All Somali refugees referred for resettlement to the United States are required to be evaluated, and treated if necessary, for TB before coming to the United States. CDC provides the technical oversight and training for all panel physicians, regardless of affiliation. Depending on the country of processing, PDMS is conducted approximately 2 weeks before departure for the United States for refugees previously diagnosed with a Class B1 TB, pulmonary condition abnormal chest x-ray with negative sputum TB smears and cultures, or pulmonary TB diagnosed by panel physician and treated by directly observed therapy.
The screening includes a medical history and repeat physical exam. This screening primarily focuses on TB signs and symptoms, and includes a chest x-ray and sputum collection for sputum TB smears if required. Depending on the country of processing, refugees with other chronic or complex medical conditions may receive pre-departure evaluation to assess fitness for travel.
PECs are conducted to determine fitness for travel, and to administer presumptive therapy for intestinal parasites and malaria. In addition to vaccines received through national immunization programs and NGO vaccination campaigns, Somali refugees are likely to receive vaccines as part of the voluntary Vaccination Program for US-bound Refugees. Depending on age, vaccine availability, and other factors, refugees may receive vaccines to protect against hepatitis B, rotavirus, Haemophilus influenzae type b, pneumococcal disease, diphtheria, pertussis, tetanus, polio, measles, mumps, and rubella.
Hepatitis B surface antigen testing is conducted for refugees receiving hepatitis B vaccine, and positive results are documented on the DS forms. Those with hepatitis B infection require follow-up after arrival in the United States. For those without infection, the hepatitis B vaccine series is usually initiated before departure, and vaccination should be completed after arrival, according to an acceptable ACIP schedule.
All vaccines administered through the Vaccination Program for US-bound Refugees, as well as records of historical prior vaccines provided by NGOs and national programs, are documented on the DS Vaccination Documentation Worksheet form.
Additional information regarding presumptive therapy for parasitic infections can be found here. CDC recommends that refugees receive a post-arrival medical screening domestic medical examination within 30 days of arrival in the United States.
The purpose of these comprehensive examinations is to identify conditions for which refugees may not have been screened during their overseas medical examinations and to introduce refugees to the U. CDC provides guidelines and recommendations for the domestic medical examination of newly arrived refugees. State refugee health programs determine who conducts the examinations within their jurisdictions.
Screening examinations may be performed by health department personnel, private physicians, or federally qualified health centers. Most state health departments collect data from the domestic screening. Among 1, adult refugee patients screened in Washington State, HBV infection prevalence was substantially higher among Somali speakers Additionally, researchers found that the majority of cases were in children over 5 years of age, likely reflecting increasing childhood vaccination rates Among Somali Bantu refugees residing in Kakuma, Kenya, 0.
Somalia and countries where Somali refugees are being processed for resettlement to the United States have a high TB burden. Depending on the country, between 1.
Table 1 describes, in detail, the TB burden in Somalia and key countries of asylum for Somali refugees. For additional information regarding TB burden estimates and data in Somalia or countries where Somali refugees have sought asylum or are being processed, please see the WHO Tuberculosis Country Profiles external icon. Before departing for the United States, all refugees are screened for TB and receive treatment, if necessary.
As part of the recommended domestic medical screening, newly arrived refugees are also screened for TB. Overall, the prevalence of active TB disease diagnosed during the domestic medical screening has decreased since and has remained below 1.
Clinicians should approach TB diagnosis with sensitivity and confidentiality. Individuals who have been diagnosed with active TB disease often face a lifetime of stigma, even after successful treatment completion. Standard antibiotic treatments for TB are often combined with traditional remedies, as well as prayer Intestinal parasites are a concern for many recently arrived refugees, including Somali refugees.
Soil-transmitted infections ascariasis, trichuriasis, and hookworm are common among refugees, and most refugees receive presumptive albendazole treatment prior to departure. Strongyloidiasis and schistosomiasis are of particular concern due to high prevalence, risk of morbidity and mortality, and long latency or infection periods. Before arrival in the United States, most Somali refugees receive presumptive treatment for Strongyloides ivermectin and schistosomiasis praziquantel. Somali refugees who have lived in or are departing from areas endemic for Loa loa external icon do not receive ivermectin before departure, due to risk of encephalopathy.
