Health Status of a Paediatric Urban Refugee and Immigrant Population in Canada

Abstract

Background: An increasing proportion of the paediatric Canadian population is foreign born. The often unique health issues and barriers to health care for this population are of rising importance for pediatricians, requiring continued emphasis on the evolving literature. Objective: To document the changing demographics and summarize the overall health status of children seen in a resident-led paediatric refugee and new immigrant clinic, affiliated with an urban settlement organization. Design: Retrospective chart review from September 2004 to September 2009, of all new immigrants, 0-20 years of age, who were seen for initial comprehensive screening assessment. Results: A total of 342 charts were reviewed: 94% were refugees with a mean age of 8.4 years and nearly equal gender distribution (males 55%, females 44%). More than half previously resided within a refugee camp prior to arrival in Canada and only 37 of these children arrived directly from their country of origin (transit times ranging from 5 days to 17 years). The most common countries of origin were Somalia (33%), Burma (16%) and Afghanistan (12%). Only 6% of patients spoke English or French as their first language. Major health issues identified were dental disease (51%) and inadequate immunizations (47%). 70% of patients had a nutritional deficiency (including iron and Vitamin D), with 19% and 20% of children measuring less than the 5th percentile for height and weight for age respectively. Ongoing psychosocial issues and moderate to severe developmental delays were also identified in 14% and 10% of patients respectively. Infectious diseases occurred in 91% of those with results: 48% of infections were do to intestinal infestations, where 35% of these had at least 1 pathogenic parasite. Skin infections were also present in 9% of children. Tuberculosis (3), malaria (2), syphilis (1), HIV (3), and hepatitis B (1) infections were also present but to a much lesser extent. Conclusions: There are many health issues affecting children newly arrived to Canada. While infectious diseases and immunizations are important from a public health perspective, we must not minimize the consequences of undiagnosed nutritional deficiencies, developmental delays, and psychosocial problems, as these have the potential to hinder successful integration into new schools and communities. Therefore, an understanding of these issues as well as initial targeted screening plan are valuable in ensuring that these children receive appropriate and timely care.