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Background Tunisia, situated at the crossroads of North Africa and Europe, has increasingly become an important origin, destination, and transit point for sub-Saharan migrants and refugees in recent decades. Despite growing migration flows, there remains a paucity of research on how these populations navigate healthcare access in Tunisia. This study addresses this gap by exploring migrants’ experiences with and perceptions of Tunisia’s healthcare system, with a focus on barriers to and facilitators of healthcare. Methods A qualitative study was conducted in four urban areas (Tunis, Medenine, Sousse, and Sfax) with concentrated migrant populations between May and December 2023. A purposive sample of migrants, migrant community leaders, and nongovernmental organization (NGO) staff were engaged through semi-structured interviews and focus-group discussions. Data were analysed via thematic analysis, combining inductive and deductive coding via NVivo 14 software, guided by an adaptation of Levesque’s conceptual framework. Results In total, 120 migrants and 43 NGO staff members participated in the study. The participants identified structural barriers such as legal status limitations, language barriers, and financial constraints, as well as social and cultural issues such as stigma and distrust of health system. While informal networks provide critical health information, they often lead to fragmented care. The private sector was perceived as better quality but unaffordable for the majority of migrants. Key facilitators included NGO support for referrals and coordination, particularly for undocumented migrants. Access was further hindered by communication gaps and limited awareness of the healthcare process. Conclusions Our study underscores the complex interplay of structural and individual barriers to accessing healthcare for migrants in Tunisia. Addressing these challenges requires culturally sensitive policies, multilingual resources, simplified administrative processes, and expanded health insurance coverage. Strengthening collaboration between NGOs, healthcare providers, and policymakers is essential to ensure equitable healthcare access for migrants.

Digital transformation in health care has a lot of opportunities to improve access and quality of care. However, in reality not all individuals and communities are benefiting equally from these innovations. People in vulnerable conditions, already in need of more care and support, are often not participating in digital health programs. Fortunately, numerous initiatives worldwide are committed to make digital health accessible to all citizens, stimulating the long-cherished global pursuit of universal health coverage. Unfortunately initiatives are not always familiar with each other and miss connection to jointly make a significant positive impact. To reach universal health coverage via digital health it is necessary to facilitate mutual knowledge exchange, both globally and locally, to link initiatives and apply academic knowledge into practice. This will support policymakers, health care providers and other stakeholders to ensure that digital innovations can increase access to care for everyone, leading towards Digital health for all.

Abstract Background The electronic Personal Health Record (ePHR) is a health information system that registers health data on newly arriving migrants and was implemented in eight European countries (Bulgaria, Croatia, Cyprus, Greece, Italy, Romania, Serbia and Slovenia). This is a cross-sectional study aimed to describe the health problems and health status of all migrants attended at health clinics as part of the health assessment programme established in the reception centres (2016–2019). Methods Data were collected on demographics, clinical and laboratory findings and diagnostics performed, including medical records. We classified all diseases using pre-specified algorithms according to information on pre-specified variables from the ePHR questionnaire, ICD-10 codes, positive laboratory findings or review of medical records. Crude proportions were calculated and odds ratios (OR) estimated using logistic regression modelling. Results The ePHR dataset contained a total of 19 564 clinical episodes in 14 436 individuals, recorded between January 2016 and October 2019. Most individuals (75%) were refugees or asylum seekers (22%) from 92 different nationalities. There were 2531/19 564 (12.9%) infectious diseases episodes reported during the study period, being 1283/2531 (50.7%) of them pharyngo-tonsillitis, 529 (20.9%) scabies, 158 (6.2%) viral hepatitis and 156(6.1%) lower respiratory infections. There were 2462 (17.1%) individuals with non-communicable diseases reported; including 821 (5.7%) cardiovascular diseases, 1183 (8.2%) neurological condition, 644 (4.5%) Diabetes mellitus and 212 (1.5%) kidney disease cases. Having Diabetes Mellitus (adjusted OR, aOR 3.3, [95% confidence interval, CI 2.7–4.1], P < 0.001), and neurological disorders (aOR 1.8, [95% CI 1.4–2.2], P < 0.001) were associated with cardiovascular disorders in the multivariable logistic regression model. Mental health problems were reported in 641/14 436 (4.4%) individuals and were associated with increasing age. Furthermore, 610 episodes of acute injuries were reported among 585/14 436 (4.1%) people, 517 (88.4%) of them in men (P < 0.001). Conclusions The ePHR is a valuable tool to efficiently collect health-related data to better address migrant health issues. We described a mostly healthy population with many acute infectious disease episodes particularly in children, but also with significant number of chronic conditions and less frequent injuries or mental health problems.

