The Care of Immigrant Children with Haemophilia.

Canada, like many industrialised countries, has a history of accepting immigrants and a significant proportion of the population of major cities like Toronto is comprised of visible minority groups. The provision of health care to recently arrived immigrant families presents a number of challenges including difficulties in communication, economic inequalities experienced by migrating families and complications of underlying conditions not often seen in countries with well-resourced health care systems. Over the last decade the Hospital for Sick Children (HSC) has been referred a number of children with haemophilia who have recently immigrated. We reviewed the presenting features and subsequent management of recently immigrated children with haemophilia at HSC. We compared objective joint assessment scores of these patients at presentation to follow-up joint assessment scores. Joint assessment scores were performed according to published guidelines with a normal joint score being graded as zero and the maximum joint score (total scores of both elbows, knees and ankles) being 162. Seventeen patients with haemophilia (haemophilia A N=15, haemophilia B N=2) were identified representing 9.2% of all patients with haemophilia at HSC and is comparable to the proportion of people who have recently immigrated to the Toronto area from other countries over the years 1995 to 2001 according to census data. The patients were seen initially at HSC at an average age of 7.3 years (range 0.6 years to 12.2 years) and have been managed at HSC for an average of 3.1 years (range 0.5 to 9.3 years). Fifteen patients have severe haemophilia and of these patients, 7 had no definite previous treatment with clotting factor concentrate. Two patients had been exposed to infection with the hepatitis C virus. None of the patients were HIV virus positive. Joint assessment scores at initial presentation to HSC were available for 13 patients with a mean score of 9.4 (range 0 to 24). Two of the patients were not weight-bearing at presentation. The mean repeat joint assessment scores for ten of the recently immigrated patients was 7.8 (range 0 to 27). With specific treatment and rehabilitation the joints scores improved in the majority of patients. Addressing the challenges of providing health care to recently immigrated children with haemophilia in a culturally sensitive manner can lead to effective medical management and greatly improve joint function in these children.