key: cord-0016685-lx8i2ino
authors: Salami, Bukola; Fernandez-Sanchez, Higinio; Fouche, Christa; Evans, Catrin; Sibeko, Lindiwe; Tulli, Mia; Bulaong, Ashley; Kwankye, Stephen Owusu; Ani-Amponsah, Mary; Okeke-Ihejirika, Philomina; Gommaa, Hayat; Agbemenu, Kafuli; Ndikom, Chizoma Millicent; Richter, Solina
title: A Scoping Review of the Health of African Immigrant and Refugee Children
date: 2021-03-28
journal: Int J Environ Res Public Health
DOI: 10.3390/ijerph18073514
sha: 38d984b037395e71e2d4ab5dceb6396f95fe075f
doc_id: 16685
cord_uid: lx8i2ino

Migration is a growing phenomenon around the world, including within the African continent. Many migrants, especially African children, face challenges related to health and social inclusion and can face increased health risks. A systematic scoping review of available literature on the health of African migrant children across the globe was conducted to offer insight into these health risks. The review was conducted over a 15-month period from January 2019 to April 2020, yielding 6602 articles once duplicates were removed. This search included electronic databases, reference lists of articles reviewed, and searches of libraries of relevant organisations. A total of 187 studies met the inclusion criteria, of which 159 were quantitative, 22 were qualitative, and 6 used mixed methods. The findings reveal decreased health in this population in areas of nutrition, infectious diseases, mental health, birth outcomes, sexual and reproductive health, physical and developmental health, parasitic infections, oral health, respiratory health, preventative health, endocrine disorders, health care services, and haematological conditions. The findings offer insights into factors influencing the health of African immigrant and refugee children. Further studies, especially qualitative studies, are needed to determine barriers to service access after migration and to investigate other underexplored and overlooked health concerns of African migrant children, including pneumonia and child maltreatment.

Global migration is a growing phenomenon heavily influenced by global economic, social, political, and technological transformations, and climate change [1] . The International Organisation for Migration [1] estimates that of some 272 million international migrants, anaemia, haemoglobinopathies, chronic hepatitis B, latent tuberculosis infection, intestinal infection, oral health problems, vitamin D deficiency, wasting, and stunting [21, 22] . While several systematic reviews have been published on the health of immigrant and refugee children, we found none that focus on the health of African immigrant children; previous reviews often combined African immigrant children with other immigrants and lacked an in-depth analysis of their particular vulnerabilities. Thus, a review of existing studies is necessary to fill this gap. A review focusing on African immigrant children's health is particularly important given the poor health status of African immigrants [7, 8] . Further study of the health status of African immigrants is also needed to ensure and inform the development of relevant interventions. Interventions should involve the participation of, and centre the voices of, African migrant and refugee children.

A scoping review is appropriate for identifying existing research activity on a particular topic and key research gaps [23, 24] . We conducted a systematic scoping review over a 15-month period from January 2019 to April 2020. This review followed the five-stage approach to scoping reviews as outlined by Arksey and O'Malley [25] : developing the research question; identifying the relevant studies; selecting the articles; data charting and data extraction; and collating, summarizing, and reporting the results. The review has been reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Extension for Scoping Review Guidelines [26] .

Stage 1 aimed to refine questions on the body of evidence related to African immigrant and refugee children. Our research questions were as follows:

1.

What is the scope, range, and nature of evidence on the health of African migrant children? 2.

What is known from the existing literature on the health of African migrant children?

Stage 2 involved identifying the relevant studies. The search included electronic databases, a reference list of articles reviewed, and searches of libraries of relevant organisations. The following databases were searched on 21 January 2019 by a health science librarian: Medline, Embase, Ovid Global Health, Ovid PsycInfo, Cochrane Library, CINAHL, SocIndex; EBSCO Child Development and Adolescent Studies, ProQuest Sociological Abstracts, and ProQuest Dissertations and Theses Global. The search terms used represent associated keyword combinations of child health, immigrant health, and Africa (Table 1 : Search Terms). A total of 12,720 records were identified and retrieved, and 6602 records remained after duplicates were removed. These articles were exported into Covidence, an online software that works in collaboration with Cochrane to enhance the selection and completion of systematic reviews. This software allows for independent reviewers to screen records based on inclusion criteria. Results were checked by two research assistants. Stage 3 involved article selection. Two research assistants independently selected and reviewed each article that met the following inclusion criteria: (1) focus on the health of African child migrants and refugees; (2) child's age is between 0 and 18 years old; (3) child is either a first-generation or second-generation immigrant; (4) report original research studies; and (5) data are on children who crossed an international border. We excluded articles related to internally displaced children and internal migrants because they are still located within the same country and policy jurisdiction. We also excluded articles on African American children (in which information was not provided on whether they are immigrants), African Caribbean children, and articles that focused on the challenges of parents without sufficient information on the health of the child. We also excluded articles that did not have disaggregated data on African immigrant children (e.g., those in which data on African immigrants were combined with other immigrants). All publications such as conference abstracts, literature reviews, book chapters, brief reports or case reports, posters, study protocols, and theses that did not qualify as an empirical output were also excluded (see list in the flow chart). Screening of titles and abstracts and excluding articles resulted in a remaining 615 articles. Only articles published in English and Spanish were included. We screened the full text of all 615 and rejected another 426 based on the inclusion criteria to arrive at 187 articles used in the analysis (see Figure 1 for PRISMA flow chart). At each stage, disagreements between the two reviewers were resolved by consensus or by a third reviewer. 

A total of 187 studies were ultimately included in this scoping review ( Figure 1 ). Supplementary Table S1 shows the key characteristics of the articles. The majority of the stud- Stage 4 involved data charting and data extraction. The following information was extracted from each of the 187 articles: author(s) name, year of publication, research questions or objectives, theoretical framework, method (sampling, sample size, age of the child, data source (parent vs. child vs. health professional vs. medical records vs. clinical assessment vs. laboratory tests), clinical area of focus (e.g., mental health, nutrition, cardiovascular health), period of data collection, country of origin or region, destination country or region, and summary of findings. In total, six research assistants extracted and collated data. Each paper was reviewed by one research assistant and verified by another for accuracy. The research assistants received four hours of training on scoping reviews and attended weekly meetings to discuss emerging findings.

