Background Older Syrian refugees have a high burden of non-communicable diseases (NCDs) and economic vulnerability. Understanding the predictors and reasons for the inability to manage NCDs in this population is important for policies, interventions and humanitarian programming. This study aimed to develop and internally validate a predictive model for the inability to manage non-communicable diseases in older Syrian refugees in Lebanon, and to describe reasons for non-adherence to medications.
Methods This was a nested cross-sectional study within a multi-wave longitudinal survey in Lebanon. The study population was older Syrian refugees aged 50 years or older who self-reported having hypertension, diabetes, history of cardiovascular disease or chronic respiratory disease. The sampling frame included a listing of all households from a non-governmental organization providing humanitarian assistance to Syrian refugees. All households with a refugee aged 50 years or older were invited to participate. Data were collected through telephone surveys between September 2020 to January 2021. Participants were asked about whether they had chronic conditions and the outcome variable was self-reported inability to manage hypertension, diabetes, history of cardiovascular disease and chronic respiratory disease. Predictors of the inability to manage any NCD were assessed using logistic regression. The model was internally validated using bootstrapping techniques, which gave an estimate of the optimism in the discrimination and calibration of the model. These were presented using the c-statistic and calibration slope (c-slope), respectively.
Results Out of 3,222 Syrian refugees, 1,893 reported having at least one NCD condition including 43% who had hypertension, 24% diabetes, 24% history of cardiovascular disease, and 11% chronic respiratory disease. There were 387 (20%) participants who were unable to manage at least one of their NCDs. Predictors of the inability to manage any NCD were younger age, not receiving humanitarian assistance, household water insecurity, household food insecurity and having multiple chronic diseases. The optimism-adjusted c-statistic was 0.65 (95%CI: (0.62–0.67)) and c-slope was 0.88 (95%CI: 0.73–1.03). The unaffordability of medication (41%), beliefs that they did not require the medication anymore after feeling better (22%) and unavailability of medication (14%) were the primary reasons for non-adherence to medications.
Discussion This study identified key predictors that deter ability to manage NCDs among Syrian refugees in Lebanon, which will aid humanitarian organizations in setting up strategies to address the problem. However, model performance could be improved. Context-appropriate assistance is required to overcome financial barriers and enable equitable access to NCD medication, which will improve the health and wellbeing of this vulnerable population.
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