3 March 2012
We support the call of Patradoon-Ho and Ambler1 for universal post-arrival health screening for all refugee children arriving in Australia. We briefly outline our recent experience with paediatric refugee screening in Western Australia (WA) based on the frameworks outlined previously in the Journal of Paediatrics and Child Health.2–4 Earlier, more extensive data have also been described.5 The wide array of health concerns that may be encountered in this vulnerable population is highlighted.
Humanitarian refugees resettled in WA are offered free health screening through the central Humanitarian Entrant Health Service (HEHS) in Perth. Attendance is facilitated by settlement agencies and uptake approximates 90% (Dr A Thambiran, Medical Director HEHS, pers. comm., 2011). Children (<16 years) found to have medical and/or psychosocial concerns are then referred to the multidisciplinary Paediatric Refugee Health Clinic at Princess Margaret Hospital for Children. Since January 2012, all refugee children are also referred to school or community dental services through a new collaborative pathway.
A database review of 100 new referrals from 15 August to 19 December 2011 gives an insight into the complexity of issues identified through routine screening. The median age of children was 6.4 years (range 5 months–15 years). Almost all had evidence of nutritional deficiencies (Vitamin D insufficiency (<78 nMol/L) in 91%, iron deficiency in 15%). The majority had paediatrician-identified dental caries (58%). Infections were common: positive strongyloides serology in 20%, schistosomiasis in 10%, latent tuberculosis (TB) infection in 7%, active pulmonary TB in 1%, acute falciparum malaria in 4% and chronic hepatitis B infection in 3% of children. Half of these children (n = 51) experienced transit times of >5 years, 59% had experienced close family separation and 16% were held in detention before being granted refugee status. Symptoms of post-traumatic stress, nocturnal enuresis and language delay were identified in 10%, 12% and 6%, respectively. Two girls were identified as being at risk of female genital mutilation.
Advocating for universal post-arrival health screening for refugee children is warranted in order to avoid devastating outcomes such as described by Patradoon-Ho and Ambler.1 It should be an integral aspect of resettlement for families who have had limited exposure to preventative health care, flee areas of endemic infectious diseases and face multiple barriers to accessing health care on arrival. A similar case could be made for extending screening to children held in detention. A model involving comprehensive screening followed by referral to multidisciplinary paediatric services as required, such as that employed in WA, may be applicable to other States and Territories.