Aspects of safety and appropriateness of healthcare delivered by volunteers for undocumented migrants in Belgium
Creators: name: Madl, Julia
Publisher: name: Zenodo
Year: 2025
Subjects: subject: Human Migration
subject: Primary Health Care
subject: Infectious Disease Medicine
subject: Scabies

description: AbstractBackgroundIn Belgium universal health coverage depends on registration in the national registrywherefor an address and a residence permit are mandatory. Therefore, undocumentedmigrants and the homeless often have no effective access to health services. Médecins duMonde Belgium (MdM-BE) is a medical NGO providing health care to the most vulnerablepeople by organizing medical consultations in several different projects across Belgium withvolunteer physicians, nurses, and midwives. This study seeks to evaluate aspects of safety andappropriateness of care delivered during medical consultations.MethodsThis study uses a quantitative retrospective analysis of data from electronic healthrecords and protocols obtained from MdM-BE. Patient encounters with diagnosis of acuteotitis media and cystitis were used to assess appropriateness of treatment, those with scabies,tuberculosis, and haemoptysis to assess safety of care. An algorithm for correct treatment wasdefined and variables such as age, gender, region of provenance, housing, and project wereextracted. Statistical process control (p-charts and run charts) was used to describe patternsover time and logistic regression with the binary outcome of correct treatment was performedto assess influence of different predictors.Results908 of 37,229 consultations in projects between 01/2019 and 12/2021 matched theinclusion criteria and after data-cleaning (elimination of duplicates) 897 consultations wereleft for analysis. 158 diagnoses of cystitis were made in 58 men and 100 women with a medianage of 32 years (IQR=24-42). 83 patients received treatment according to guidelines whereas50 did not and for 25 patients information was missing. In logistic regression with age, gender,project and region as predictors, the odds ratio (OR) for receiving correct treatment forwomen compared to men was 4.4 (95%CI: 1.8-11.1, p=.002), ORs for receiving correcttreatment in Hub and care antennas compared to Centre d’accueil, soins etorientation(CASO)/Center for opvang, zorg en orienteering(COZO) were 0.19 (95%CI: 0.03-0.75, p=.025) and 0.05 (95%CI: 0-0.25, p=.014) respectively. McFadden’s R-squared was 0.259and the c-statistic 0.795.542 diagnoses of scabies were made during the project period in 42 women and 500men with a median age of 24 years (IQR=20-30). An initial analysis revealed an overall medianof only 44% (IQR=33.5-60) correct referral, however after manually adding missing dataretrieved through individual chart views this increased to an overall median of 94%(IQR=80.75-100). A p-chart with proportion of missing data clearly indicated a change instability end 2019. After parting the chart, the median percentage of missing data was 63%(IQR=44-75) until 11/2019 and 21% thereafter (IQR=9.5-36.5).ConclusionCare delivered by volunteers in projects of MdM-BE is comparable to Belgian nationalstandards and positive changes over time could be depicted. Yet big differences betweenprojects exist. Additional protocols and better encoding of medical consultations arenecessary ways forward to facilitate evaluation and guarantee adequate quality in all projects.