Migrants in the Middle East and North Africa (MENA) region face an increased tuberculosis (TB) risk due to socioeconomic and structural barriers. This systematic review synthesises evidence on TB burden, clinical outcomes, and epidemiological characteristics among migrants in MENA. We searched six electronic databases and grey literature sources for studies published between 2000 and September 2024 in any language. Eligible studies reported primary data on TB prevalence, incidence, treatment outcomes, and clinical or epidemiological features in migrants. Pooled estimates were calculated using DerSimonian & Laird's random-effects model where applicable or narratively synthesised. Of the 779 records identified, we included 57 studies, comprising 95,190 TB cases and 3,532,359 migrants across 12 MENA countries. TB incidence was consistently higher in migrants than non-migrants (26.7–69.8/100,000 vs. 11.5–16.8/100,000). Migrants had lower TB-related mortality (pooled OR 0.8, 95 % CI 0.7–0.9; I2 = 2.9 %), however, treatment success rates were consistently below the WHO-recommended 90 % threshold. Migrant TB patients were younger (mean age difference: 12.8 years; 95 % CI 8.8–16.0; I2 = 86.5 %) and predominantly male (sex ratio: 1:5). Drug-resistant TB was more common among migrants, though this was not always statistically significant (multi-drug-resistant TB: pooled OR 1.2; 95 % CI 0.9–1.6; I2 = 40.2 %), while extrapulmonary TB was more prevalent among non-migrants (33.4–83.4 % vs. 16.6–72.9 %). Migrants in MENA region experience disproportionate TB burden and poorer treatment outcomes, underscoring the need for targeted interventions. Enhanced data, especially from North Africa, is essential to support regional TB elimination aligned with World Health Organization and Sustainable Development Goals. •TB incidence and drug resistance are higher among migrants in MENA than non-migrants.•Migrant TB patients are younger, have lower mortality rates, but poorer treatment success.•Data on TB among North African migrants is critically scarce.•Migrant-focused strategies and better data are urgently needed to meet WHO's End TB targets.

IntroductionGlobal migration has steadily risen, with 16% of the UK population born abroad. Migrants (defined here as foreign-born individuals) face unique health risks, including potential higher rates and delays in diagnosis of infectious and non-communicable diseases, compounded by significant barriers to healthcare. UK Public Health guidelines recommend screening at-risk migrants, but primary care often faces significant challenges in achieving this, exacerbating health disparities. The Health Catch-UP! tool was developed as a novel digital, multidisease screening and catch-up vaccination solution to support primary care to identify at-risk adult migrants and offer individualised care. The tool has been shown to be acceptable and feasible and to increase migrant health screening in previous studies, but to facilitate use in routine care requires the development of an implementation package. This protocol describes the development and optimisation of an implementation package for Health Catch-UP! following the person-based approach (PBA), a participatory intervention development methodology, and evaluates our use of this methodological approach for migrant participants.Methods and analysisThrough engagement with both migrants and primary healthcare professionals (approximately 80–100 participants) via participatory workshops, focus groups and think-aloud interviews, the study aims to cocreate a comprehensive Health Catch-UP! implementation package. This package will encompass healthcare professional support materials, patient resources and potential Health Catch-UP! care pathways (delivery models), developed through iterative refinement based on user feedback and behavioural theory. The study will involve three linked phases (1) planning: formation of an academic–community coalition and cocreation of guiding principles, logic model and intervention planning table, (2) intervention development: focus groups and participatory workshops to coproduce prototype implementation materials and (3) intervention optimisation: think-aloud interviews to iteratively refine the final implementation package. An embedded mixed-methods evaluation of how we used the PBA will allow shared learning from the use of this methodology within the migrant health context.Ethics and disseminationEthics approval granted by the St George’s University Research Ethics Committee (REC reference: 2024.0191). A community celebration event will be held to recognise contributions and to demonstrate impact.