Stage 5 involved collating, summarizing, and reporting the results. Given the vast number of articles included, we coded and summarised data based on areas of focus and thematically analysed the content. We also compared data across the coding segments. The purpose of the comparison was to identify relevant linkages (relationships, interactions, and consequences) across data. Numerical data are represented using descriptive statistics, frequencies, measures of central tendency, and measures of variability. As a scoping review, the purpose is to map out the existing evidence and summarise key study findings within different domains rather than evaluate the quality of individual studies to determine the risk of bias related to particular outcomes. Hence, in line with the review aim of providing an overview of the existing evidence base, a formal quality assessment of each study was not undertaken [25] .

A total of 187 studies were ultimately included in this scoping review ( Figure 1 ). Supplementary Table S1 shows the key characteristics of the articles. The majority of the studies were quantitative (n = 159), with less representation in terms of qualitative (n = 22) and mixed methods (n = 6) research. The oldest year of publication was 1965, and the most recent article was published in 2019. The majority of studies either did not mention their sampling method (n = 133) or utilised a non-probabilistic method (n = 42). Data were collected from diverse sources including children, parents, medical records, national registries, and health care professionals. The top three modes of data collection were via multiple methods (n = 63), surveys and questionnaires (n = 38), and diagnostic or laboratory testing (n = 34). Few studies reported the use of a theoretical framework (n = 10); those that did, used frameworks based on health services for community living, cognitive theory, a social-ecological framework, a cultural competence framework, the health access model and household resources model, anthropological theory, the theory of segmental assimilation, narrative inquiry and ethnographic impressionism, and transgenerational trauma transference.

A broad range of children's ages was examined: under 1 year old (n = 25), 1-6 years old (n = 30), 7-11 years old (n = 22), and 12-18 years old (n = 133). Most studies either reported on migrants from multiple countries (n = 37) or generalised to migrants from Africa (n = 28). Others reported participants were from Somalia (n = 27), Ethiopia (n = 24), and sub-Saharan Africa (n = 13). European (n = 69) and African (n = 39) countries were the primary destinations, although a notable number of studies were conducted in Israel (n = 26), the United States (n = 22), and Australia (n = 21).

The studies included in this review report on 11 areas of health, namely, infectious diseases (n = 25), including parasitic infections (n = 17); nutrition (n = 40); mental health (n = 28); birth outcomes and sexual/reproductive health (n = 23); physical and developmental health (n = 19); oral health (n = 16); respiratory health (n = 9); preventative health (n = 8); endocrine health (n = 8); health care services (n = 8); and haematological conditions (n = 5).

Overall, 25 of the articles focus on infectious diseases . The literature indicates high rates of human immunodeficiency virus (HIV) infection in AMC [45] [46] [47] [48] [49] [50] , and Germany [51] . Studies in Israel and Belgium found a high prevalence of mother-to-child HIV transmissions [45, 48] . AMC living with HIV in the United States and the Netherlands are often diagnosed in the host country, with antiretroviral therapy started at an older age [47, 50] However, HIV-infected parents migrating to Sweden are unlikely to disclose their status to their children due to fear of double stigma [46] .

Research shows hepatitis A and B are prevalent among AMC in Italy and Spain [27, 28] . Similarly, problems with Chlamydia trachomatis, cholera, and varicella-zoster virus are evident in AMC in the United States and Algeria [29] [30] [31] . The presence of measles and rubella also affects the health of AMC in Cameroon and Cote d'Ivoire [32, 33] , as did Heliobacter pylori in Australia, although the latter was reduced by premigration antimalarial therapy [34] [35] [36] [37] . Tinea capitis is a common infectious disease among AMC in New Zealand [38] , Israel [39] , Spain [40, 41] , and Australia [42] . Other scalp infections from Trichophyton violaceum and Trishophyton soudanense are also present in AMC living in Sweden and the United States [43, 44] .

A total of 16 articles report on parasitology-seven report on malaria [52] [53] [54] [55] [56] [57] [58] , four discuss helminth infections [35] [36] [37] 59] , and five focus on unspecified infections [60] [61] [62] [63] [64] . Intestinal parasites are common among AMC in the United States, Spain, and Australia [61] [62] [63] 65] . Similarly, the infestation rate of head lice among AMC in Israel is high [64] . Among migrants to Spain, parasitic infections are most common in people originating from sub-Saharan and North Africa and are frequently associated with eosinophilia [62] . However, AMC in England have much lower helminth carriage rates than other migrant populations [59] . In Australia, helminth infections are also common but are not associated with reduced growth or with H. pylori infection [36] , are not predicted by gastrointestinal symptoms and significantly elevated cytokines [37] , and do not elevate urinary hepcidin [36] . The literature also shows imported childhood malaria is increasing among AMC in England [58] and Spain [52] . Similarly, Plasmodium falciparum infections are disproportionately high among AMC compared to populations in receiving countries such as Canada [53] , the Democratic Republic of Congo [54] , Australia [55] , and Zambia [56] . Prevalence is thought to be partly connected to malnutrition [54] , and receiving countries must be prepared to treat children for P. falciparum infections on arrival.

A total of 40 articles report on nutrition following arrival to the host country . Concerning breastfeeding practices among mothers of AMC, scholars largely centre their attention on high-income settings such as Norway and Australia, or conversely on refugee camps in Africa. In developed countries, some authors report positive attitudes towards breastfeeding [66] ; however, others note an interruption of breastfeeding at six months post-birth primarily due to insufficient milk supply [67] , a decline in breastfeeding after arrival to the host country [68] , and increased challenges to exclusive breastfeeding [69] . In contrast, refugees in Ghana improved their breastfeeding practices with increasing time in the receiving country [70] . Infant refugees to Algeria often experience excessive iodine intake [71] and are constantly underweight [72] .

Evidence on dietary choices and feeding behaviours of AMC vary across settings. In Algeria, Italy, and Spain, several authors report lower quality diets in AMC soon after their arrival [73, 74] . For instance, some immigrants to Italy are less likely to have breakfast compared to Italians [75] . Conversely, AMC in Norway appear to align with Norwegian dietary recommendations [76] , and AMC in the United States make dietary choices that are highly influenced by their culture [77] . Factors associated with child hunger and food insecurity include poor English proficiency and shorter length of stay in the host country [78, 79] .

