Objective:

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Roma and non-Roma health in EU - main
priorities Kvetoslava Rimárová MEHO PROJECT
WP 10
Institute of Public Health, University of PJ
Safarik, Medical Faculty, Kosice, Slovakia
"This project is funded under the framework of
Public Health Programme 2003-2008 of the
European Commission (contract number 2005122)"
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Overview

• Roma communities around Europe create estimated
  amount of 8 10 millions Roma people living
  prevalently in Eastern and Central Europe
• Identifying Roma as an ethnic group brings the
  problem due the national policy in former CEE
  countries where nationality is voluntary in the
  census and the person can conceive a nationality
  as a personal feeling
• Roma people themselves do not like to be
  called Roma or Gypsies, most of identification
  is coming from external observers featuring main
  visible signs

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Estimated amount of Roma in CCE ()
Percentage in population
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Geographic distribution of Roma population in
Slovakia (official statistics by nationality)
Source Infostat Slovakia
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Main issues for MEHO

• reproductive health parameters
• cardiovascular health parameters
• infectious diseases

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Countries

• Slovak republic
• Czech republic
• Hungary, versus Romania, depends on existing
  data

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Main differences between migrants and Roma

• no national register
• voluntary nationality not valid (see previous
  graphs)
• no birth register
• no birth place identification
• surname classification no possible
• different internal categorization, some
  countries use also integrated, semi-,
  non-integrated Roma

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Indicators development

• indicators possible to compare with national
  data or semi/country data or regional data
• misclassification f.e. in national registry are
  Roma as well as in the both of groups -- in
  control and in exposed, the same Roma persons
  are also in most cross/sectional studies
• questionnaires and self/evaluation very
  problematic different transcultral issues

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Kosice, Slovakia
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REPRODUCUTIVE HEALTH

• possibilities to evaluate many indicators
  including gender issues and woman health issues
  
• discrimination issues
• teenage pregnancies
• classical gynecological, pregnancy and
  newborn outcomes

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REPRODUCTIVE PARAMETERS

• Sample
• 947 Roma and 2713 non-Roma mothers
• cross-sectional study
• data collection 7 centre s in Slovakia ,
  Faculty Hospital, Kosice in years 2004-2008
  ongoing

• Underlying determinants
• SES, marital status, education, employment,
  residency
• Proximate determinants
• smoking, drinking alcohol, coffee, weight gain
  during
• pregnancy, teenage pregnancy

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Methods 2

• Outcomes
• Newborn medical outcomes
• newborns parameters
• sex of newborn
• birth weight / length/LBW
• chest / head circumference
• Apgar score for newborn vitality

• Mothers reproductive outcomes
• preterm delivery
• gestational age
• aborts spontaneous / arteficialis
• type of delivery spontaneous vs. other or
  Caesarean
• parity
• complications during pregnancy

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Dichotomisation of variables

• LOW
• Birth weight lt 2500 g
• Birth length lt 45 cm
• Chest circumference lt 30 cm
• Head circumference lt 32 cm
• Apgar newborn score lt 9
• Gestational age lt 38 weeks
• Mothers weight increase lt 10 kg
• Abortus spontaneous ? 1
• Abortus artificialis ? 1
• Primipara - 1st delivery vs.
  multipara - 2nd or other delivery
• Spontaneous delivery vs. Caesar
  section or other
• 
  complications

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Frequency of SES underlying factors between Roma
and Non-Roma
plt0,001 n.s. not significant




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OR of SES underlying factors for Roma mothers
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Frequency of proximate factors between Roma and
Non-Roma
plt0,001 n.s. not significant

n.s.


n.s.
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OR of proximate - intermediate factors for Roma
mothers
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OR and 95 CI of Roma newborns risk parameters
plt0,001 plt0,01 plt0,05 n.s. not
significant




n.s.
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Ethnic differences in birth weight (g) (Roma vs.
Non-Roma)
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Ethnic differences in gestational age
(weeks) (Roma vs. Non-Roma)
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Ethnic differences in low birth weight (logistic
regression)
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Differences in selected indicators Roma and
non-Roma(ANOVA)
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Outputs 1

