Immunisation for refugees in Australia: a policy review and analysis across all States and Territories.

OBJECTIVE: Although people of refugee background are likely to be under-immunised before and after resettlement, no study to date has evaluated refugee specific immunisation policies in Australia. We developed a framework to analyse immunisation policies across Australia to highlight the strengths and gaps so as to inform development of more effective refugee specific immunisation policies. METHODS: We sourced publicly available immunisation policy documents from state and territory government websites. Content analysis of seven policy documents was undertaken using a developed framework comprising crucial policy determinants. RESULTS: Immunisation policy differed substantially across the jurisdictions. While most policies did not highlight the importance of data collection on immunisation for refugees and the public funding of vaccines for refugees, policy determinants such as accessibility and obligations were fulfilled by most jurisdictions. CONCLUSION: Our findings indicate stark differences in immunisation policy for people of refugee background across Australia. Highlighted gaps demonstrate the need to revise current policies so that they are aligned with their intended outcome of enhancing uptake of vaccines and improving immunisation coverage among resettled refugees in Australia. Implications for public health: Immunisation policy development for refugees needs to be robust enough to ensure equitable health services to this group

Policies, practices, and future directions in the provision of immunisation services to newly arrived refugees in Australia

Refugees are at increased risk of being under-immunised due to a range of factors associated with fragile public health systems and limited access to basic services in their country of origin and while in exile. It is unlikely that a new arrival will be fully immunised according to Australia’s National Immunisation Program (NIP). While a few studies examine the underlying causes of under-immunisation from the refugees’ perspective, little research explores the overarching health system and provider-specific issues that may contribute to under-immunisation in this group. Based on the premise of equity, refugees should be immunised equivalent to Australian-born residents of the same age. This thesis examines the policies and practices with regards to immunising refugees in Australia with the aim of advocating and informing evidence-based policy and practice changes to improve vaccine coverage for refugees. Immunisation policies for refugees across all jurisdictions in Australia were analysed to identify gaps and opportunities for improvement in future policy developments. From a policy perspective, the key issues identified included a dissonance between national and jurisdictional policies and significant gaps in funding and mechanisms to monitor immunisation coverage of this group. In-depth interviews were conducted with key immunisation stakeholders across Australia to gain a rich understanding of the barriers and facilitators impacting service delivery; and strategies for enhancing vaccine uptake among refugees. Key themes arising from this research were need for training on refugee-specific immunisation needs among general practitioners and clarity of roles and responsibilities for catch-up, both impediments to service delivery. The final component of this doctoral research was the development of an online training program targeting Australian general practitioners informed by data gathered collectively from the literature review, interviews and policy review. This thesis established a clear need for a national strategy for refugees to ensure there is consistency and improved immunisation coverage among refugees across Australia. This research has identified the need for strategies including improved data collection nationally, improved integration between key stakeholders in service delivery, increased guidance and support for general practitioners on catch-up vaccine delivery and universal funding for vaccines for refugees of all ages to ensure equitable access

Women Taking a Folic Acid Supplement in Countries with Mandatory Food Fortification Programs May Be Exceeding the Upper Tolerable Limit of Folic Acid: A Systematic Review.

BACKGROUND: In preconception and pregnancy, women are encouraged to take folic acid-based supplements over and above food intake. The upper tolerable limit of folic acid is 1000 mcg per day; however, this level was determined to avoid masking a vitamin B12 deficiency and not based on folic acid bioavailability and metabolism. This review's aim is to assess the total all-source intake of folate in women of childbearing age and in pregnancy in high-income countries with folate food fortification programs. METHODS: A systematic search was conducted in five databases to find studies published since 1998 that reported folate and folic acid intake in countries with a mandatory fortification policy. RESULTS: Women of childbearing age do not receive sufficient folate intake from food sources alone even when consuming fortified food products; however, almost all women taking a folic acid-based supplement exceed the upper tolerable limit of folic acid intake. CONCLUSIONS: Folic acid supplement recommendations and the upper tolerable limit of 1000 mcg set by policy makers warrant careful review in light of potential adverse effects of exceeding the upper tolerable limit on folic acid absorption and metabolism, and subsequent impacts on women's health during their childbearing years

Influenza vaccine as a coronary intervention for prevention of myocardial infarction.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. Influenza is one of the leading infectious causes of morbidity and mortality globally, and evidence is accumulating that it can precipitate acute myocardial infarction (AMI). This is thought to be due to a range of factors including inflammatory release of cytokines, disruption of atherosclerotic plaques and thrombogenesis, which may acutely occlude a coronary artery. There is a large body of observational and clinical trial evidence that shows that influenza vaccine protects against AMI. Estimates of the efficacy of influenza vaccine in preventing AMI range from 15% to 45%. This is a similar range of efficacy compared with the accepted routine coronary prevention measures such as smoking cessation (32-43%), statins (19-30%) and antihypertensive therapy (17-25%). Influenza vaccine should be considered as an integral part of CVD management and prevention. While it is recommended in many guidelines for patients with CVD, rates of vaccination in risk groups aged <65 years are very low, in the range of 30%. The incorporation of vaccination into routine CVD prevention in patient care requires a clinical practice paradigm change