Issues related to obesity and overweight have appeared upon resettlement of AMC in host countries including the United States, the Netherlands, and Australia [80] [81] [82] [83] . Some authors attribute these health issues to cigarette smoking [84] and changes to traditional lifestyle [81] . Similarly, vitamin D deficiency or insufficiency is a frequent concern for AMC living in Australia and Germany [85] [86] [87] . In contrast, AMC with body mass indexes (BMIs) indicating underweight problems are also reported in the literature, specifically in Canada [88] , Saudi Arabia [89] , Zaire [90] , Israel [91] , Kenya [92] , Scotland [60] , the United States [65] , and in migrants to Kenya, Ethiopia, Uganda, and Algeria [93] . Some authors credit weight issues to non-consumption of milk, low literacy of fathers, and having no immunisation card [94] .

To resolve nutrition-related concerns of AMC, host countries such as Australia have designed, implemented, and evaluated culturally competent obesity-prevention programs through community-partnered participatory approaches [95] . Likewise, lipid-based nutrient supplement programs have been implemented in Algeria [96] , nutrient-dense fortified spread programs in the United States [97] , and maize meal fortification in Zambia [98] . However, despite an increase of interventions, acute malnutrition remained prevalent in Somalia [99] , no significant change in haemoglobin with micronutrient powder was observed in Kenya [100] , and malnutrition rates for migrants to Zaire persisted [101] .

In total, 25 of the articles focus on the mental health of AMC . Post-traumatic stress disorder (PTSD) is linked to having experienced traumatic events such as war and violence [105] [106] [107] . Girls are more likely to develop this problem [107] . Other mental health issues among AMC in Israel include suicide ideation and alcohol abuse [108, 109] , anxiety, and depression [109, 110] . Similarly, in Uganda, exposure to violence is associated with higher symptoms of depression among AMC [111] , and the psychosocial well-being of AMC is impacted by the potential influx of refugees [112] . However, in Norway, AMC experience less stressful events compared to migrants from Asia [113] , and in Australia, the social-emotional well-being of AMC improves over time, with children who had four or more protective factors at low risk of poor social-emotional well-being [114] .

Many authors report issues of discrimination, racism, and emotional breakdowns experienced by AMC in the Netherlands [115] , Canada [116] , and the United Kingdom [117] . Likewise, behavioural problems are seen to arise with ambivalent acculturation patterns [105, 118] and negative perspectives on mental illness in AMC [119] . In Canada and Israel, some authors identify personal characteristics, interpersonal relationships, environmental characteristics, and the family as factors that influence AMC's identity and sense of belonging [120, 121] . In Italy, AMC who integrated into the national culture show higher self-esteem, life satisfaction, and socio-cultural competence relative to their non-integrated counterparts [122] . Despite the mental health concerns among AMC, contact with mental health services in destination countries such as the UK appears limited [123] .

Three articles discuss child trafficking among AMC [124] [125] [126] . Iyakaremye and Mukagatare [124] note that child trafficking is facilitated by the poor standard of living in the refugee camp, convoluted camp layout, and inadequate security system, which negatively impacts girls' reproductive health, social integration, and mental health. As a result, researchers in Rwanda found that stigma negatively impacted girls' access to health services [125] . Finally, Warria [126] concludes that cultural-responsive care becomes a highly important practice method for a child welfare practitioner when engaging with transnational trafficked children from diverse sociocultural, linguistic, economic, and ethnic backgrounds.

Overall, 23 of the articles included in this review examine birth outcomes, with less focus on the reproductive and sexual health of AMC . A higher prevalence of preterm births is seen in Portugal and Belgium [133] [134] [135] , while infant mortality is prevalent in places including Tanzania [136] , Canada [137] , Italy [138] , and South Africa [139] . Similarly, perinatal mortality in African migrant women is high in Sweden [140] and Belgium [135] . Birthweights of AMC vary across studies; for instance, some authors report low birthweights or high risk for low birthweights in Belgium, Israel, and Spain [141] [142] [143] [144] , whereas others note higher birth weights among AMC in these same countries and less likelihood of being born preterm or with low birth weight [145] [146] [147] . In the United States, researchers found new-borns to Somali immigrants are at increased risk for prolonged hospitalisation, lower 5-min Apgar scores, assisted ventilation, and meconium aspiration [148] . In contrast, other authors report no relationship between preterm birth and low birth weights [149] .

In terms of sexual and reproductive health, in Ethiopia, AMC reported multiple sources of sexual and reproductive health information including parents, peers, and religious leaders [150] . Migrants to Portugal reported difficulties talking about sex with parents, the tendency to begin sexual life early, and the infrequent use of condoms [151] . On the other hand, some authors report no evidence linking female circumcision to perinatal death in migrants to Sweden [152] and confirm the significance of non-therapeutic male circumcision in migrants to Spain [153] . In addition, the literature shows Somali girls accept but are less likely to complete the human papillomavirus (HPV) vaccine series [154] , and AMC in the United States who live in minority diversity neighbourhoods saw protective effects on infant health [155] .

A total of 19 articles discuss physical and developmental health [61, 95, 119, [156] [157] [158] [159] [160] [161] [162] [163] [164] [165] [166] [167] [168] [169] [170] [171] and shed light on AMC's growth and development. For example, AMC in Israel, the United States, and France are more likely to fail tests assessing fine-motor skill, linguistic, and socio-emotional domains [156] , and to have poor growth [61] and a low BMI [61] . In addition, AMC in the USA represent the majority of profound biotinidase deficiency (BTD) cases; however, none had partial BTD [157] . Conversely, AMC in Scotland grow to taller heights than Asian migrants [158] .

Ethiopian child migrants to Israel have lower rates of pervasive developmental disorder (PDD), compared to immigrants from other countries and native Israeli children [159] . AMC in Sweden and the United States have a high prevalence of autism spectrum disorder (ASD) [160] [161] [162] . In other receiving countries, some authors report familial challenges to the acceptance and understanding of child migrants' autism, which include cultural attitudes towards mental illness, behaviour, and disability, in addition to a lack of vocabulary to describe the disorder [163] . Additionally, AMC in Australia report a negative perspective on mental illness within the community, with 85% reporting bad perceptions of ASD [119] .

AMC in the Netherlands are significantly more likely to watch television for two or more hours per day, compared to native Dutch children [164] . East African migrants report a desire to be physically active, but migrants to both the United States and Australia face challenges to physical inactivity, including social, environmental, and cultural barriers [165, 166] . On the contrary, Somali child migrants to the United States are more likely to play soccer than other black peers; the girls have lower activity levels compared to black and white peers, but no differences are noted for boys [167] .

