Non-Communicable Diseases

Syrian Refugee Health Profile

Chronic and non-communicable diseases have been reported in Syrian refugees. Chronic and non-communicable conditions in this population include anemia, cancer, hypertension, diabetes, malnourishment, renal disease, and hemoglobinopathies/thalassemias.

In a recent survey of Syrian refugee households (n=1550) residing in non-camp settings in Jordan, half of all households reported having at least one household member with a previous diagnosis with one of five non-communicable diseases: arthritis, cardiovascular disease, chronic respiratory diseases, diabetes, or hypertension 49. Among adults (>18 years of age) in the survey population, hypertension prevalence was highest (10.7%), followed by arthritis (7.1%), diabetes (6.1%), cardiovascular disease (4.1%), and chronic respiratory disease (2.9%). However, disease prevalence was substantially higher for older refugees, particularly those 60 years of age or older (Table 3) 49. Additionally, in a separate survey (n=210) among elderly Syrian refugees (>60 years of age) living in Lebanon, 22% of respondents reported high cholesterol, while 15% reported chronic pain. Digestive tract and neurological diseases were reported by 9% and 5% of survey participants, respectively 50.

Table 3. Chronic disease prevalence among Syrian refugees in Jordan by age group 49

Age in years Survey Total N Hypertension Cardiovascular Disease Diabetes Chronic Respiratory Disease Arthritis
N % N % N % N % N %
0-17 5147 6 0.1 20 0.4 8 0.2 153 3.0 18 0.3
18-39 3019 60 2.0 25 0.8 26 0.9 66 2.2 75 2.5
40-59 1040 220 21.2 78 7.5 125 12.0 39 3.8 154 14.8
60+ 373 195 52.1 80 21.4 121 32.4 22 5.9 85 23.7
Adult Prevalencea 4433 475 10.7 183 4.1 272 6.1 127 2.9 314 7.1

a “Adult” defined as any individual >18 years of age
Source: Doocy et al 2015

Anemia

Anemia, as a marker for overall micronutrient deficiency, appears to be common in Syrian refugees. An evaluation of anemia prevalence in the Zaatari refugee camp and surrounding areas showed that 48.4% of children younger than 5 years of age, and 44.8% of women 15-49 years of age suffered from anemia 51. These data indicate a severe problem of public health significance, as classified by WHO, as prevalence is well over 40% in these groups 52.

Hemoglobinopathy/Thalassemia

Hemoglobinopathies (thalassemias) are prevalent in Syria, and throughout Mediterranean and Middle Eastern countries. Approximately 5% of the Syrian population are carriers of beta thalassemia trait, and less than 5% are carriers of alpha thalassemia trait 53. These disorders vary from severe, life-threatening disease needing frequent transfusion and ongoing care (e.g., beta thalassemia major), to very minor or asymptomatic disease presenting with mild anemia or red blood cell anomalies (e.g., alpha-thalassemia silent carrier). These disorders should be considered in any individual with anemia and/or other red blood indices anomalies and appropriate diagnostics performed (including haemoglobin electrophoresis). Sickle cell disease is uncommon, and less than 1% of the population are carriers for the disease 54. Glucose-6-phosphate dehydrogenase deficiency (G6PD) has been reported in 3% of the Syrian population 55.

Genetic Disorders

Familial Mediterranean Fever is a common inherited disorder in the Syrian population. Familial Mediterranean Fever is an autosomal recessive inflammatory disease causing periodic fever and pain in serosal membranes, including those of the abdomen, chest, and joints. Past studies revealed that the mean age of disease onset was 14 years of age, with a male-to-female preponderance of 4:1. In an assessment of healthy individuals, 17.5% were identified as carriers of Familial Mediterranean Fever 56.

Lead Toxicity

Increased blood lead levels may be uncommon in Syrian children, although additional data are needed. Domestic screening in Syrian refugee children (aged 6 months to 16 years) in Texas January 2016 to July 2016 found 1.3% (N=158) of those screened had elevated lead levels (>5 µg/dL) [39]. However, until more data are available, routine screening should be performed, according to CDC’s Domestic Lead Screening guidelines.

