Launch of new priority area: Oral health for refugees and asylum-seekers

 

Authored by: Jan Clarkson, Mary Macdonald, Rebecca Harris, Mark Keboa, Abirami Kirubarajan and Lara Hollmann

According to the United Nations Refugee Agency, by the end of 2017, the number of forcibly displaced individuals worldwide had reached over 68.5 million.¹ This number has increased over the last decade. Many refugee and asylum-seekers arrive to their country of destination without access to proper healthcare or sanitation. The health priorities of refugee and asylum-seekers include mental health needs, skin diseases, and infections — these concerns are complicated by the social determinants of refugee health, which include missing medical records, delayed access to care, and often mistrust of the medical system.

As a response, many host countries have shifted their policy priorities to better meet the needs of their refugee population. Research and evidence-informed guidelines have also been published to better address primary care, such as the articles , such as the articles published in Evidence Aid’s own evidence collection on refugee and asylum-seekers’ health.

However, many healthcare practitioners and policymakers are unaware of the importance of oral health for refugees and asylum-seekers. Many refugees, especially refugee children, have not had access to dental care for many years, have never had tooth-brushing education, and have suffered fractured teeth, tooth decay and dental abscesses. In many host countries, dental care may be relatively expensive and difficult to access, even for people who are not refugees.² Additional concerns for refugees include difficulty navigating the dental system, language barriers, and limited finances to access care. Dental care is also sometimes affected by cultural practices and beliefs, such as the fear related to tooth extractions, routine extraction of anterior teeth in home countries, or practices such as brushing with a stick rather than a toothbrush.² It is important for healthcare providers to be better aware of these practices in order to better address any misconceptions or answer any questions.

Poor oral health can negatively affect quality of life, cause pain disrupting sleep and the ability to learn at school, and work. It is also now thought to increase the risk of chronic diseases, such as diabetes and cardiovascular disease.³

While oral health for refugee claimants has been consistently noted as an area of concern, there is little literature on the topic.

Here at Evidence Aid, the Refugee Collection team has expanded our five existing priority areas (common mental health disorders, vaccine-preventable diseases, skin conditions, tuberculosis, sexual and physical violence) to include the new priority area of Oral Health for refugee and asylum seekers. Our team assembled a group of oral health experts in order to systematically search the literature for publications relevant to refugee oral health. These experts include Professor Rebecca Harris from University of Liverpool, Professor Jan Clarkson from the Cochrane Oral Health Group, and Dr. Mark Keboa and Dr. Mary Ellen Macdonald from McGill University.

As of January 2019, we have identified four key systematic/scoping reviews (Keboa 2016, Riggs 2017, Reza 2016, Abuhaloob 2018), as well as Dr. Kevin Pottie’s Evidence-informed clinical guidelines for immigrants and refugees, published in 2011.^2,4-7 Each article has been summarized for ease of access, along with a relevant tag and classification.

An Oral Health priority area has officially been launched on the Evidence Aid website, available here. Please do not hesitate to contact us if you have any questions about the priority area, or if you would like to assist our initiative in any way.

About the authors:

Professor Jan Clarkson: Jan Clarkson graduated from the University of Newcastle upon Tyne in 1987 and after 10 years at the University of Manchester, she entered the Specialist List for Paediatric Dentistry and joined the Dental Health Services Research Unit at the University of Dundee. Since 1998 she has been the Effective Dental Practice Programme Director. She is a founding member of the Cochrane Oral Health Group and her role as Joint Co-Ordinating Editor has influenced her research activity. Jan is Director of the Scottish Dental Practice Based Research Network. As Lead for Clinical Effectiveness, she is responsible for the development, production and dissemination of guidance in priority areas for dentistry in Scotland and her research focuses on the translation of evidence into practice.

Dr. Mary Macdonald: Mary Ellen (PhD: Medical Anthropology) is an Associate Professor in the Faculty of Dentistry at McGill University. Her research program focuses on the health of vulnerable populations in Canada, looking across three main domains: oral health, Indigenous health, and palliative care.

Professor Rebecca Harris: Rebecca Harris is Professor of Dental Public Health and Dean of the Institute of Population Health Services at the University of Liverpool, UK. She has a long standing interest in refugee health since her PhD on Vietnamese refugee oral health and their attitudes and cultural beliefs about dentistry and experience of the provision of dental services in refugee camps at the Thai-Cambodian border.

Dr. Mark Keboa: Dr. Mark Keboa is a post-doctoral researcher at the McGill Faculty of Dentistry, Montreal, Canada. He holds a PhD in Craniofacial Health Sciences, with focus on population health. Prior to joining McGill, he obtained a Masters in International Health and Diploma in Tropical Medicine and Public Health from Germany. After his dental training in Nigeria, Mark worked as a dental surgeon and freelance public health consultant in Cameroon for over a decade. He combines expertise in qualitative, quantitative, and mixed methodologies to conduct research aimed at improving access and quality of health care for vulnerable populations.

Abirami Kirubarajan: Abi is the Co-ordinator of the Evidence Aid Refugee Health Collection. Her work at Evidence Aid started as an internship as part of the Queen Elizabeth II Scholarship in Strengthening Health Systems from McMaster University. Abirami is currently an MD student at the University of Toronto Faculty of Medicine in Canada, in addition to pursuing her MSc. in Systems Leadership and Innovation at the Institute of Health Policy, Management, and Evaluation.

Lara Hollmann: Lara started to volunteer for the Evidence Aid Refugee Health Collection in late 2017. She is currently pursuing a MSc in Global Health degree at the University of Copenhagen Faculty of Health and Medical Science in Denmark.

 

References

1. http://www.unhcr.org/globaltrends2017/
2. Keboa MT, Hiles N, Macdonald ME. The oral health of refugees and asylum seekers: a scoping review. Globalization and health. 2016 Dec;12(1):59.
3. Selwitz RH, Ismail AI, Pitts NB. Dental caries. The Lancet. 2007 Jan 6;369(9555):51-9.
4. Riggs, E., Rajan, S., Casey, S., & Kilpatrick, N. (2017). Refugee child oral health. Oral diseases, 23(3), 292-299.
5. Reza M, Amin MS, Sgro A, Abdelaziz A, Ito D, Main P, Azarpazhooh A. Oral health status of immigrant and refugee children in North America: a scoping review. J Can Dent Assoc. 2016;82(g3):1488-2159.
6. Abuhaloob, L., Carson, S., Richards, D., & Freeman, R. (2018). Community-based nutrition intervention to promote oral health and restore healthy body weight in refugee children: a scoping review. Community dental health, 35(2), 81-88.
7. Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer LJ, Ueffing E, MacDonald NE, Hassan G. Evidence-based clinical guidelines for immigrants and refugees. Canadian Medical Association Journal. 2011 Jan 1:cmaj-090313.