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Show STUDY METHODS Subjects Subjects for this study were drawn from the approximately 130-member "Lost Boys" population resettled in Salt Lake City. Lists of the youth were obtained from the Salt Lake offices of the Catholic Community Services (CCS) and the International Rescue Committee (IRC), who served as resettlement agencies for approximately 50 and 80 boys, respectively. Subjects were selected randomly from these lists for inclusion in the study. Data Collection Data for the study was obtained via detailed reviews of the medical records of 70 Sudanese youth. All 70 were initially screened and examined by a physician of the Salt Lake Family Health Center, with whom the Utah Department of Health contracts to conduct the initial screening for all incoming refugees. Most continued to receive additional treatment from this physician following the initial screening process. Forty-two records reviewed belonged to IRC-sponsored youth and the remaining 28 records belonged to youth sponsored by the CCS. Careful patient confidentiality was maintained through use of a numeric coding system. Data was abstracted from all portions of the medical records, including laboratory test results, US Visa Application health examination, domestic health screening and physical examination, written physician notes, x-ray and referral reports, insurance information, and a personal history form filled out by each patient. RESULTS AND FINDINGS Demographics Demographic information was drawn from a personal history form filled out by each subject at the time of his initial health screening in Salt Lake. All 70 subjects considered in this identified themselves as male, single, and Sudanese-born. Almost all identified themselves as ""student" when asked about their occupation. All subjects had Medicaid coverage at the time of their initial screening (Utah Department of Health, 1997). Each of the 70 youth is between the ages of 20 and 26 years old. However, only four had listed an actual date of birth. The remaining 66 listed "l/l/[Year]" as their date of birth because their actual date of birth is unknown. Years of birth of the subjects range from 1/1/76 to 1/1/82. US Visa Health Screening All Sudanese youth immigrating to the United States, including the 70 young men examined in this study, received two health screenings. The first health screening was administered as part of their US Visa Application during the latter part of 2000, and was conducted by a panel of international physicians appointed by the US. The purpose of the Visa Application medical examination is to serve as an "exclusion process, identifying those with physical or mental disorders that might prove harmful to the general U.S. population" (Refugee Coordinator Network, 1994). These were very basic examinations, consisting only of a chest x-ray for tuberculosis, and serum tests for both syphilis and HIV. The youth were also screened, (not tested) for various other physical and mental defects and disorders such as leprosy, insanity, and psychopathic personality. None of the 70 subjects had any serious or contagious "Class A" disorders. None tested positive for HTV,* and only 1 tested positive for syphilis. Some youth were cleared to come who had one or more "Class B" disorders, mainly inactive and non-infectious tuberculosis (see below). Presence or absence of Tb infectivity was determined by a chest x-ray and, if necessary, examination of sputum. In general, all refugees who are allowed admission to the United States who test positive for either infectious Tb and/or syphilis have to complete Tb treatment regimens prior to departure to the United States (Refugee Health Coordinator Network, 1994). This applied only to one of the seventy subjects (syphilis). All 70 subjects received empirical treatment for malaria and parasites before departure to the United States. They were given 600 mg of albendazole along with 1575 mg of a meflo-quine/fansidar combination. Albendazole is a broad-spectrum de-worming agent that is effective against many dangerous parasites, including Ascaris lumbricoides, Trichuris trichiura, Neca-tor americanus, and Stongyloides stercoralis. Albendazole also causes no side effects and is relatively inexpensive (Muenning, Pallin, Sell, & Chan, 1999). Mefloquine is an anti-malaria drug and fansidar is effective against Plasmodium falciparum, another parasite. However effective, these drugs do not cover all of the parasites that are endemic in the countries where these youth have lived (Table 6 below). Utah Health Screening After arriving in Utah, the youth received their second health screening (Table 1) along with a physical exam (Table 2). Results for HTV and syphilis testing correlated exactly with the original health screening given in Kakuma. Hepatits B was tested for as part of the second screening, and 9 subjects (13%) tested positive. Prevalence of Hepatitis B among these 70 subjects is higher than statistics reported by the World Health Organization, which lists Hepatitis B prevalence at equal to or greater than 8% in sub-Saharan Africa. Prevalence, however, in the United States is much lower, at less than 2%. The vision measurements were of interest, as only five of the 63 (8%) who had vision measurements recorded had vision worse than 20/30 (considered to be a slightly myopic measurement) in either eye. Moreover, nearly half of those screened had perfect 20/20 vision, hi comparison, a large population-based study of people aged 4 to 74 years in the US showed that 43% had 20/30 vision or worse. (8) Reasons for such high percentages of good-to-perfect vision among this population compared to the US average is unknown and could be explored further. Physical examination results for most of the subjects were normal (Table 2). Unfortunately, height was not included as part Figure 1. The Lost Boys learning about light bulbs. Photo courtesy of the "St. Petersburg Times" Utah's Health: An Annual Review Volume DC 47 |