Background Agricultural workers face high heat stress risk due to environmental and working conditions. Migrant agricultural workers (MAW) are especially vulnerable due to additional structural factors including irregular migratory status and high economic needs. Our study explores the lived experiences of occupational heat stress among MAW and its impact on health. Methods An interpretive, qualitative design was employed. Through purposive sampling we selected MAW in Almeria, Lleida, and Huelva for semi-structured interviews. Interviews were audio-recorded, transcribed, and analyzed using reflexive thematic analysis. Results Thirty interviews were conducted with six female and 24 male MAW, predominantly from sub-Saharan and North-Africa. The findings were organized into five overarching themes: Working under the sun: exposure and embodiment; The dilemma of heat: work or wellbeing; Employer´s efforts to protect workers: a regime of discretion; Protecting oneself from the heat: navigating limited agency; and non-work-related factors: compounding vulnerabilities. Participants described discomfort and heat-related illness symptoms. Protective strategies included drinking water, wearing appropriate clothing, and taking breaks, but pressure from supervisors to maintain a fast work pace and limit breaks often compromised these protective efforts. Employer discretion largely determined access to heat-protective measures. Participants also reported limited ability to cool down after work due to high indoor temperatures in substandard housing. Conclusions Occupational heat risk for MAW extends beyond environmental factors and is amplified by socioeconomic inequities. Implementation of more specific and enforceable heat-protection measures and improved enforcement mechanisms, alongside mandated improvements to working and living conditions, are needed to reduce heat-related health risks.

Egypt has recently been certified as malaria-free. To sustain this status, the Egyptian Ministry of Health has implemented a policy of centralised malaria treatment at specialised hospitals, provided free of charge to all populations regardless of migrant status. This study examines migrants' malaria care-seeking experiences, the factors influencing their choices, and strategies to improve access. A qualitative study was conducted in Cairo using semi-structured interviews, inviting adult migrants from malaria-endemic countries and with prior malaria experience. Participants were recruited through purposive and convenience sampling. Data were collected in Arabic, transcribed, translated, and analysed thematically. We recruited 21 individuals, all Sudanese; 90.5% were female. Five participants (24%) developed malaria symptoms immediately upon arrival in Egypt; others developed symptoms within six months. Three themes emerged from the analysis: “Malaria-specific healthcare practices,” “Determinants of healthcare-seeking behaviour,” and “Recommendations.” Although participants recognised the severity of malaria and the need for treatment, 19 (90.5%) initially relied on traditional remedies or self-medication without malaria testing. Factors influencing healthcare-seeking behaviour included, at the patient level, a lack of trust in healthcare professionals, reluctance to disclose a malaria diagnosis due to stigma, fears of quarantine, concerns about adverse drug effects, and exposure to negative rumours and misconceptions about treatment. Factors within the healthcare system encompassed malaria services' affordability, accessibility, and perceived quality. Sudanese migrants’ malaria care-seeking behaviours are influenced by multiple personal and systemic factors. Improving access requires targeted health education to address misconceptions, raise awareness, and build trust in the healthcare system. •Egypt has achieved malaria elimination; however, the ongoing conflict in Sudan now poses a serious threat to the sustainability of this achievement.•Both individual and systemic barriers shape Sudanese migrants' healthcare-seeking behaviour for malaria in Egypt.•A lack of trust in the local healthcare system emerged as the main factor influencing malaria care-seeking behaviour among Sudanese migrants.•Enhancing Sudanese migrants' capacity and awareness, and building trust in the health system, are key to improving their access to and navigation of malaria healthcare services.

