Does the presence of refugees affect the health status of the hosting community? The case of Cameroon

Abstract

Abstract Background: The United Nations High Commission for Refugees (UNHCR) estimates that nine out of ten refugees settle in developing countries. These countries have weak health systems with high maternal and child mortality. With little literature on the influence of refugees on the health of their host, the aim of this study was to explore the impact of refugees on maternal and child health of the local host population. Setting: By 2011, 100,000 refugees, mainly from the Central African Republic (CAR) had settled in Cameroon since 2006. The main area of settlement was the eastern border of the Adamaoua and East regions and spread over 50.000 square kilometers. Methods: Using the 2011 Cameroon’s Demographic and Health Survey, we evaluated maternal and child health indicators of the local refugee host population. These indicators were compared to those of a control group selected through propensity score matching from the rest of the country. Our main outcomes were attendance of less than four antenatal clinics (ANC), delivery out of health facilities and non-completion of DPT3 vaccine. The main exposure was living in the refugee occupied zone. Results: Of the 15426 women in our analysis, 902 were resident in the refugee zone. When compared to the rest of the country, women living in the refugee zone were likely to attend less than four ANCs (56.1% vs 35.4%; p<0.001), and be delivered out of health facilities (66.6% vs 32.1%; p-<0.001). However, non-completion of DPT 3 vaccination showed no difference (40.9% vs 37.8%; p=.19). After propensity score matching, the risks of attending less than four ANCs and delivering out of health facilities were still higher in the refugee host by 12.7% (95%CI=8.5-17%; p<0.001) and 17.6% (95%CI=13.9%-21.6%; p<0.001) respectively. Compared to the disparities in 2004, only the gap in infant vaccination coverage had been closed by 2011. Conclusion: Our findings demonstrate that with the presence of refugees, maternal health of the host improves slightly while child health improves more. In this light, emphasising on maternal health during assistance programmes to refugees could maximize the host health benefits.