However, most Somali refugees receive ivermectin, as Somalia and most countries where Somali refugees are processed are not endemic for Loa loa. Similarly, there was a noticeable decrease in schistosomiasis prevalence after arrival. Among Somali refugees, the most common clinical presentation for schistosomiasis is asymptomatic hematuria, either gross or microscopic. However, schistosomiasis can cause a broad range of signs and symptoms. Schistosomiasis should be considered in any individual of Somali descent who has lived in or visited endemic areas and presents with, or is found to have, hematuria or any unexplained symptoms Malaria is endemic in the Horn of Africa, including southern Somalia and in countries where Somali refugees are being processed for resettlement.
However, prevalence among new arrivals is very low. Non-communicable diseases NCDs are becoming increasingly common among refugees, including Somalis, resettled to the United States. Behavioral health diagnoses, such as depression and PTSD Additionally, more than half of all adult refugees were overweight or obese Among Somali patients, researchers reported a high prevalence of cardiovascular risk factors, with a significantly higher prevalence of diabetes mellitus It is likely that changes in diet and physical activity related to migration and assimilation contribute to the high prevalence of obesity, diabetes mellitus, and cardiovascular risk factors among Somali immigrants and refugees Anemia is common among Somali refugee children, and can be caused by iron deficiency, parasitic infections, thalassemias, and hemoglobinopathies In a study of refugee children resettled to Colorado, Philadelphia Pennsylvania , Minnesota, and Washington State from to , In this study population, anemia was prevalent in both male Domestic screening results from Minnesota also indicate a high prevalence of anemia among Somali refugees of all ages.
From to , 9, male Somali refugees and 9, female Somali refugees were screened for anemia. Lead exposure and elevated blood lead levels are a concern among Somali refugee children, both before and after resettlement. Prior to arrival in the US, refugees may have been exposed cottage industries that use lead in an unsafe manner, and lead-containing products such as herbal remedies, cosmetics, or spices 50 , In the US, refugees, including Somali refugees, often live in substandard housing, where environmental lead may be encountered.
Additionally, imported cosmetics, candies, and herbal remedies may contain lead. Within 3—6 months of resettlement, a follow-up blood lead test should be conducted on all refugee children aged 6 months—6 years of age, regardless of the initial screening BLL result. Complete lead screening recommendations for refugee children, and information on potential lead exposures, are provided in the CDC Lead Screening during the Domestic Medical Examination for Newly Arrived Refugees.
For additional information on lead poisoning and prevention, see the CDC Lead website. Malnutrition is common in Somali refugees, especially children, due to lack of nutritious food. Among children measuring to cm in height, 9. Table 4 outlines the nutritional status of Somali refugee children under 5 years of age, as well as children between 5 and10 years of age, before resettlement. Overall, Somali refugee children have a significantly higher prevalence of wasting and stunting, and lower prevalence of obesity, than low-income children in Washington State Mental health issues may be common in Somali refugees being resettled in the United States.
In a community-based cross-sectional survey of adult refugees in Melkadida refugee camp in Southeast Ethiopia, more than one third Researchers also found that displacement as a refugee, lack of secure housing, witnessing the murder of family or friends, and other traumatic events were significantly associated with depression among camp residents Mental health issues continue to be a challenge for Somali refugees after resettlement.
However, religiosity was found to be protective among older Somali refugees, with war trauma not associated with high levels of PTSD Immunization is generally well received by refugee groups, including Somalis.
In recent years, some Somali community members in the United States have expressed concern about the disproportionately high number of Somali children enrolled in early childhood special education programs for autism. Community members were drawn to information promoting the misconception that autism was linked to the MMR vaccine.
Additionally, anti-vaccine proponents reached out directly to the Somali community, bolstering fears that MMR vaccine caused autism, and encouraging Somali parents to refuse vaccination. More recently, coverage rates have begun to improve, and the majority of new Somali arrivals support MMR vaccination In early , Minnesota health officials reported an outbreak of measles in the Minneapolis-St.
Paul metropolitan area. As of August , Minnesota had recorded 79 confirmed measles cases. Clinicians who administer childhood vaccines should be respectful of parent concerns, and should approach discussions about immunization with cultural humility and empathy Clinicians should also be aware that vaccination decisions may be made outside a clinical setting. Somali parents may be influenced by community members, including persons they may not know personally but who belong to and identify with the local Somali community.