The objective of this study was to evaluate whether long stays in non-European countries influence the composition, diversity, and dynamics of gut microbiota, considering the potential impact of travelling, close contact with new people, and consumption of water and food. Two prospective cohorts were analyzed: (i) A longitudinal cohort comprising long-term travellers who provided fecal samples before and after their travels. (ii) A cohort consisting of long-term travellers and recently arrived migrants from non-European countries, which was compared with non-traveller controls. Each participant self-collected fecal samples and provided demographic and epidemiological data. Microbiota was characterized through 16 S rRNA gene sequencing. The longitudinal cohort comprised 17 subjects. A trend toward higher bacterial diversity was observed after travelling (Shannon index 3.12vs3.26). When comparing 84 travellers/migrants with 97 non-travellers, a confirmed association of higher diversity levels with travelling was observed (Phylogenetic diversity: 22.1vs20.9). Specific genera enriched in travellers' gut microbiota were identified, including Escherichia/Shigella, Bacteroides, and Parabacteroides. The analysis revealed three major clusters with profound differences in their bacterial composition, which exhibited differential distribution between travellers and non-travellers (Adonis P < 0.001; R2 = 30.6 %). Two clusters were more frequently observed in travellers: The first cluster, characterized by dominance of Escherichia/Shigella, exhibited the lowest levels of richness and diversity. The second cluster, dominated by Faecalibacterium and Bacteroides, displayed the highest richness and diversity patterns. These findings highlight the diverse impact of international travel on gut microbiota composition and underscore the importance of considering microbiota resilience and diversity in understanding the health implications. •International travels are associated with gut microbiome composition and diversity changes.•Diverse patterns after long-term travels are influenced by travellers’ epidemiological background.•We observed a low diversity and richness pattern dominated by Escherichia and Shigella,•Also, a rich and diverse pattern enriched with Faecalibacterium and Bacteroides.

Since Strongyloides can persist in its host for decades, and cause life threatening infections data on prevalence, the burden and risk factors for infection is crucial in migrant populations. In this observational retrospective cohort study, we describe the epidemiological, clinical, and microbiological characteristics of imported strongyloidiasis diagnosed at the Karolinska University Hospital, Stockholm, Sweden, during 2010–2021. We identified 98 individuals with strongyloidiasis, 89 (90.8%) born in endemic and 9 (9.2%) in non-endemic countries. Sub-Saharan Africa was the most common origin among the group born in endemic countries (62, 69.7%), (p < 0.005). There were 22 individuals with an underlying immunosuppressive condition. Gastrointestinal symptoms (53/98, 54.1%) were the symptoms most frequently described, and were more frequent in adults (57.0%) vs children (0%) (p = 0.013). Eosinophilia was detected in 74 (75.5%), being more frequent in the endemic-borne group (79.8% vs 33.3%, p = 0.002). Eight persons developed complications of strongyloidiasis because of either hyperinfection or disseminated disease. No people living with HIV with CD4 <500/mm3 (n = 6) developed severe strongyloidiasis. A limited number of strongyloidiasis cases was identified, with few complicated cases in immunosuppressed patients. Further studies focusing on identifying and exploring the risk of complicated strongyloidiasis in immunosuppressed patients are needed.

Each year, thousands of migrants enter the EU. Data on drug use in migrant populations are scarce and inconclusive. However, several risk factors make them particularly vulnerable to engaging in problematic drug use. In this perspective, we summarize the limited information that is available on migrants who use drugs and make a case as to why it is essential to improve access to health and social services, including harm reduction services, for this population. With this aim, we call for the co-creation of integrated services that better address the needs of migrants who use drugs in Europe.