{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T22:13:24Z","timestamp":1783808004389,"version":"3.55.0"},"reference-count":59,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T00:00:00Z","timestamp":1697587200000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,7,4]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine the changing health needs of refugee children and young people (CYP) entering Australia, in relation to key government policy changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Retrospective analysis of health service use data over 11 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Paediatric refugee clinics in South Western Sydney (SWS), the Australian region with the largest annual resettlement of refugees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Refugee CYP (\u226425 years) attending the SWS paediatric refugee clinics for their first visit between 2009 and 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>Clinician defined health conditions categorised as communicable and non-communicable disease (NCD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data were analysed for 359 CYP, mean age 9.3 years; 212 male (59.1%). Most CYP (n=331, 92.2%) had health problems identified; 292 (81.3%) had \u22651 NCD and 24 (6.7%) had \u22651 communicable disease. The most frequent individual NCDs were dental disease (n=128, 35.7%) and vitamin D deficiency (n=72, 20.1%). Trend analysis showed increased odds of identifying an NCD from 2013 onwards (crude OR 1.77, 95%\u2009CI 1.06 to 2.96). Neurodevelopmental problems, especially Global Developmental Delay (n=31, 8.6%), emerged as more prevalent issues in the latter half of the decade. There were significantly increased odds of identifying a neurodevelopmental problem in 2016\u20132019, especially in 2016\u20132017 (adjusted OR 2.93, 95%\u2009CI 1.34 to 6.40). Key policy changes during this period included acceptance of refugees with disabilities from 2012, additional Australian Humanitarian Programme intake from the Eastern Mediterranean region and mandatory offshore processing for those seeking asylum by boat from 2013. In response to the changing needs, local health services adopted nurse-led primary healthcare screening, early childhood services, youth and disability clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Refugee CYP in Australia are presenting with a growing burden of NCDs, with neurodevelopmental problems contributing. Government policy changes affect the sociodemographics of resettled populations, influencing health profiles. Paediatric refugee health services need to be responsive to the changing needs of these populations to optimise well-being.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-064497","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T13:23:48Z","timestamp":1697635428000},"page":"e064497","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Changing landscape of paediatric refugee health in South Western Sydney, Australia: a retrospective observational study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5660-547X","authenticated-orcid":false,"given":"Lahiru","family":"Amarasena","sequence":"first","affiliation":[{"name":"School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Zwi","sequence":"additional","affiliation":[{"name":"School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia"},{"name":"Department of Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Hu","sequence":"additional","affiliation":[{"name":"Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raghu","family":"Lingam","sequence":"additional","affiliation":[{"name":"School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia"},{"name":"Department of Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanti","family":"Raman","sequence":"additional","affiliation":[{"name":"School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia"},{"name":"Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"key":"2025121508291095000_13.10.e064497.1","unstructured":"UNICEF . Child displacement. 2021. Available: https:\/\/data.unicef.org\/topic\/child-migration-and-displacement\/displacement\/"},{"key":"2025121508291095000_13.10.e064497.2","unstructured":"WHO . Report on the health of refugees and migrants in the WHO European region: no public health without refugee and migrant health (2018); 2018."},{"key":"2025121508291095000_13.10.e064497.