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Immigrant and Refugee Health

Non-Communicable Diseases (NCDs)

Central American Refugee Health Profile

El Salvador, Guatemala, and Honduras do not maintain national non-communicable disease registries. However, over the past 25 years, chronic illnesses such as cardiovascular disease, cancer, type 2 diabetes, and chronic respiratory diseases have replaced communicable diseases as the most common causes of death. Rates of adult obesity, hypertension, and tobacco use are similar in all three countries. Communicable diseases continue to be the primary cause of mortality for children under 5 years old. Neonatal and maternal mortality are high, with elevated teen pregnancy rates and lack of prenatal and perinatal care as likely contributing factors. Deaths related to road traffic accidents and violence have noticeably increased in recent years50,51,52,53.

Anemia

Anemia is common in El Salvador, Guatemala, and Honduras. The prevalence in children under 5 years old is 30%, 47%, and 40%, respectively, in these countries54, 55,56. Pregnant women also have been noted to have high prevalence of anemia, particularly in Guatemala, where 22% of pregnant women are anemic57, 58. Iron deficiency due to poor nutrition or chronic parasitic infection (which can cause indolent blood loss) is the chief etiology of anemia. However, many other conditions may contribute to anemia, such as lead exposure, untreated chronic disease, and hemoglobinopathies. Arriving children should be screened for anemia with a complete blood count. Please see the CDC Summary Checklist for the Domestic Medical Examination for Newly Arriving Refugees for further guidance.

Dental Caries

It should be presumed that most children have had little, if any, dental care, preventive or otherwise, before arrival in the United States. Preventive fluoride varnish should be applied in all children from first tooth eruption through 5 years of age (up to four applications per year, depending on state guidelines)59. Children should be referred for dental care as soon as possible after arrival60.

Developmental Delays

Access to medical care in Central America is often limited61, and studies show a lag in diagnosis of developmental delays among non-English speaking children in the United States62. It is important that children receive appropriate developmental screening at recommended intervals using screening tools that have been validated in Spanish-speaking populations63. If delays are identified, children should be referred for home-based or school-based early intervention services.

All children should have age-appropriate vision (ages 3 years and over) and hearing (ages 4 years and over—and at any age if the child is noted to have speech or developmental delays) screens to rule out deficits that could significantly impact development and learning64.

El Salvador, Guatemala, and Honduras do not have national newborn screening programs for life-threatening, treatable medical conditions. U.S. providers should follow state-specific guidelines for newborn screening in immigrant and refugee infants65. If no state-specific guidelines exist, newborn metabolic screening should be considered for infants <6 months of age. For children between 6 months and 3 years old, thyroid function testing is reasonable.

Lead Exposure

Lead poisoning has been reported among children in Central America as a result of exposure to home remedies, lead-glazed ceramics, and industrial contamination66. A study in 337 Honduran school-aged children (median age 7.2 years) evaluated blood lead levels. Of these, 19.6% had elevated blood lead levels (>5 ug/dl)67. Additionally, in one El Salvadoran city where lead acid car batteries are manufactured and disposed of, thousands of residents, both children and adults, were chronically exposed to lead68. Of note, anemia and malnutrition, both common among children in Central America, increase lead absorption.

All infants and children (6 months to 16 years old), as well as pregnant teens, should be screened for elevated lead levels. Elevated lead in pregnant women increases the risk for spontaneous abortion, low birth weight infants, and developmental delays in infants with significant exposures in utero69. Given the risk for persistent lead exposure in the United States, it is recommended to repeat lead testing 3-6 months after arrival for infants and children (6 months to 59 months of age), and for older children with extended exposure history. Please see CDC Refugee Tool Kit for guidelines for lead poisoning prevention among newly arrived refugee children for further information.

References

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