Clinical profile and care pathways among unaccompanied minor asylum seekers in Vaud, Switzerland

The objectives of this study were to describe the overall clinical profile (somatic and psychological health) and the care pathways of unaccompanied minor asylum seekers (UMAS) who arrived in the Swiss canton of Vaud in 2015.

This was a retrospective study based on information extracted from the medical files of 109 patients over 1 year of follow-up. All the reasons for consultation and referrals as well as the diagnoses made were noted and coded using ICD-10. The healthcare providers for all diagnoses and referrals were also noted.

Our sample was predominantly male (87.2%) and hailed primarily from Eritrea (39.4%) and Afghanistan (32.1%). Gatekeeping nurses at a specialized migrant care facility (MCF) referred 67.7% of the UMAS to other providers for further medical care, including 45.4% to the Interdisciplinary Division for Adolescent Health (DISA). However, 46.8% of the 109 UMAS also sought care at other structures without any referral by MCF or DISA as intended. Of the patients 39.4% were found to have at least one mental health problem, mainly functional disorders (21.1%), symptoms and episodes of depression (17.4%), symptoms of post-traumatic stress disorder (PTSD) (13.8%) and sleeping disorders (12.8%). The most common diagnoses of infectious diseases included community-acquired respiratory infections (43.1%), scabies (20.2%) and cases of skin abscesses and furuncles (13.8%). In fewer instances, cases of active tuberculosis (3.7%), chronic hepatitis B (2.8%), intestinal parasites (1.8%) and gastritis caused by Helicobacter pylori (1.8%) were also diagnosed. A significant proportion of UMAS presented traumatological (30.3%) and ophthalmological (25.7%) problems. Among the female UMAS (12.8% of the sample), evidence of genital mutilation (21.4%), pregnancy (21.4%) and abortion (14.3%) was common.

An integrated approach involving efficient coordination between different providers is necessary in order to respond adequately to the major healthcare needs of UMAS. Special attention should be paid to mental health.