Waterborne illness and common health problems among Nicaraguan refugee children in Costa Rica

Background: The 1 million refugees in Costa Rica have significant health disparities and little access to the country's universal health insurance. Children are particularly vulnerable because of unclean drinking water, crowding, and poverty. Little current information is available for this population. This study seeks to shed new light on pediatric refugee health issues by analyzing the public health problems encountered in a non-governmental free clinic. Methods: A chart review was conducted of clinic visits from January 2006 to January 2007. Patient age, number of visits, and diagnoses were recorded and classified using ICD-9 codes. We then tabulated the frequency of diseases associated with unclean water. Results: There were 997 patient visits by 790 patients. The median patient age was 7 years (range: 11 months to 17 years). The most common ICD-9 categories were respiratory diseases (n=545, 69% of patients), infectious and parasitic diseases (n=412, 52%), and skin disease (n=130, 16%). There were 43 (5%) preventative health visits. Most patients, (n=403, 51%) had a diagnosis associated with unclean water: parasites (n=323, 41%), diarrhea (n=39, 5%), failure to thrive (n=26, 3%), and gastroenteritis (n=15, 2%). Conclusions: In this clinic serving pediatric refugees, unclean water and other public health issues are common causes of chronic health problems. In addition to acute care, there is a pronounced need for preventative and well-child care. As the world's economic situation spirals downward, pediatric refugee populations, such as the one described here, will certainly grow and these preventable health problems will worsen.