Article

The burden of Europe's immigration crisis on mother‐child healthcare services and opportunities for culturally sensitive family‐centred care

Article

The burden of Europe's immigration crisis on mother‐child healthcare services and opportunities for culturally sensitive family‐centred care

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Abstract

Europe is facing an immigration crisis, as more than five million immigrant children each year are coming from other countries to the Mediterranean area. These children represented just under a third of the first‐time asylum seekers in 2015 and they were searching for asylum for a number of reasons. These included safety from exploitation and abuse, better living conditions, economic opportunities and family reunification. Sometimes there was more than one reason.

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... Many surveys have highlighted how few parents receive anticipatory guidance [15,[25][26][27][28][29][30][31]. Parents with high education level have easier access to primary care, receive more advice, and ask the doctor for more information [25,28], while families with less social support and who are more deprived (for example, newly arrived immigrants in Italy) often receive less advice and almost certainly have less access to understandable anticipatory guidance for developmental milestones [32]. Written advice is a useful tool for families [27] but may have some disadvantages related to parents' literacy and health literacy [33,34]. ...
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Background Children of immigrants in Denmark have excess risk for some of the most well-established risk factors for cerebral palsy (CP). Objectives To study differences in risk of CP between children of immigrants and children of Danish-born mothers, and explore whether socioeconomic status drives any potential association. Methods A register-based cohort study including 1,274,616 children born in Denmark between 1981 and 2007. Of these, 2807 had a validated CP diagnosis in the Danish CP Register. We estimated the risk of CP as odds ratios (OR) using logistic regression and assessed mediation through socioeconomic status using natural effect models. Results In children of Danish-born mothers, 2.2/1000 had CP overall and the prevalence was similar for children of immigrants. However, children of immigrants had lower risk of unilateral spastic CP than children of Danish native-born mothers; OR = 0.59 (95% CI:0.38–0.91) for Western and OR = 0.79 (95% CI:0.61–1.03) for Non-Western immigrants. By contrast, the risk of bilateral spastic CP was higher in children of Non-Western immigrants (OR = 1.27 (95% CI:1.05–1.53)), especially from Turkey and Pakistan compared with children of Danish native-born mothers. The mediation analysis revealed an indirect effect (through maternal educational level and household income) with an OR of 1.06 (95% CI:0.99–1.14) for children of Non-Western immigrants. Conclusions While children of immigrants had lower risk of unilateral spastic CP than children of Danish-born mothers, the risk of bilateral spastic CP was increased in children of Non-Western immigrants. Socioeconomic status did not appear to be a significant contributor to the increased risk of bilateral spastic CP.
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Introduction The proportion of births by immigrants has been increasing rapidly in Denmark during the last decades. Children of immigrants have higher risk of being born preterm and with low birth weight, which are strong determinants for cerebral palsy (CP), compared with children born to Danish women. Objective To investigate differences in risk of CP between children of Danish-born mothers and children of immigrants and to explore to what degree socioeconomic status mediates the potential association between maternal immigrant status and CP. Method We conducted a register-based study including 1,274,653 children born in Denmark between 1981 and 2007 of whom 2807 had CP (2.2 per 1000). Mothers’ country of origin derived from nationwide registers was used to determine the mothers’ immigrant status. Children with CP were identified by linkage with the Danish National Cerebral Palsy Registry that includes all pre- and perinatal acquired CP cases that have been validated by neuro-pediatricians at age one to six years. Odds ratios (OR) of CP according to maternal immigrant status were estimated by using multiple logistic regression. We studied whether a potential association was explained by maternal educational level or household income by performing mediation analysis applying a counterfactual approach. Results In this study, 141,540 (11.1%) were immigrants; 3.5% from Western and 7.6% Non-Western countries. Children of immigrants from Western and Non-Western countries had lower risk of unilateral spastic CP than children of Danish mothers; OR = 0.6 (95% VI: 0.4–0.9) and OR = 0.8 (95% CI: 0.6–1.0), respectively. Children of Non-Western immigrants had higher risk of bilateral spastic CP compared with children of Danish mothers; OR = 1.3 (95% CI: 1.1–1.5), and it was the Turkish (OR = 1.7 (95%CI: 1.2–2.4) and Pakistani (OR = 1.7 (95% CI: 1.0–2.9) immigrants that accounted for the increased risk. Results from mediation analysis indicated that the association between maternal immigrant status and bilateral spastic CP was not mediated by socioeconomic status. Due to insufficient statistical power, the mediation analysis was not applicable for unilateral spastic CP. Conclusion Our results show that the risk of CP in children born in Denmark between 1981 and 2007 differed according to maternal country of origin. The higher risk of bilateral spastic CP in children of Non-Western immigrants, in particular Turkish and Pakistani, does not seem to be explained by inequality in education or household income. Future research should investigate whether the increased risk is caused by consanguineous parenthood, lifestyle factors, or suboptimal prenatal and obstetric care for immigrants.
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