Athari za lugha nyingine kwenye mizizi ya maneno ya lugha ya Kisambaa

Utafiti huu unahusu Athari za lugha nyingine kwenye mizizi ya maneno ya lugha ya Kisambaa. Utafiti umeongozwa na nadharia ya Mofolojia Leksika. Data za utafiti huu zilikusanywa kutoka Wilaya ya Lushoto, kata ya Kwesimu. Lengo kuu la utafiti huu ni kuchunguza athari za lugha nyingine kwenye mizizi ya maneno ya lugha ya Kisambaa. Malengo mahsusi ya utafiti huu ni; Kubainisha mizizi ya maneno ya lugha ya Kisambaa iliyoathiriwa na lugha nyingine; Kueleza athari za lugha nyingine kwenye mizizi ya maneno ya lugha ya Kisambaa; Kubaini mambo yaliyosababisha Lugha nyingine kuathiri mizizi ya maneno ya lugha ya Kisambaa. Mtafiti alitumia mbinu za hojaji na mahojiano katika ukusanyaji wa data. Sampuli ya watafitiwa 32 ilihusishwa kwa njia ya usampulishaji nasibu na usampulishaji kusudio, kwa kuzingatia kigezo cha umri, jinsia na elimu. Tafiti mbalimbali zilizofanywa katika kuchunguza vipengele mbalimbali katika sarufi ya lugha ya Kisambaa kwa ujumla si katika kuangalia athari za lugha nyingine kwenye mizizi ya maneno ya lugha ya Kisambaa. Matokeo ya utafiti huu yamedhihirisha kwamba mizizi ya maneno ya lugha ya Kisambaa inaweza kuathiriwa na lugha nyingine zinazotumika pamoja . Pamoja na hayo vilevile utafiti huu umebainisha kuwa athari hazitokei kiholela zipo sababu/mambo yanayosababisha athari hizo kutokea na pia utafiti huu umebainisha mbinu za kutumia ili kukabiliana na athari za lugha nyingine kwenye mizizi ya maneno ya lugha ya Kisambaa

Blood, donors and dollars: Rethinking financial sustainability of safe blood services in Tanzania

Introduction: Collection, processing and distribution of safe blood in Tanzania occurs within a free-for-service context, that is, a collection from non-remunerated blood donors and distributing freely to the needy people through health facilities. The safe blood services in the country appear to be crippled with many challenges and cannot meet the demand for blood and its products. As such, a need for rethinking collection methods, financial models and possible mechanisms for donor remuneration is evident. Methods: In this paper, we venture on multi-stakeholder meetings and ongoing discussions regarding the internal mechanisms of safe blood transfusion financing. The intent is to offer a perspective on the considerations for self-sustaining safe blood services in the country and the extent to which they may be implemented or not. Results: We suggest that despite huge demand, the external donor dependent financing mechanisms for safe blood services in the country are ineffective. Therefore, we discuss two potential ‘internal’ financing mechanisms that have been identified in recent shareholders forums 1) introducing a blood processing fee accompanied by policy change to allow direct charging of either recipients or hospitals or 2) influencing the introduction of ‘blood services’ within the current insurance schemes. Conclusion: We conclude that there is a need for constructing alternative financial mechanisms to sustain the demand of safe blood in the country. We discuss two cost recovery mechanisms, blood processing fee and insurance schemes; however, warning is noted that their implementation warrants structural adjustments, massive community sensitization and optimum stakeholder engagement to maximize acceptability within the country

Speaking COVID-19: supporting COVID-19 communication and engagement efforts with people from culturally and linguistically diverse communities.

BACKGROUND: Since the emergence of COVID-19, issues have been raised regarding the approach used to engage with Culturally and Linguistically Diverse (CaLD) communities during this public health crisis. This study aimed to understand the factors impacting communication and engagement efforts during the COVID-19 pandemic from the perspective of crucial CaLD community stakeholders and opinion leaders. METHODS: Forty-six semi-structured telephone interviews were undertaken with key stakeholders who have an active role (established before the pandemic) in delivering services and other social support to CaLD communities in Australia. RESULTS: Seven key themes emerged: (1) the digital divide and how to connect with people; (2) information voids being filled by international material; (3) Differentiating established with new and emerging communities' needs; (4) speaking COVID-19; (5) ineffectiveness of direct translations of English language resources; (6) coordination is needed to avoid duplication and address gaps and (7) recognising the improvements in governments' approach. CONCLUSION: Alliances must be set up that can be activated in the future to reduce issues around resource development, translation, and dissemination of messages to minimise gaps in the response. Financial assistance must be provided in a timely way to community organisations to support the development and dissemination of culturally appropriate communication materials

Improving the uptake of pre-travel health advice amongst migrant Australians: exploring the attitudes of primary care providers and migrant community groups.

BACKGROUND: Migrant travellers who return to their country of origin to visit family and friends (VFR) are less likely to seek travel-related medical care and are less likely to adhere to recommended medications and travel precautions. Through this study, we aimed to get an understanding of the views of stakeholders from community migrant centres and primary care providers on barriers for migrants, particularly from non-English speaking backgrounds, in accessing travel health advice and the strategies that could be used to engage them. METHODS: A qualitative study involving 20 semi-structured interviews was undertaken in Sydney, Australia between January 2013 and September 2014. Thematic analysis was undertaken. RESULTS: Language barriers, a lower perceived risk of travel-related infections and the financial costs of seeking pre-travel health care were nominated as being the key barriers impacting on the uptake of pre-travel health advice and precautions. To overcome pre-existing language barriers, participants advocated for the use of bilingual community educators, community radio, ethnic newspapers and posters in the dissemination of pre-travel health information. CONCLUSIONS: Travel is a major vector of importation of infectious diseases into Australia, and VFR travellers are at high risk of infection. Collaboration between the Government, primary care physicians, migrant community groups and migrants themselves is crucial if we are to be successful in reducing travel-related risks among this subgroup of travellers