Resumen de Evidència de salut dels migrants: anàlisi crítica de revisions i pautes sistemàtiques
Background: The significant increase in international migration is a global public health concern and presents a compelling need for national and international migrant-specific evidence-based health guidance, highlighting the numerous contextual factors affecting the implementation of existing guidance and health service provision.
Objective: To identify and assess evidence on the quality of clinical practice guidelines (CPGs) and systematic reviews (SRs) on migrant health, and to develop evidence-based recommendations in this field.
Methods: The first study, a systematic review, focused on the appraisal of the quality of clinical practice guidelines (CPGs) on migrant health with the AGREE II instrument. The second study assessed the methodological quality, the risk of bias, and the reporting of systematic reviews on this topic using the instruments AMSTAR-2, ROBIS, and PRISMA, respectively. The third study evaluated the available evidence for the screening and treatment of schistosomiasis and strongyloidiasis in newly arrived migrants from endemic countries in the EU/EEA. In the fourth study, we formulated evidence-based recommendations based on the GRADE approach for screening and treatment of schistosomiasis and strongyloidiasis in the same population.
Results: In the first study we identified 32 CPGs; nine (28%) were deemed “recommended”, six (19%) were “recommended with modifications”, while seventeen (53%) were “not recommended. The lowest mean scores observed for the AGREE II domains were in the “rigour of development” (34%), “applicability” (40%), and “editorial independence” (27%) domains. In the second study, we included 57 systematic reviews. The methodological quality in 30 (52.6%) SRs was low/critically low. The overall risk of bias of included SR was high in 23 (40.4%), while the quality of reporting in 36 (63.2%) SRs was moderate. In the third study we included 27 SRs. The certainty of evidence on the effectiveness of screening techniques was low and the certainty supporting treatment efficacy for both parasitic infections was moderate to high. Overall, antibody-detecting serological tests were the most effective screening tests for both schistosomiasis and strongyloidiasis in low-endemicity settings, because they have higher sensitivity than conventional parasitological methods. Short courses of praziquantel and ivermectin were safe, highly effective, and cost-effective. In the fourth study, for schistosomiasis, the panel recommended serological screening and treatment (for positive cases) to all migrants from countries of high endemicity in sub-Saharan Africa and focal areas of transmission in Asia, South America, and North Africa. The panel also recommended offering serological screening and treatment (for positive cases) for strongyloidiasis to all migrants from countries of high endemicity in Asia, Africa, the Middle East, Oceania and Latin America (conditional recommendations based on low quality evidence).
Conclusions: 1) The majority of CPGs on migrant health have suboptimal quality with much room for improvement, especially in the domains of rigour of development, applicability, and editorial independence. 2) The methodological quality, risk of bias, and reporting of SRs on migrant health is still suboptimal, with critical gaps linked to low protocol registration, assessment of risk of bias and publication bias, additional analysis of synthesized evidence, and available funding. 3) The certainty of evidence on the effectiveness of screening techniques was low, and the certainty of evidence supporting treatment efficacy for both parasitic infections was moderate to high. 4) Newly-arrived migrants from endemic countries in the EU/EEA should be offered schistosomiasis and strongyloidiasis screening and treatment tailored to their region of origin.