Non-communicable diseases such as neonatal jaundice [168] sickle-cell disease [169] , and Kawasaki disease [170] are common in AMC in Norway, Canada, and the United States.

In total, 17 of the included studies focus on oral health [61, 65, [172] [173] [174] [175] [176] [177] [178] [179] [180] [181] [182] [183] [184] [185] , with many examining the oral health of AMC in Israel. While some report an issue with missing teeth [172, 173] , others note low levels of caries, especially if the AMC has recently arrived [65, [174] [175] [176] [177] . Additionally, parents of AMC report less frequent daily toothbrushing and dentist visits, when compared to their Israeli counterparts [178] . Few or no dental visits are common among AMC in the United States [184] and Canada [179] . Dental abnormalities, poor oral hygiene, and prevalence of caries are also common among AMC [61, 181] Barriers to the prevention of early childhood caries are associated with home-based prevention, early detection, and health care access [182] .

Nine articles discuss respiratory health [61, [186] [187] [188] [189] [190] [191] [192] [193] . AMC in Israel, the United States, and the Netherlands report issues with asthma; however, most show a lower prevalence and better health-related quality of life, compared to local children [186] [187] [188] . Authors report issues with tuberculosis (TB) among AMC in the United States, Sweden, Israel, and Australia [61, [189] [190] [191] [192] [193] . The appearance of this disease has been linked to lower height-forage z scores [61] . AMC are typically diagnosed within three years upon arriving in the host country [190] , and asthma in young AMC (0-4 years) is frequently detected [190] .

Nine studies report on preventative health in AMC [30, 154, 156, [194] [195] [196] [197] [198] [199] . Paxton et al. [194] note that 97% of AMC have incomplete or uncertain immunisation status, while other authors suggest serological screening to update the immunisation status of AMC in Italy [195] . In Malawi, evidence shows AMC sometimes lack their second dose of measles vaccine [196] . Similarly, in the United States, girls generally accept initiating the HPV vaccine but less likely to complete the series [154] . In contrast, AMC in Israel and the United States have complete vaccination schedules [154] , and their antibody levels against many viruses are similar or higher than non-immigrants [197] . Regarding cardiovascular health, Colombatti et al. [198] declare a need for parental education in the native language on stroke risk and prevention of sickle cell disease (SCD) to increase compliance. Likewise, two studies point out the need for updated policies, education, and an increase of vaccine uptake or routine testing for antibodies [30, 199] .

Of the eight articles that report on endocrine health, four focus on type 1 diabetes (T1D) [200] [201] [202] [203] and four on thyroid pathologies [71, 204, 205] . The literature shows T1D is often present in AMC in host countries such as Italy, the Netherlands, and Sweden [200] [201] [202] , and that this issue often develops after arrival in host countries [200] . Further, AMC have a higher risk of T1D with increasing time their mother spent in the receiving nation [201] . In contrast, AMC in Finland have a similar prevalence of T1D as Finnish children [203] .

On the other hand, researchers report excessive iodine intake in infants in Algeria [204] and children suffering from endemic goitre likely caused by excessive iodine intake [205] ; a relationship between excessive iodine intake with thyroid dysfunction and poorer developmental status is reported [204] . Conversely, Ethiopian immigrants to Israel experience a high prevalence of goitre with a low frequency of hypothyroidism, which may be attributed to food goitrogens and iodine deficiency prevailing in Ethiopia [206] .

Eight of the studies included in this review analyse health care services [119, 123, [207] [208] [209] [210] [211] [212] . AMC in the UK indicate not having contact with health care services [123] ; AMC in Israel adopt Western practices and go to the clinic for medical treatment, but if this does not prove satisfactory, they seek out solutions according to familiar patterns from their country of origin for medical, social, or emotional problems [207] . Similarly, AMC caregivers in South Africa report dissatisfaction with health care services [208] , and AMC in Spain report a sense of pointlessness in seeking out health care services [209] . On the contrary, AMC in Australia have highly accessible primary care [119, 210] , and the major barriers to access are the availability of interpreters and lack of information [211] . For migrants to Uganda, proximity, maternal perceived severity of illness, financial resources, and permission from the father determine treatment access [212] .

Five of the included articles focus on haematology concerns [158, 169, [213] [214] [215] . For instance, Plotinsky et al. (2008) [213] note that blood lead levels (BLLs) of refugees are significantly higher than among non-refugee children. Similarly, Goel et al. (2009) [158] suggest nutritional iron deficiency remains the most common cause of anaemia in African immigrants. AMC in Canada represent 25% of all patients with SCD born abroad [214] : some authors suggest that early recognition and intervention may reduce this problem [215] . In addition, bilingual migrant children to Italy with SCD display a rate of cognitive impairment similar to their monolingual counterparts but have a more pronounced and precocious onset of language difficulties [169] .

In providing a comprehensive overview of the empirical evidence on AMC, this scoping review systematically synthesises the breadth, range, and nature of the evidence on the health of African migrant children across the globe. It is crucial to scope the literature on African migrant children to map the research in the field and gain more insight into the gaps in the literature. Due to our large time range (1967-2019), it is important to note that changes in policies over time may affect migrants. Our findings indicate that scholars have largely focused on the nutritional, mental, and infectious diseases of migrant children from Sudan, Ethiopia, and Somalia who are living in European countries such as Spain and Italy. Results from our review indicate most included articles utilise a quantitative approach, with only a few incorporating a theoretical lens to guide research. More qualitative and participatory action research studies are needed because these approaches are essential to amplify the voices of African migrant children further through research processes. While many of the studies included children as data sources, these were overwhelmingly quantitative. Only 10 studies were qualitative and gathered data from migrant and refugee children from countries in sub-Saharan Africa [112, 116, 120, 124, 125, 129, 132, 150, 166, 207] . The rest of the qualitative studies gathered data about children from parents or service provider participants. In addition, there is a need to focus on children as bearers of rights under the United Nations Convention on the Rights of the Child. For example, children have the right to have basic needs met and the right to access the necessities of a good life. Based on these discoveries, we make recommendations for practice, public health policy, and future research.

Evidence on African immigrants and refugees in a mental health care setting shows that, by actively involving study participants, researchers are able to ensure meaningful and culturally appropriate scholarly work [216] . Similarly, Murray et al. [217] found participant engagement in the research process positively influenced physical activity behaviour in East African communities in the United States; these engagements undoubtedly tap into communal agency, knowledge, and sense of belonging. Worth noting also is that many articles included in this review lack a theoretical framework. We, similar to others, argue that theory can permeate the entire research process, thus allowing intellectuals to enhance the plan, design, and evaluation of their investigations [218] [219] [220] . We suggest a theorydriven approach can add value to future research on AMC, including intervention work.