Malnutrition

Preliminary findings from a study in the Zaatari refugee camp and surrounding area indicated a low prevalence of global acute malnutrition among Syrian refugee children aged 6-59 months (1.2% and 0.8%, respectively). However, the prevalence of chronic malnutrition (stunting) was more pronounced with 17% of children inside the camp and 9% outside the camp affected 51.

Renal Disease

No national data exist on the prevalence of renal disease in the Syrian population. In a pre-crisis, cross-sectional survey of hemodialysis sites in Aleppo, Syria, 550 patients (0.022% of the total population) were receiving hemodialysis. Hemodialysis patients ranged in age from 5 to 82 years with a mean of 44.7 years. The top three causes of end-stage renal disease in this population were hypertension (21.1%), glomerulonephritis (20.5%), and diabetes (19.5%). Hereditary causes were identified in 6.2% of this group. The low rate of hemodialysis in Aleppo was attributed to prohibitively high cost, high mortality, and low rates of ultimate transplantation 57.

Tobacco Usage

Prior to the crisis in Syria, tobacco usage was very high. It was estimated that 60% of men and 17% of women smoked cigarettes, and 20% of men and 5% of women used water pipes (hookahs or nargiles) 58. According to this study, most cigarette smokers were daily smokers, while water pipe users were intermittent users, often smoking in social settings 58.

Tobacco use is also reported to be quite high among Syrian adolescents. Water pipes or hookahs have quickly replaced cigarettes as the most popular method of tobacco use among youth throughout the Middle East 59. More than 20% of adolescents (13-15 years of age) used tobacco products other than cigarettes. When stratified by gender, nearly 30% of boys and more than 15% of girls 13-15 years of age use tobacco products 60.

Traumatic Injuries

In a study of refugees living in Jordan and Lebanon, 5.7% of refugees had significant injuries directly related to the conflict. One out of every 15 refugees in Jordan, and 1 in 30 refugees in Lebanon had suffered war-related injuries 61. Of the reported war-related injuries, 58% were due to bombing, shrapnel, and gunshot wounds, and 25% were from falls and burns 61.

References

  1. Doocy, S., et al., Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan. BMC Public Health, 2015. 15: p. 1097
  2. Strong, J., et al., Health status and health needs of older refugees from Syria in Lebanon. Confl Health, 2015.9: p. 12.
  3. Bilukha OO, et al., Nutritional Status of Women and Child Refugees from Syria-Jordan, April–May 2014. Morbidity and Mortality Weekly Report (MMWR), 2014. 63(29): p. 638-9.
  4. World Health Organization, Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011.
  5. Hamamy HA and Al-Allawi NAS, Epidemiological profile of common haemoglobinopathies in Arab countries. J Community Genet, 2013. 4(2): p. 147-167.
  6. El-Hazmi MAF, Al-Hazmi AM, and Warsy AS, Sickle cell disease in Middle East Arab countries. Indian J Med Res, 2011. 134(5): p. 597-610.
  7. Beutler E, Duparc S, and G6PD Deficiency Working Group, Glucose-6-Phosphate Dehydrogenase Deficiency and Antimalarial Drug Development. Am. J. Trop. Med. Hyg, 2007. 77(4), pp. 779–789.
  8. Mattit HH, Familial Mediterranean fever in the Syrian population: gene mutation frequencies, carrier rates and phenotype-genotype correlation. European journal of medical genetics, 2006. 49(6): p. 481-486.
  9. Moukeh G, et al., Epidemiology of hemodialysis patients in Aleppo city. Saudi Journal of Kidney Diseases and Transplantation, 2009. 20(1): p. 140-146.
  10. Ward KD, et al., The tobacco epidemic in Syria. Tob Control, 2006. 15(Supp 1): p. i24-i29.
  11. Maziak, W., The waterpipe: an emerging global risk for cancer.Cancer Epidemiol, 2013.37(1): p. 1-4.
  12. Maziak, W., et al., The global epidemiology of waterpipe smoking. Tob Control, 2015. 24 Suppl 1: p. i3-i12.
  13. de Leeuw L, The situation of older refugees and refugees with disabilities, injuries and chronic diseases in the Syrian Crisis. Handicap International 2014.
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