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmjpo-2019-000516","article-title":"Health needs of refugee children identified on arrival in reception countries: a systematic review and meta-analysis","volume":"3","author":"Baauw","year":"2019","journal-title":"BMJ Paediatr Open"},{"key":"2025121508291095000_13.10.e064497.4","article-title":"Infectious diseases among refugee children","volume":"6","author":"Shetty","year":"2019","journal-title":"Children (Basel)"},{"key":"2025121508291095000_13.10.e064497.5","unstructured":"Wood S , Ford K , Hardcastle K , et al . Adverse childhood experiences in child refugee and asylum seeking populations. Public Health Wales; 2020. 3."},{"key":"2025121508291095000_13.10.e064497.6","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1111\/jpc.13559","article-title":"Adversity and resilience amongst resettling Western Australian paediatric refugees","volume":"53","author":"Hanes","year":"2017","journal-title":"J Paediatr Child Health"},{"key":"2025121508291095000_13.10.e064497.7","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1080\/1369183X.2016.1243462","article-title":"Educational attainment of childhood immigrants: how does immigration type matter","volume":"43","author":"Hou","year":"2017","journal-title":"J Ethn Migr Stud"},{"key":"2025121508291095000_13.10.e064497.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmjpo-2018-000338","article-title":"Impact of punitive immigration policies, parent-child separation and child detention on the mental health and development of children","volume":"2","author":"Wood","year":"2018","journal-title":"BMJ Paediatr Open"},{"key":"2025121508291095000_13.10.e064497.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.k4200","article-title":"The health of forced migrants","volume":"363","author":"Burnett","year":"2018","journal-title":"BMJ"},{"key":"2025121508291095000_13.10.e064497.10","doi-asserted-by":"crossref","DOI":"10.1186\/1744-8603-10-24","article-title":"Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need","volume":"10","author":"Amara","year":"2014","journal-title":"Global Health"},{"key":"2025121508291095000_13.10.e064497.11","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.93.2.286"},{"key":"2025121508291095000_13.10.e064497.12","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03520460086048"},{"key":"2025121508291095000_13.10.e064497.13","unstructured":"ASID and RHeaNA . Recommendations for comprehensive post-arrival health assessment for people from refugee-like backgrounds; 2016."},{"key":"2025121508291095000_13.10.e064497.14","doi-asserted-by":"crossref","DOI":"10.1186\/s40985-017-0065-4","article-title":"Review of infectious diseases in refugees and asylum seekers\u2014current status and going forward","volume":"38","author":"Eiset","year":"2017","journal-title":"Public Health Rev"},{"key":"2025121508291095000_13.10.e064497.15","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1505-5-1"},{"key":"2025121508291095000_13.10.e064497.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2012.02429.x"},{"key":"2025121508291095000_13.10.e064497.17","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.13551"},{"key":"2025121508291095000_13.10.e064497.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-6405.2009.00431.x"},{"key":"2025121508291095000_13.10.e064497.19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2009.01550.x"},{"key":"2025121508291095000_13.10.e064497.20","unstructured":"CDC . Refugee health guidance. U.S. Department of Health & Human Services; 2021. Available: https:\/\/www.cdc.gov\/immigrantrefugeehealth\/guidelines\/refugee-guidelines.html"},{"key":"2025121508291095000_13.10.e064497.21","unstructured":"UNHCR . Guidance for public healthinterventions for repatriation; 2011."},{"key":"2025121508291095000_13.10.e064497.22","unstructured":"World Health Organization . Non-communicable diseases; 2021."},{"key":"2025121508291095000_13.10.e064497.23","unstructured":"World Health Organization . Report on the health of refugees and migrants in the WHO European region: no public health without refugees and migrant health, report no: 9289053844; 2018."},{"key":"2025121508291095000_13.10.e064497.24","doi-asserted-by":"publisher","DOI":"10.1007\/s10900-012-9552-1"},{"key":"2025121508291095000_13.10.e064497.25","unstructured":"World Health Organization . Report on the health of refugees and migrants in the WHO European region: no public health without refugees and migrant health; 2018."