title: Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan.
abstract: BACKGROUND
  The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings.
  
  
  METHODS
  A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households.
  
  
  RESULTS
  Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications.
  
  
  CONCLUSIONS
  Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
authors.forename: Shannon
authors.initials: S
authors.lastname: Doocy
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
authors.forename: Emily
authors.initials: E
authors.lastname: Lyles
authors.affiliation: Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Laila
authors.initials: L
authors.lastname: Akhu-Zaheya
authors.affiliation: Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Arwa
authors.initials: A
authors.lastname: Oweis
authors.affiliation: World Health Organization, Amman, Jordan.
authors.forename: Nada
authors.initials: N
authors.lastname: Al Ward
authors.affiliation: United Nations High Commissioner for Refugees, Amman, Jordan.
authors.forename: Ann
authors.initials: A
authors.lastname: Burton
mesh_terms: D001168:Arthritis / Q000453:epidemiology / Q000628:therapy; D002908:Chronic Disease; D003695:Delivery of Health Care; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D007597:Jordan / Q000453:epidemiology; D008297:Male; D011787:Quality of Health Care; D011788:Quality of Life; D012036:Refugees; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000628:therapy; D013593:Syria