• Between Roma and non-Roma significant differences
  exist in
• SES distal factors (education, unemployment,
  single status, rural residence,)
• proximate factors
• (smoking, teenage pregnancy, low weight
  increase)
• pregnancy outcomes(preterm delivery, low
  gestational age)
• newborn characteristics(birth weight, birth
  length, chest and head circumference)

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Outputs 2
Between Roma and non-Roma no significant
differences in

• proximate factors(drinking alcohol, coffee)
• pregnancy outcomes(number of abortions)
• newborn characteristics(Apgar score)
• positive issues for Roma
• ? frequency of spontaneous delivers , 4x
  lower frequency of Caesarean section, frequency
  of abortions, Apgar score

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Conclusions 1

• the most important risk factors for birth
  weight
• reduction are education, smoking and
  martial status
• for low gestational age the risk factors are
  smoking,
• education and unemployment
• LBW after adjustment for all possible variables
  is lower
• in Roma

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Conclusion

• the results show that between Roma and non-Roma
  significant differences exist in, proximate and
  distal factors influencing on pregnancy and
  newborn outcomes
• AVAILABLE INDICATORS
• birth weight and other parameters
• gestational age not so precise namely in Roma
• IUGR intrauterine growth retardation
• SES status

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CARDIOVASCULAR HEALTH

• BMI index and others growth parameters
• body parameters
• food consumption survey
• evaluation of blood cholesterol triglycerides
  and other risk parameters
• risk factors as smoking, alcohol,
• difficult task to follow classic

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RESULTS FROM NUTRITIONAL SURVEY

• cross-sectional study 2007
• 150 Roma school-children
• interview and regulated questionnaires
• SES
• smoking
• food frequency in the family
• healthy food opinions

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Number of smoked cigarettes per family in Roma
group of children  
CIGARETTES
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Frequency of vegetables and fruit intake per week

FRUIT AND VEGETABLES INTAKE
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Frequency of daily food
FREQUENCY OF DAILY FOOD
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Anthropometric studies

• cross-sectional anthropometrical survey,
  including basic body parameters 2007
• subjects were Roma preschool and schoolchildren
  aged 3-12 years
• 710 Roma (332 boys, 378 girls), semi-segregated
  group
• compared to National Anthropometric Survey
  Results from 2001 (no SES)
• part of group TCH total cholestrol blood pressure
  

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Ethnic differences in height (boys)
plt0.05 plt0.01 plt0.001
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• Conclusions
• use of body parameters if there is a national
  anthropometric survey
• use of local comparison and Roma
• possibilities to compare between countries
• new databases results are showing minimal
  difference in TCH / total cholesterol and blood
  pressure in Roma and local non Roma
• but confirming difference in body parameters

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• Problems in Roma health evaluation
• cross country comparison
• most of data are different in different countries
• most of data - questionnaires data
• medical records data not legal since policy and
  discrimination
• social factors data, level of integration
• planning Roma health conference sept. 2009
• small monograph trying to compare Roma health
  data data

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INFECTIOUS DISEASES

• precise vaccination survey in primary health care
  center 2006-2008
• cross-sectional study 18 years old Roma children
  (300 medical vaccination reports)
• the Roma have 87- 92 shots which should be done
  in the age of 18
• delay in vaccination schedule very common
  between 2 shots
• question of antibody booster and outbreak of
  infection
• antibodies not measured
• Conclusion
• support in regular visit of primary health care
  centers
• vaccination os mandatory, parents can be
  prosecuted

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Acknowledgements

• Roma health research part was supported by the
  EU grant Public
• health 2007-2009 MEHO
• and national VEGA grant No.1231605, Slovak
  Republic

Address for correspondence
Kvetoslava Rimarova, MD, PhD. Institute of
Public Health Medical Faculty University of P.J.
Safarik Srobarova 2 040 01 Kosice,
Slovakia kvetoslava.rimarova_at_upjs.sk
"Disclaimer The study has received funding from
the European Commission under the Public Health
Programme 2003-2008. However, the sole
responsibility for the study lies with the author
and the European Commission is not responsible
for any use that may be made of the information
contained therein."