},{"key":"2025121508291095000_13.10.e064497.26","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2014-307221"},{"key":"2025121508291095000_13.10.e064497.27","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s00787-017-1082-z","article-title":"The impact of detention on the social\u2013emotional wellbeing of children seeking asylum: a comparison with community-based children","volume":"27","author":"Zwi","year":"2018","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"2025121508291095000_13.10.e064497.28","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2015-3994","article-title":"Learning problems in children of refugee background: a systematic review","volume":"137","author":"Graham","year":"2016","journal-title":"Pediatrics"},{"key":"2025121508291095000_13.10.e064497.29","doi-asserted-by":"publisher","DOI":"10.1007\/s10567-010-0081-0"},{"key":"2025121508291095000_13.10.e064497.30","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2018-315105"},{"key":"2025121508291095000_13.10.e064497.31","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1111\/apa.15861","article-title":"Health needs of accompanied refugee and asylum-seeking children in a UK specialist clinic","volume":"110","author":"Harkensee","year":"2021","journal-title":"Acta Paediatr"},{"key":"2025121508291095000_13.10.e064497.32","unstructured":"Karlsen E . Refugee resettlement to Australia: what are the facts? Parliament of Australia; 2016. Available: https:\/\/www.aph.gov.au\/about_parliament\/parliamentary_departments\/parliamentary_library\/pubs\/rp\/rp1617\/refugeeresettlement#_Toc461022112"},{"key":"2025121508291095000_13.10.e064497.33","unstructured":"NSW Government . Faqs - where do refugees settle? NSW Ministry of Health; 2019. Available: https:\/\/www.swslhd.health.nsw.gov.au\/refugee\/faq-statistics.html"},{"key":"2025121508291095000_13.10.e064497.34","unstructured":"Department of Home Affairs . Settlement reports parliament of Australian; 2019. Available: https:\/\/immi.homeaffairs.gov.au\/settling-in-australia\/settlement-reports"},{"key":"2025121508291095000_13.10.e064497.35","unstructured":"NSW Health . South Western Sydney: NSW government; unknown. Available: https:\/\/www.health.nsw.gov.au\/lhd\/Pages\/swslhd.aspx"},{"key":"2025121508291095000_13.10.e064497.36","unstructured":"World health Organisation . WHO regional offices. 2020. Available: https:\/\/www.who.int\/about\/who-we-are\/regional-offices"},{"key":"2025121508291095000_13.10.e064497.37","unstructured":"WHO . International classification of diseases (ICD-10 Version: 2010)."},{"key":"2025121508291095000_13.10.e064497.38","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-015-0125-0","article-title":"Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada","volume":"4","author":"Godin","year":"2015","journal-title":"Syst Rev"},{"key":"2025121508291095000_13.10.e064497.39","unstructured":"Paxton G . Refugee policy and timeline. The Royal Children\u2019s Hospital Melbourne; 2020. Available: https:\/\/www.rch.org.au\/immigranthealth\/clinical\/refugee-policy-and-timeline\/"},{"key":"2025121508291095000_13.10.e064497.40","unstructured":"NSW Refugee Health Service . NSW refugee health service 2018\/19 annual summary."},{"key":"2025121508291095000_13.10.e064497.41","unstructured":"Hotton P , Freeman C , Smith M , et al . Triple burden of developmental disability in refugee children in South Western Sydney; 2017."},{"key":"2025121508291095000_13.10.e064497.42","unstructured":"IBM . IBM SPSS Statistics 28.0. 2022. Available: https:\/\/www.ibm.com\/support\/pages\/downloading-ibm-spss-statistics-280"},{"key":"2025121508291095000_13.10.e064497.43","unstructured":"Spinks H , Sherrell H . Budget review 2019\u201320; immigration. Parliament of Australia;"},{"key":"2025121508291095000_13.10.e064497.44","unstructured":"The Syrian and Iraqi humanitarian crisis. [press release]; 2015."},{"key":"2025121508291095000_13.10.e064497.45","unstructured":"United Nations . Convention on the rights of persons with disabilities; 2008."},{"key":"2025121508291095000_13.10.e064497.46","unstructured":"World Health Organisation . World report on disability; 2011."},{"key":"2025121508291095000_13.10.e064497.47","unstructured":"The Parliament of the Commonwealth of Australia . Enabling Australia; inquiry into the migration treatment of disability; 2010."},{"key":"2025121508291095000_13.10.e064497.48","unstructured":"Andrew and Renata Kaldor Centre for International Refugee Law . Australia\u2019s refugee policy: an overview. University of New South Wales, 2019."},{"key":"2025121508291095000_13.10.e064497.49","doi-asserted-by":"crossref","unstructured":"Triggs G . Human rights equal opportunity commission. The forgotten children: national inquiry into children in immigration detention 2014, report no: 192144956X. Australia Australian Human Rights Commission; 2014.","DOI":"10.5694\/mja15.00551"},{"key":"2025121508291095000_13.10.e064497.50","unstructured":"Australian Institute of Health and Welfare . 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