Clinicians should aim to build trust with patients and their families, as well as build relationships with leaders in the Somali community The domestic medical screening allows clinicians to identify individuals who may require additional or specialty care. From to , 19, referrals were given to Somali patients Table 5 Most often, referrals to public health nursing were related to the management of LTBI Skip directly to site content Skip directly to page options Skip directly to A-Z link.
Immigrant, Refugee, and Migrant Health. Section Navigation. Facebook Twitter LinkedIn Syndicate. Somali Refugee Health Profile. Minus Related Pages. On This Page. Priority Health Conditions Somali refugees have been resettled for many years in communities across the United States. Background After gaining independence from Italy and Great Britain in , Somalia was a stable nation. Somalia is a coastal nation, bordering Djibouti, Ethiopia, and Kenya. Close Somalia is a coastal nation, bordering Djibouti, Ethiopia, and Kenya.
Ethnic Groups Ethnic Somalis are unified by culture, language, religion Islam , and common Samaale ancestry. Clan Structure Ethnic groups in Somalia can be further divided into clans.
Language Somali is the primary official language. Education and Literacy Civil war resulted in a complete breakdown of the formal education system in Somalia. Religious Beliefs The provisional federal constitution of Somalia recognizes Islam as the state religion and requires that all laws must comply with the general principles of sharia Family and Kinship Somali society tends to be patriarchal, and men and women are generally separated in most spheres of life.
Tips for Clinicians The majority of Somalis, particularly those who have lived in urban areas, have had some experience with Western medicine. Additional Resources For more information about the orientation, resettlement, and adjustment of Somali and Somali Bantu refugees, please visit EthnoMed external icon.
Top of Page. Healthcare Access and Health Concerns Nonprofit organizations often provide health services to Somali refugees living in refugee camps and urban areas. Immunizations Some Somalis may have been vaccinated prior to displacement through national immunization campaigns. Adaptation of an acculturation scale for African refugee women. J Immigr Minor Health Feb;18 1 — Mental health screening among newly arrived refugees seeking routine obstetric and gynecologic care.
Psychol Serv Nov;11 4 —6. Perceptions of obstetrical interventions and female genital cutting: insights of men in a Somali refugee community. Ethn Health Aug;19 4 — Obstet Gynecol Int ; Seven things to know about female genital surgeries in Africa. Hastings Cent Rep. Basra Mohamud Hire's son-in-law, Abdikadir, helps her walk on ice outside her home in St. Cloud, Minnesota. She relocated to St. Cloud, a city about 60 miles outside Minneapolis, from a refugee camp in the desert of northeast Kenya.
Nazaryan traveled to Minneapolis after a former contact introduced him to a young Somali man who lived there. His photos show the day-to-day lives of young Somalis, and he hopes it provides "a bit of nuance in the way that people see the community.
That it's not quite so simple as a couple of headlines might relate. Two months before Nazaryan arrived in Minneapolis, six young Somalis from the area were arrested. Last September, a year-old Somali was shot dead after stabbing 10 people at a mall in St. Cloud, a city about 60 miles away from Minneapolis. Karmel, one of two major Somali malls in Minneapolis, hosted a Quran reading competition for children in its upstairs mosque.
The event drew Somali families from all over the country. Those seven Muslim-majority nations were initially identified as "countries of concern" under the Obama administration to address "the growing threat from foreign terrorist fighters. Saciido Shaie arrives home with her year-old son after picking him up from school.
Islam forbids believers to eat pork products or drink alcohol. Those who strictly follow Islam may not work in an establishment that serves either pork or alcohol. Islam requires the faithful to pray five times per day. Some Somalis will stop work to pray at prescribed times or pray during a break or other arranged time.
Somali women may cover their heads and bodies when they are in public in accordance with Islamic tradition. Arrival in U. Since , Somalis have come to Minnesota as refugees. The majority of Somalis in Minnesota have come as secondary migrants from other regions of the U.
Increasingly, Somali families can be found moving to Metro area suburban communities — Eden Prairie has close to Somali families — and rural Minnesota. You can provide New Americans with a strong start to a new life by making a donation to the Institute.
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