1484 Meeting the health needs of unaccompanied asylum seeking children: a scoping review of routine health assessment

<h3>Background</h3> Approximately, 34 million of 79.5 million forcibly displaced persons globally are minors, many of whom are unaccompanied asylum seeking children (UASC). UASC often experience unmet health needs, physical harm or emotional trauma in their birth country, or during their journey to seek asylum. International guidelines recommend health screening for all migrant children. <h3>Objectives</h3> Scope the literature on UASC routine health assessment across Australia, European Economic Area, Canada, New Zealand, Switzerland, United Kingdom and United States (n=36). Analyse health screening programmes to inform future health policy. <h3>Methods</h3> Literature published (2010-March 2021) was systematically searched across MEDLINE, Web of Science, Cochrane and CINAHL. Records were screened against the inclusion criteria. A framework analysis across national and international organizations’ websites identified additional documents. <h3>Results</h3> 33 of 1432 records were included. UASC screening was reported across 13/36 countries, summarised in table 1. Commonly, studies were observational reports lacking references to clinical guidelines. Tuberculosis disease screening was offered in 12/13 countries. 8/13 countries used a risk-based approach, meaning UASC exposed to risk factors or from areas endemic for conditions (such as tuberculosis, hepatitis or parasites) were screened. Non-communicable disease screening guidance was present across 10/13 countries. 7/13 proposed blood testing for anaemia and nutritional deficiencies. Dental checks and developmental assessments were suggested in 7/13. Mental health screening was recommended in 6/13 countries. <h3>Conclusions</h3> Studies reporting UASC health assessment were not found for all countries. We found considerable procedural variation, which can exacerbate health inequalities. While we do not assume UASC health needs in these countries are not addressed, it raises concerns of the standards followed. Countries reporting screening may represent settings where optimal assessment is being followed. However, no audit data are available to compare guideline implementation and effectiveness. Frequently, emphasis was placed on infectious disease screening whilst other health components like mental health were less commonly addressed. UASC health should be prioritised, guidelines must include mental and social wellbeing parallel to communicable disease assessment. The UN Convention on the Rights of the Child recognises children’s right to the highest attainable standard of health. Voluntary comprehensive health assessments could ensure no child is deprived of their rights.

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