrived refugees
a
Children Refugee Health Clinic. NCD 150
Ugwu et al. (2008) All newly-arrived refugees
a
Children and adults Health Department ID 12 505
Stauffer et al. (2006) Not defined Children and adults Refugee Health Clinic ID 103
Savin et al. (2005) All newly-arrived refugees
a
Children and adults University Departments of
Family Medicine and
Psychiatry/State Department
of Public Health and
Environment
NCD 1 580
Maroushek et al. (2005) All newly-arrived refugees
a
Children Paediatric Clinic at County
Medical Centre
ID 57
Trepka et al. (2005) All newly-arrived refugees
a
Children Refugee Health Assessment
Centre
NCD 479
LoBue and Moser (2004) All newly-arrived refugees
a
Children and adults Local public health department ID 571
Entzel et al. (2003) All newly-arrived refugees
a
Children Refugee Health Assessment
Centre
ID þNCD 881
Lifson (2002) All newly-arrived refugees
a
Children and adults Public Health Clinic/Private
Provider/Clinic
ID 2 545
Geltman et al. (2001) All newly-arrived refugees
a
Children ‘Clinical Sites’of a Refugee
Health Assessment Program/
Public Health Department
ID þNCD 1 825
Peterson et al. (2001) Not defined Undefined Not defined (laboratory surveil-
lance of samples from screen-
ing programmes)
ID 4 695
Geltman et al. (2000) All newly-arrived refugees
a
Children International Clinic at Medical
Centre
NCD 31
Miller et al. (2000) All newly-arrived refugees
a
Children and adults International Organisation for
Migration ‘IOM’
ID 390
Buchwald et al. (1995a) Refugees seeking medical
care (gastrointestinal
symptoms)
Children and adults Refugee Clinic at Medical Centre ID 201
Buchwald et al. (1995b) All newly-arrived refugees
a
Adults Refugee Health Clinic NCD 1 998
Truong et al. (1995) All newly-arrived refugees
a
Adults Public TB Clinic ID 191
Sarfaty et al. (1983) Refugees seeking medical
care (various reasons)
Children Health Centre ID 96
Sutherland et al. (1983) All newly-arrived refugees
a
Children and adults Multi-specialty HealthCare Clinic ID þNCD 426
Goldenring et al. (1982) All newly-arrived refugees
a
Children and adults Indochinese Health Screening
Clinic
ID þNCD 623
Catanzaro and Moser (1982) Not defined Children and adults Centre for Indochinese Health
Education/University/Medical
Centre
ID þNCD 709
ID: Infectious Diseases; NCD: Non-Communicable Diseases.
a
Arriving within a defined timespan in a given area.
ANNALS OF HUMAN BIOLOGY 5
Europe
Eight studies were conducted in Europe: one in Ireland
(Murphy et al., 1994), one in Sweden (Persson & Rombo,
1994), one in Italy (Sa~
n
e Schepisi et al., 2013), two in
Germany (B€
ottcher et al., 2015; Mockenhaupt et al., 2016)
and three in Denmark (Hansen et al., 2000; Kristensen &
Mandrup, 2005; Wilcke et al., 1998)(Table 6). All the studies
were conducted between 1994–2016.
In four studies, all participants arriving in an area within a
defined timespan were offered screening. In one study only
unaccompanied minor refugees were offered screening. In
one study refugees presenting with a medical condition at a
free primary healthcare centre were offered a screening test.
In one study the study population consisted of all who sent
in a faeces sample as part of a surveillance study. One study
did not state how the participants were selected. Six studies
included both children and adults. One study only presented
data on children and one only on adults.
Screening for helminithes, dental problems and tubercu-
losis was reported in three studies each. In two studies,
screening was performed for hepatitis, parasites and
anaemia, moreover a general medical examination was per-
formed. Vitamin D deficiency, gynaecological examination,
hypertension, mental health, STDs, schistosomiasis, MRSA and
HIV screening were included in one study each.
In two studies the participants came from Syria; in each of
three studies, the participants came from Bosnia, Vietnam
and Kosovo/Albania, respectively. In the remaining three
studies the population consisted of refugees from various
countries.
The number of participants varied from 50–3938. The par-
ticipation rate was only stated in two studies: 100% in one
and 1.6% in the other.
Discussion
Screening of refugees at resettlement was rarely conducted
as a systematic public health intervention, but was most
often part of limited projects and with large variation in con-
tent. We found literature on health screening after resettle-
ment from three different continents, Europe, North America
and Australia/New Zealand. All of these are categorised as
developed countries and frequent destinations for refugees
escaping war, violence and oppression in developing coun-
tries (UNHCR, 2015b). The refugee populations were mainly
from Asia, Africa and the Middle East.
We found that, in spite of the heterogeneity, many of the
studies included screening for the same diseases. Almost half
of the studies included screening for tuberculosis and
approximately a third of the studies included screening for
Table 6. Studies where Europe was the area of resettlement.
Paper
Who was the screening avail-
able to? Age Healthcare provider
Screening for ID
and/or NCD n
Murphy et al. (1994) All newly-arrived refugees
a
Children and adults General practitioner ID þNCD 187
Persson and Rombo (1994) All newly-arrived refugees
a
Children and adults Refugee and Asylum
Seeker Health
Assessment Centre
ID 3938
Wilcke et al. (1998) All newly-arrived Vietnamese
refugees
a
Children and adults Infectious Disease
Department at
University Hospital
ID 1936
Hansen et al. (2000) Not defined Children and adults District Hospital ID 50
Kristensen and Mandrup (2005) All newly-arrived refugees
a
Children and adults General Practitioner ID þNCD 55
Sa~
n
e Schepisi et al. (2013) Refugees, asylum seekers and
migrants seeking medical
care (Various reasons)
Adults Free Primary Care Centres ID 3350
B€
ottcher et al. (2015) Refugees and asylum seekers
(Not further defined)
Children and adults Asylum Seeker Reception
Centres and Public
Health Departments
ID 629
Mockenhaupt et al. (2016) All unaccompanied minor
refugees
a
Children GeoSentinel Site ID þNCD 488
ID: Infectious Diseases; NCD: Non-Communicable Diseases.
a
Arriving within a defined timespan in a given area.