In 2017, of the 36 million African transnational migrants, 19 million live within the African continent, and the rest migrated transcontinentally; African migrants younger than 24 years of age made up 38% of the total number of migrants, over six million were migrant children, and about seven million were internally displaced [221] . Data from 2019 show African migrants and refugees continue to move within the African continent, with Egypt, Morocco, Algeria, and Sudan among the top sending countries and Cote d'Ivoire and South Africa the leading host countries [1] . Even though European countries continue to be the top destinations for African migrants who go pancontinental, other countries, such as Canada, have recently reported an arrival increase of African nationals [222] . Thus, further research is needed in countries that host large numbers of AMC, such as South Africa and Canada. Again, contrary to the long-publicised wave of African migrants moving away from the continent in the media, further research on African migrants within the continent itself is also needed because, as observed in this review, a relatively higher proportion of African migrants continue to be hosted in other African destination countries. In West Africa, for example, there is considerably more interaction among countries within the subregion due to the Economic Community of West African States (ECOWAS) free movement of people and goods protocol. Quite admittedly, however, destination countries outside the African continent are more unfriendly and unfamiliar for many migrants compared to those within Africa and, therefore, the health-related outcomes for many AMC outside the African continent may be graver than for those within the region but outside their countries of origin. Finally, the current global COVID-19 outbreak will undoubtedly have impacts on the health of AMC. Future studies are needed to understand these impacts and implications.

The results from this scoping review underline major issues that could be related to the health beliefs and cultural practices of migrant families that impact child health. Many scholars report the poor communication between AMC and their parents about sex, a lack of importance given to their oral health and dietary choices, and inadequacy of breastfeeding practices. These findings are consistent with other research on African immigrant populations, in which scientists have found traditional beliefs of African immigrant women interfere with exclusive breastfeeding during the first six months of a child's development [223] . Likewise, African immigrants in college culturally perceive American food as unhealthy, yet they become acculturated to it [224] . In contrast, Cooper Brathwaite and Lemonde [225] discovered that immigrants from Ghana and Nigeria rely on their health beliefs and cultural practices in the prevention of type 2 diabetes, and also preserve their culture through their food choices.

The articles included in this scoping review report on the experiences of AMC and the health care system. Studies show barriers across a range of destination country contexts include language barriers and a lack of translation services [226] , long wait times and dissatisfaction with care [11, 208] , and financial costs, especially concerning non-basic health care [11] . As explained above, migration and settlement journeys can impact health and access to care in new countries. Lack of status or proper documentation is an acute barrier to access. For example, even though children under six years of age in South Africa are entitled to health care regardless of status, they often do not have access to the necessary paperwork [227] .

Our results echo other research with immigrant populations, in which discrimination, racism, fear, cultural diversities, and the lack of effective communication with health care providers often lead to dissatisfaction towards health care services [228] [229] [230] . These barriers to African immigrant and refugee children's access to health care have demonstrable impacts on child health. Data from the United States show race and immigration status impact youth health in intersectional ways; specifically, many Somali immigrants and refugee children are not meeting Healthy People 2020 Objectives, scoring particularly low in mental health and healthy weight goals [231] . There is an urgent need for culturally trained practitioners, especially in areas high in migrants. Cultural competency interventions have been shown to improve a series of outcomes such as access to health care and patient outcomes [232] . Hence, we suggest the implementation of these interventions could help to improve the satisfaction of AMC with the health care systems in host countries by increasing awareness of cultural norms among health care providers.

Finally, childhood tuberculosis and latent tuberculosis are important topics to consider in African Immigrant children's health. However, this scoping review found little data concerning either diagnosis and treatment or prevention among this population. More studies are needed to fill this gap.

Our findings suggest a need to investigate other least researched health concerns of AMC. The World Health Organization [233] reported that, in 2015, pneumonia killed more than 900,000 African children under 5 years old, and about a quarter of all African adults had suffered physical violence during their childhood. Similarly, AMC to Europe are repeatedly exposed to maltreatment during their migration journey [234] . Child maltreatment can include physical, emotional, or sexual abuse, neglect, negligence, or exploitation. In this regard, we suggest the creation of policies aimed at providing health assessments for AMC to identify individualised health care needs as soon as possible. Health examinations should emphasise the newly arrived AMC and also involve continuous care. This is important because evidence shows recent immigrants present a healthy immigrant effect [235] . As UN Member States aim to achieve universal health coverage (UHC) by 2030, which is a critical part of the Sustainable Development Goals, it is imperative to optimise full access to the range of essential, quality health services, from health promotion to preventive, curative, and rehabilitative care.

This scoping review provides a comprehensive overview of the empirical evidence on AMC; however, it has its limitations. Due to the nature of the methodology, details of the included studies are not discussed in this article, nor is a formal critical appraisal or bias assessment available. Although we conducted a broad search, some articles might have been missed if they were published in other languages, used alternative keywords, were published in African journals not indexed in the databases searched, cultural sensitivity in service provision, climatic adaptation, and clothing support. Additionally, there is a limitation in considering only the experiences of sub-Saharan migrants and excluding those from North Africa. However, we make this distinction due to differences in culture between countries in North Africa and other regions. 

