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Reproductive health services for refugee and host populations in Uganda : policy implications

donderdag, 26 oktober, 2006 - 18:00
Campus: Brussels Health Campus
Faculteit: Medicine and Pharmacy
auditorium P. Brouwer
Christopher Garimoi Orach
doctoraatsverdediging

Worldwide, the majority of refugees live in the
developing countries. Most (80%) are women and
children. Uganda hosts an estimated 200,000
refugees. We investigated the extent reproductive
health (RH) needs of refugee and host populations
are met in West Nile region, Uganda.

Data on major obstetric interventions (MOI) for
absolute maternal indications (AMI) for refugees
and hosts were collected retrospectively for 1999-
2000 and 2003-2004, and prospectively for 2001in
three districts. Community surveys using the
sisterhood methodology were conducted in
Adjumani district to estimate maternal mortality
ratios (MMR) on samples of 3,087 adult refugees
and 3,227 hosts in 2002. Costs of reproductive
health interventions were estimated using a
modified WHO mother-baby package from 38 (33%)
health facilities in 2003. In-depth key informant
interviews and focus group discussions were held
to assess community perspectives on integration of
health services.

We found that rates of MOI for AMI were
significantly higher for refugees than hosts during
1999-2001 (1.01% [95% CI 0.77-1.25] versus 0.51%
[0.47-053]; p<0.0001) and 2003-2004 (1.02%
[0.79-1.25] versus 0.85% [0.80-0.90]; p<0.05)
respectively. MMR was 2.5 times higher in the host
322 [95% CI 247-396] compared to 130 [95% CI 81-
179] per 100,000 births in the refugee population.
Per capita cost of health care was 2.7 times higher
for refugees than hosts. However, integration
contributed to improved host accessibility and
utilisation of health services and more harmonious
relationship between the two populations.

Our findings suggest policy recommendations to
integrate and strengthen the capacity of hosts’
health system in refugee-affected settings in
developing countries.