Impact of Refugees on Local Health Systems: A Difference-in-Differences Analysis in Cameroon

• Published in: PloS one 2016-12, Vol.11 (12), p.e0168820-e0168820
• Main Authors: Tatah, Lambed, Delbiso, Tefera Darge, Rodriguez-Llanes, Jose Manuel, Gil Cuesta, Julita, Guha-Sapir, Debarati
• Format: Article
• Language: English
• Subjects: Accountability; Adult; AIDS vaccines; Analysis; Biology and Life Sciences; Cameroon; Cesarean Section - statistics & numerical data; Child; Child Care - statistics & numerical data; Child health; Child Health Services; Children; Childrens health; Confidence intervals; Data analysis; Delivery (Childbirth); Demographics; Developing countries; Drug delivery systems; Epidemiology; Female; Health care facilities; Health care industry; Health services; Health Services Accessibility; Humans; Indicators; Internet; LDCs; Maternal & child health; Maternal Health Services; Maternal mortality; Medicine and Health Sciences; Obstetrics; People and Places; Population; Prenatal Care; Refugees; Refugees - statistics & numerical data; Retrospective Studies; Studies; Surveys; Vaccination; Vaccination - statistics & numerical data; Women's Health Services; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0168820

Hosting refugees may represent a drain on local resources, particularly since external aid is frequently insufficient. Between 2004 and 2011, over 100,000 refugees settled in the eastern border of Cameroon. With little known on how refugee influx affects health services of the hosting community, we investigated the impact of refugees on mother and child health (MCH) services in the host community in Cameroon. We used Cameroon's 2004 and 2011 Demographic and Health Surveys to evaluate changes in MCH indicators in the refugee hosting community. Our outcome variables were antenatal care (ANC) coverage, caesarean delivery rate, place of delivery and child vaccination coverage; whereas the exposure variable was residence in the refugee hosting community. We used a difference-in-differences analysis to compare indicators of the refugee hosting community to a control group selected through propensity score matching from the rest of the country. A total of 10,656 women were included in our 2004 analysis and 7.6% (n = 826) of them resided in the refugee hosting community. For 2011, 15,426 women were included and 5.8% (n = 902) of them resided in the hosting community. Between 2004 and 2011, both the proportion of women delivering outside health facilities and children not completing DPT3 vaccination in the refugee hosting community decreased by 9.0% (95% Confidence Interval (CI): 3.9-14.1%) and 9.6% (95% CI: 7.9-11.3%) respectively. However, ANC attendance and caesarean delivery did not show any significant change. Our findings demonstrate that none of the evaluated MCH service indicators deteriorated (in fact, two of them improved: delivery in health facilities and completing DPT3 vaccine) with the presence of refugees. This suggests evidence disproving the common belief that refugees always have a negative impact on their hosting community.