Insights into the 'healthy immigrant effect': Health status and health service use of immigrants to Canada

The healthy immigrant effect: Patterns and evidence from four countries

Healthy immigrant effect by immigrant category in Canada

Immigrant generation, assimilation, and adolescent psychological well-being

An internationally comparative study of immigration and adolescent emotional and behavioral problems: Effects of generation and gender

Incidence of psychotic disorders among first-generation immigrants and refugees in Ontario

Understanding the healthcare experiences and needs of African immigrants in the United States: A scoping review

African immigrant health

Changes in social status and postmigration mental health among West African immigrants

A qualitative study on African immigrant and refugee families' experiences of accessing primary health care services in Manitoba, Canada: It's not easy! Int

Migration Policy Institute. Sub-Saharan African Immigrants in the United States; Migration Policy Institute

Migration and social determinants of mental health: Results from the Canadian Health Measures Survey

Parenting practices of African immigrants in destination countries: A qualitative research synthesis

Adolescent risk behaviours and psychological distress across immigrant generations

An evaluation of the healthy immigrant effect with adolescents in Canada: Examinations of gender and length of residence

Psychological distress in refugee children: A systematic review

The mental health needs of refugee children: A review of literature and implications for nurse practitioners

Review of child and adolescent refugee mental health

Resilience of children with refugee statuses: A research review

Health needs of refugee children identified on arrival in reception countries: A systematic review and meta-analysis

Oral health status of immigrant and refugee children in North America: A scoping review

Guidance for conducting systematic scoping reviews

Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach

Scoping studies: Towards a methodological framework

PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation

Hepatitis A, B, C and D in a community in Italy of immigrants from NE Africa

Infectious diseases in sub-Saharan African immigrant children in Madrid

Follicular conjunctivitis caused by chlamydia trachomatis in an infant Saharan population: Molecular and clinical diagnosis

Seroprevalence of antibody to varicella among Somali refugees

Epidemic cholera among refugees in Malawi, Africa: Treatment and transmission

Outbreak of measles and rubella in refugee transit camps

Molecular tilizationion of measles virus strains among refugees from Central African Republic in Cameroon in 2014

An insight into the relationships between hepcidin, anemia, infections and inflammatory cytokines in pediatric refugees: A cross-sectional study

The epidemiology of Helicobacter pylori infection in African refugee children resettled in Australia

Helicobacter pylori, helminth infections and growth: A cross-sectional study in a high prevalence population

Associations between helicobacter pylori infection, co-morbid infections, gastrointestinal symptoms, and circulating cytokines in African children

Tinea due to trichophyton violaceum and trichophyton soudanense in

Tinea capitis outbreak among paediatric refugee population, an evolving healthcare challenge

Prevalence of undetected tinea capitis in a school survey in Spain

Prevalence of undetected tinea capitis in a prospective school survey in Madrid: Emergence of new causative fungi

High prevalence of tinea capitis in newly arrived migrants at an English-language school

Pediatric tinea capitis caused by Trichophyton violaceum and Trichophyton soudanense in Rochester, Minnesota, United States

Increasing tinea capitis prevalence in Stockholm reflects immigration

Prevention of human immunodeficiency virus mother-to-child transmission in Israel

Disclosure and planning for their children's future

Country of birth does not influence long-term clinical, virologic, and immunological outcome of HIV-infected children living in the Netherlands: A cohort study comparing children born in the Netherlands with children born in Sub-Saharan Africa

High seroprevalence of antibodies against Kaposi's sarcoma-associated herpesvirus (KSHV) among HIV-1-infected children and adolescents in a non-ethnic population

HIV infection in children born before and after immigration to Belgium

Country of birth of children with diagnosed HIV infection in the United States

HIV-1 Subtype diversity and prevalence of primary drug resistance in a single-center pediatric cohort in Germany

Imported malaria in children: A comparative study between recent immigrants and immigrant travelers (VFRs)

Malaria at the Hospital for Sick Children

Sensitivity of Plasmodium falciparum in vivo to chloroquine and pyrimethaminesulfadoxine in Rwandan patients in a refugee camp in Zaire

Selective ambulatory management of plasmodium falciparum malaria in paediatric refugees

Adherence to the combination of sulphadoxine-pyrimethamine and artesunate in the Maheba refugee settlement, Zambia

Malaria in immigrant and traveler children: Clinical presentation and risk factors for complications

Increasing Plasmodium falciparum malaria in southwest London: A 25 year observational study

Survey of intestinal pathogens from immigrant children

The prevalence of haemoglobinopathies, nutritional iron and folate deficiencies in native and immigrant children in Glasgow

Growth status and related medical conditions among refugee children in Massachusetts, 1995-1998

Should parasitic disease be investigated in immigrant children with relative eosinophilia from tropical and sub-tropical regions? Paediatr

Screening for intestinal parasites in recently arrived children from east Africa

The prevalence of ectoparasites in Ethiopian immigrants

Nutritional status of refugee children entering DeKalb County

Breastfeeding among Somali mothers living in Norway: Attitudes, practices and challenges

Breast-feeding and complementary feeding practices in the first 6 months of life among Norwegian-Somali and Norwegian-Iraqi infants: The InnBaKost survey

Infant feeding practices among Sudanese women now living in regional south east Queensland, Australia

Length of time in Ghana is associated with the likelihood of exclusive breastfeeding among Liberian refugees living in Buduburam

Thyroid function among breastfed children with chronically excessive iodine intakes

Infant feeding practices in the Saharawi refugee camps Algeria, a cross-sectional study among children from birth to six months of age

Diet quality of Moroccan adolescents living in Morocco and in Spain

Coeliac disease: A potentially treatable health problem of Saharawi refugee children

Risk factors of overweight and obesity among preschool children with different ethnic background

Food and nutrient intake among 12-month-old Norwegian-Somali and Norwegian-Iraqi infants

Enablers and barriers to dietary practices contributing to bone health among early adolescent Somali girls living in Minnesota

Child hunger: Its prevalence and association with body mass index and dietary intake among Somali refugee children in the United States

Food security and child hunger among recently resettled Liberian refugees and asylum seekers: A pilot study

Longitudinal changes and high-risk subgroups for obesity and overweight/obesity among refugees in Buffalo

Maintenance of traditional cultural orientation is associated with lower rates of obesity and sedentary behaviours among African migrant children to Australia

Obesity and undernutrition in sub-Saharan African immigrant and refugee children in Victoria, Australia. Asia Pac

Iron deficiency among children of asylum seekers in the Netherlands

Factors associated with childhood overweight and obesity among acculturated and new immigrants

Higher prevalence of vitamin d deficiency is associated with immigrant background among children and adolescents in Germany

High prevalence of asymptomatic vitamin D and iron deficiency in east African immigrant children and adolescents living in a temperate climate

Vitamin D deficiency in refugee children from conflict zones

Prevalence of nutritional deficiencies among populations of newly arriving government assisted refugee children to Kitchener/Waterloo, Ontario

Assessment of the nutritional status of Sudanese primary school pupils in Riyadh City, Kingdom of Saudi Arabia

Is mid-upper-arm circumference a useful tool for screening in emergency settings?