Table 5. Studies where Canada was the country of resettlement.
Paper
Who was the screening avail-
able to? Age Healthcare provider
Screening for ID
and/or NCD n
Redditt and Graziano (2015a,b) Refugees seeking medical
care (various reasons)
Children and adults Specialised primary care clinic
for refugees
ID 1063
Redditt and Graziano (2015a,b) Refugees seeking medical
care (various reasons)
Children and adults Specialised primary care clinic
for refugees
NCD 1063
Pottie et al. (2007) All newly-arrived refugees
a
Adults Immigrant Health Clini.
(Family medicine centre)
ID þNCD 112
Denburg et al. (2008) All newly-arrived Karen (from
Myanmar) refugees
a
Children and adults Primary care physicians/
Public Health Service/
Refugee reception Centre
ID þNCD 68
Gyorkos (1989) Not defined Children and adults General Hospital ID 567
ID: Infectious Diseases; NCD: Non-Communicable Diseases.
a
Arriving within a defined timespan in a given area.
6A. M. F. HVASS AND C. WEJSE
hepatitis, parasites, helminithes and anaemia. Generally, there
was a large proportion of studies focusing on infectious dis-
eases. Only eight (15%) studies included screening for mental
health.
Few of the studies included screening for chronic diseases,
although this is also a significant problem in refugee popula-
tions (Andersen et al., 2016; Doocy et al., 2015). Only two of
the studies screened for hypertension. The overwhelming
focus on communicable diseases may reflect that a key
incitement for implementing refugee screening programmes
may be a concern in the spread of infectious diseases to the
host country population, rather than an initiative to improve
the health status in the refugee populations.
There are considerable differences in the organisation of
refugee screening programmes. The same refugee population
from a certain country can be offered very different health
screening programmes in their resettlement country, as these
depend on the policy of the receiving country and not
necessarily on the need of the individual. Some studies only
performed screening during a certain time span, so the time
of arrival in a new country may also affect who is screened
and which tests are offered.
In the US, the official Refugee Resettlement guideline sug-
gests a ‘domestic screening’of refugees within the first
90 days after arrival. This is in addition to the medical exam-
ination performed overseas before they are allowed entry to
the US. Arrivals from endemic areas of infectious diseases
undergo specific screening (Centers for Disease Control and
Prevention, 2012). In New Zealand, refugees spend their first
6 weeks in a resettlement centre where medical screening is
part of the programme (Immigration New Zealand, 2016). In
both these programmes the refugees have a residence per-
mit before entering the country. In the European countries,
most refugees travel to their new home country and wait for
a possible residence permit in an asylum centre (The Danish
Immigration service, 2016). Because of the differences in how
refugee screening is organised, it is difficult to compare find-
ings from different countries.
In many of the studies the participation rate was not
stated. This might be due to health facilities not knowing the
total number of refugees arriving in an area during the study
time. When the total number of the target population is
unknown it is difficult to interpret the findings, as it is
unknown if the screened refugees are more or less healthy
than the ones who did not participate.
The current study has some limitations. First, the defini-
tions of refugees vary in different parts of the world and we
may have missed studies where refugees have been termed
as migrants instead. The term migrant is, according to the
UNHCR, used to refer to people who leave their home coun-
try by choice and was, therefore, not included in the litera-
ture search (UNHCR & Edwards, 2015). There may be studies
using another definition, where studies on refugees have
been labelled as studies on migrants and, therefore, have not
been included in this review.
Finally, only the PubMed database was used for the litera-
ture search, which may not cover all studies on the topic,
even though this is the most acknowledged database in
medical science.
Countries may have more extensive screening pro-
grammes than described in this scoping review, as this
review only covers the published scientific literature in this
field.
In conclusion, we have mapped the current literature on
health screening of refugees after resettlement in a scoping
review.
The available literature shows that policies in the
various countries differ considerably, and this has provided
different settings to do studies on the population of newly
resettled refugees. There are also considerable variations in
how the term ‘screening’is perceived in the different stud-
ies/countries. Therefore, the studies cannot be directly com-
pared, but there are tendencies to screen for the same
diseases across borders and continents. Generally, we
observed a tendency to focus on infectious diseases in the
studies and limited attention to mental disorders. Further
research is needed on health screening of the current refu-
gee population regarding infectious diseases, non-infectious
diseases and mental health. An international consensus on
how to perform and report studies on health screening in
refugee populations where attention to non-communicable
diseases is increased, including reporting of non-participating
populations, would significantly increase the impact of future
studies to the benefit of both host countries and refugees
worldwide.
Disclosure statement
The authors report no conflicts of interest. The authors alone are respon-
sible for the content and writing of the paper.
Acknowledgements
This research was supported by Kerrn-Jespersen Fonden (Kerrn-Jespersen
Foundation), Folkesundhed I Midten, Aarhus Municipality department of
Social Medicine and ESGITM (ESCMID Study Group for Infections in
Travellers and Migrants).
ORCID
Anne Mette Fløe Hvass http://orcid.org/0000-0002-2874-9852
Christian Wejse http://orcid.org/0000-0002-2534-2942
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