Ethiopian-born and native Israeli school children have different growth patterns

High levels of mortality, malnutrition, and measles, among recently-displaced Somali refugees in Dagahaley camp, Dadaab refugee camp complex

Iron and vitamin A deficiency in long-term African refugees

Nutrition status of children in Kasese district at the Uganda-Congo border

The healthy migrant families initiative: Development of a culturally competent obesity prevention intervention for African migrants

Rapid acceptability and adherence testing of a lipid-based nutrient supplement and a micronutrient powder among refugee children and pregnant and lactating women in Algeria

Spread fortified with vitamins and minerals induces catch-up growth and eradicates severe anemia in stunted refugee children aged 3-6

Maize meal fortification is associated with improved vitamin A and iron status in adolescents and reduced childhood anaemia in a food aid-dependent refugee population

An evaluation of supplementary feeding in Somali refugee camps

Relationship of the availability of micronutrient powder with iron status and hemoglobin among women and children in the Kakuma Refugee Camp

In the shadow of the volcanoes: The impact of intervention on the nutrition and health status of Rwandan refugee children in Zaire two years on from the exodus

Trace element concentrations in drinking water and urine among Saharawi women and young children

Comparison of the nutritional status of overseas refugee children with low income children in Washington State

From an imbalance to a new imbalance: Italian-style gluten-free diet alters the salivary microbiota and metabolome of African celiac children

The psychological impact of war and the refugee situation on south Sudanese children in refugee camps in Northern Uganda: An exploratory study

Trauma and mental health problems of Sudanese refugees in Uganda

Responses to conflict, family loss and flight: Posttraumatic stress disorder among unaccompanied refugee minors from Africa

Readiness to use psychoactive substances among second-generation adolescent immigrants and perceptions of parental immigration-related trauma

Suicidal ideation and alcohol use among Ethiopian adolescents in Israel

Meaning in life and suicidal tendency among immigrant (Ethiopian) youth and native-born Israeli Youth

The influence of caregiver depression on adolescent mental health outcomes: Findings from refugee settlements in Uganda

Protection and well-being of adolescent refugees in the context of a humanitarian crisis: Perceptions from South Sudanese refugees in Uganda

Stressful life experiences and mental health problems among unaccompanied asylum-seeking children

Protective factors for social-emotional well-being of refugee children in the first three years of settlement in Australia

Perceived group discrimination and psychological well-being in ethnic minority adolescents

A comparison of levels and predictors of emotional problems among preadolescent Ethiopians in Addis Ababa

Racism, ethnic density and psychological well-being through adolescence: Evidence from the determinants of adolescent social well-being and health longitudinal study

Problem behavior and acculturation in Moroccan immigrant adolescents in the Netherlands

Service access and perceptions for Somali Australian migrants at risk of autism

Navigating among worlds: The experience of Ethiopian adolescents in Israel

Development of personal identity among refugee adolescents: Facilitating elements and obstacles

Intercultural profiles and adaptation among immigrant and autochthonous adolescents

Psychological distress and mental health service contact of unaccompanied asylumseeking children. Child Care Health Dev

Forced migration and sexual abuse: Experience of Congolese adolescent girls in Kigeme refugee camp

It isn't that we're prostitutes": Child protection and sexual exploitation of adolescent girls within and beyond refugee camps in Rwanda

Challenges in assistance provision to child victims of transnational trafficking in South Africa

Stories of growing up amid violence by refugee children of war and children of battered women living in Canada

Individual, family and offence characteristics of high risk childhood offenders: Comparing non-offending, one-time offending and re-offending Dutch-Moroccan migrant children in the Netherlands

Internal body perceptions of Ethiopian Jews who emigrated to Israel

teacher and self-reported problem behavior in the Netherlands

Psychological acculturation and juvenile delinquency: Comparing Moroccan immigrant families from a general and pretrial detention population

Body-perception among Ethiopian-Israeli teenage girls

Decline in, and lack of difference between, average birth weights among African and Portuguese babies in Portugal

Birth weights of Black African babies of migrant and nonmigrant mothers compared with those of babies of European mothers in Portugal

High perinatal mortality rate among immigrants in Brussels

An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania

Infant mortality among the Canadian-born offspring of immigrants and non-immigrants in Canada: A populationbased study

Inequalities in infant mortality in Italy

Childhood mortality among former Mozambican refugees and their hosts in rural South Africa

Increased perinatal mortality among sub-Saharan immigrants in a city-population in Sweden

Too heavy, too late: Investigating perinatal health outcomes in immigrants residing in Spain. A cross-sectional study

Patterns of low birth weight in west Jerusalem with special reference to maternal origin

Are all immigrant mothers really at risk of low birth weight and perinatal mortality? The crucial role of socio-economic status

High birthweight in an ethnic group of low socioeconomic status

Relationship in Spain of the length of the gestation and the birth weight with mother's nationality during the period

High birthweights among infants of North African immigrants in Belgium

Birthweight differences among infants of north African immigrants and Belgians in Belgium

Increased risk of adverse pregnancy outcome among Somali immigrants in Washington State

Indicators of acculturation related to Somali refugee women's birth outcomes in Minnesota

Understanding the unique experiences, perspectives and sexual and reproductive health needs of very young adolescents: Somali refugees in Ethiopia

Adolescent's lifestyles, ethnicity and socioeconomic status in Portugal

Is there an association between female circumcision and perinatal death?

Non-therapeutic male circumcision performed on immigrant children from Africa in Spain

Completion of the human papillomavirus vaccination series lags in Somali adolescents

Exploring the health consequences of majority-minority neighborhoods: Minority diversity and birthweight among native-born and foreign-born blacks

Growth, developmental achievements and vaccines timeliness of undocumented migrant children from Eritrea compared with Israelis

High incidence of profound biotinidase deficiency detected in newborn screening blood spots in the Somalian population in Minnesota

Growth of immigrant children in the centre of Glasgow

A prevalence estimate of pervasive developmental disorder among Immigrants to Israel and Israeli natives

Prevalence of autism in children of Somali origin living in Stockholm: Brief report of an at-risk population

Prevalence of autism in children born to Somali parents living in Sweden: A brief report

Phenotypic characteristics of Autism Spectrum Disorder in a diverse sample of Somali and other children

It was like walking without knowing where I was going": A qualitative study of autism in a UK Somali migrant community

Ethnic background and television viewing time among 4-year-old preschool children: The generation R study

Barriers to participation in physical activity among south Sudanese children in South Australia: Parents' perspectives

Reducing physical inactivity and promoting active living: From the voices of East African immigrant adolescent girls

Physical activity patterns among Minnesota Somali adolescents

Neonatal jaundice and the immigrant population: A comparison study at a low-risk maternity ward in Norway

Intellectual function evaluation of first generation immigrant children with sickle cell disease: The role of language and sociodemographic factors

Incidence rate and epidemiological and clinical aspects of Kawasaki disease in children of Maghrebi origin in the Province of Quebec, Canada, compared to the country of origin

Growth rates of children of tilization African ancestry born to immigrant parents and of French children in Paris

The traditional practice of canine bud removal in the offspring of Ethiopian immigrants

Extraction of primary canine tooth buds: Prevalence and associated dental abnormalities in a group of Ethiopian Jewish children

Dental caries of refugee children compared with US children

Gaps in smiles and services: A cross-sectional study of dental caries in refugee-background children

Changing patterns of dental caries in Ethiopian adolescents who immigrated to Israel. Community Dent

Dental caries and its determinants among recent immigrants from rural Ethiopia. Community Dent

Oral hygiene habits, dental home, and toothbrushing among immigrant and native low socioeconomic class populations

Parental awareness and dental attendance of children among African immigrants

Caries and dental fluorosis in a western Saharan population of refugee children

Oral condition and background factors in Somali immigrant children newly arrived in Sweden

Is the wait-for-patient-to-come approach suitable for African newcomers to Alberta, Canada? Community Dent

Dental age estimation in Somali children and sub-adults combining permanent teeth and third molar development

Dental care issues for African immigrant families of preschoolers

Periodontal health among recent immigrants from Quara, rural Ethiopia and indications for periodontal health care

Asthma and the immune response to MMR vaccine viruses in Somali immigrant children: A cross-sectional retrospective cohort study

The second generation and asthma: Prevalence of asthma among Israeli born children of Ethiopian origin

Higher perceived HRQoL in Moroccan children with asthma and their parents

Tuberculosis infection and disease in the 2015 cohort of unaccompanied minors seeking asylum in Northern

Epidemiologic characteristics of pediatric active tuberculosis among immigrants from high to low tuberculosis-endemic countries: The Israeli experience

A prospective large-scale study of methods for the detection of latent Mycobacterium tuberculosis infection in refugee children

Interferon-gamma release assays can effectively screen migrants for the tuberculosis infection, but urgent, active cases need clinical recognition

Childhood tuberculosis in Israel: Epidemiological trends and treatment outcomes

East African immigrant children in Australia have poor tilization coverage

Italian tilization study found infectious and vaccine-preventable diseases in children adopted from Africa and recommends prompt medical screening

Measles outbreaks in the Mozambican refugee camps in Malawi: The continued need for an effective vaccine

Association of parental vaccination reports with measles, mumps, and rubella protective antibody levels: Comparison of Somali immigrant, Hispanic migrant, and US children in Rochester, Minn

Hydroxyurea prescription, availability and use for children with sickle cell disease in Italy: Results of a national multicenter survey

Transboundary nomadic population movement: A potential for import-export of poliovirus

Increasing prevalence and younger age at onset of type 1 diabetes in migrant than Italian children with type 1 diabetes: An emerging problem

The risk of type 1 diabetes among offspring of immigrant mothers in relation to the duration of residency in Sweden

Confirmation of high incidence of type 1 (insulin-dependent) diabetes mellitus in Moroccan children in the Netherlands

Prevalence and characteristics of diabetes among Somali children and adolescents living in Helsinki

Associations between thyroid dysfunction and developmental status in children with excessive iodine status

Endemic tiliz and excessive iodine in urine and drinking water among Saharawi refugee children

Goiter prevalence in children immigrating from an endemic goiter area in Ethiopia to Israel

Culture and health behaviour: The case of adolescent Ethiopian immigrants In Israel

Healthcare service delivery to refugee children from the Democratic Republic of Congo living in Durban, South Africa: A caregivers' perspective

Health promotion in the Moroccan child population in Spain: The healthy child program

Refugee children and their health, development and well-being over the first year of settlement: A longitudinal study

Demographics and utilisation of health services by paediatric refugees from East Africa: Implications for service planning and provision

The health of immigrant babies in an East African town

Risk factors for elevated blood lead levels among African refugee children in New Hampshire

The changing epidemiology of pediatric hemoglobinopathy patients in northern Alberta

The increasing prevalence of childhood sickle-cell disease in Ireland. Ir

The HEAAL project: Applying Community-Based Participatory Research (CBPR) methodology in a health and mental health needs assessment with an African immigrant and refugee faith community in Lowell

Somali perspectives on physical activity: Photovoice to address barriers and resources in San Diego

The central role of theory in qualitative research

There is nothing so practical as a good theory": A pragmatic guide for selecting theoretical approaches for implementation projects

The use of theory in research

UNICEF. Data Snapshot of Migrant and Displaced Children in Africa

Diversity of Black Population in Canada-An Overview

Language and Immigration Thematic Series

Breastfeeding beliefs and experiences of African immigrant mothers in high-income countries: A systematic review

Cultural beliefs, perceptions, and practices of young adult offspring of African immigrants regarding healthy eating and activity

Health beliefs and practices of African immigrants in Canada

Healthcare access challenges facing six African refugee mothers in South Korea: A qualitative multiple-case study

On paper" and "having papers": Zimbabwean migrant women's experiences in accessing healthcare in Giyani

Factors beyond the language barrier in providing health care to immigrant patients

Access to Norwegian healthcare system-Challenges for sub-Saharan African immigrants

Linander, I. Sub-Saharan African immigrant women's experiences of (lack of) access to appropriate healthcare in the public health system in the Basque Country

Who is meeting the Healthy People 2020 objectives?: Comparisons between racially/ethnically diverse and immigrant children and adults

Interventions to improve cultural competency in healthcare: A systematic review of reviews

Child Health; World Health Organization Regional Office for Africa

Journey for Children: The Migration Route from North Africa to Europe

The healthy immigrant effect and aging in the United States and other western countries

We acknowledge the work of several research assistants who worked on article selection for this project: Oluwakemi Amodu, Oghenevwarho Ojakovo, Alleson Mason, Siciida Ibrahim, Folakemi Ojo, and Iyanu Soyege. We also acknowledge the support of the following trainees with respect to data extraction and data analysis: Afrina Tasneem, Carolyne Dos Santos, Nicole Macleod, Beatriz Parreira Santos, and Olabisi Olagunju.

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.