Journal of Rehabilitation Medicine 51-11

862 L. V. Festvåg et al. a worldwide total of only 396 new polio cases in the period 2014–17 (6). In 2019, Afghanistan and Pakistan are the only 2 endemic countries in which wild polio vi- rus (WPV) transmission continues to be reported, with 34 cases, while 104 vaccine-derived cases (cVDPV) occurred in Nigeria and in non-endemic countries (6). Political conflicts and instability, combined with poor infrastructure and scepticism about Western health authorities and vaccines in some regions, continue to pose challenges to the eradication of the disease (3, 7). Disability as a result of polio still has profound social and economic consequences regarding employment, social class, income and marital status in developing countries (8, 9). The largest and youngest populations of people with polio today, approximately 4–5 mil- lion persons, live in non-industrialized developing countries, and many are children or of prime working age. Furthermore, polio occurs disproportionately amongst the poorest and most marginalized popula- tions, especially girls. They are the least likely to have received vaccines and often lack access to medical and rehabilitation programmes, job training, employment and social support (10). Persons with poliomyelitis from developing countries face multiple challenges when being referred to medical treatment in Western countries. Non-Western immigrants often have a complex psychosocial background, with little or inadequate treatment in the acute and rehabilita- tion phase (11). Qualitative studies in immigrant polio patients illustrate challenges associated with physical capacity, occupational performance, and strategies to gain respect and take an active part in a new and foreign society (12–14). The main aim of this study was to identify the specific challenges, regarding physical, mental and social fun- ctioning, for non-Western immigrants to Norway with previous polio. The findings were compared with similar functions in Western immigrants with polio, and with the findings of a previous study including native Norwe- gian polio survivors (15). The results should therefore elucidate the specific needs of immigrant polio patients. and who had acquired their acute poliomyelitis in that country (a total of 66 persons) were selected. This immigrant group was divided into 2: immigrants from non-Western developing countries (34 persons) and Western immigrants from developed countries (32 persons). The non-Western immigrant group comprised 11 men and 20 women; 3 persons did not answer the question regarding sex. They were all born in developing countries where poliomyelitis was endemic until the 1980s. The Western immigrant study group comprised 11 men and 21 women, from 14 countries in Europe, plus 5 from the USA (Table I). Two Western immigrants did not state their country of origin. No information was available on age at immigration to Norway. The reference group, or native Norwegian polio group, in- cluded 1,342 persons. Measurements The questionnaire included 87 items, covering a wide range of demographic, medical and psychosocial factors and data from the acute, rehabilitation and late phase of polio. The questionn- aire was designed by the Norwegian Society of Polio Survivors in collaboration with researchers, and based on earlier surveys (16, 17).The following assessments were included: Quality of life. Two questions from the quality of life scale LISAT-11 (18) were included, asking how the respondents perceived their physical and psychological health on a 7-point scale, ranging from “very unsatisfactory” to “very satisfactory”, including the category “not relevant”. Concomitant disease. A questionnaire containing 19 dicho- tomized questions (yes/no) regarding concomitant diseases was derived from a large-scale Norwegian population study (19), and the results were compared with a study on immigrant health in Norway (20). Table I. Continent and country of origin for non-Western and Western immigrant participants Non-Western immigrants with polio (n = 34) Continent of origin South America Mexico Peru Chile Africa Sierra Leone Somalia Uganda METHODS This study is based on a questionnaire that was distributed in January 2014 to all registered members of the Norwegian As- sociation of Polio Survivors (LFPS) (n = 1,998). One reminder was forwarded by post to non-responders. The response rate was 72%. The same questionnaire was sent to non-LFPS members with a polio diagnosis, who were registered by the South-Eastern Norway Health Authority 2010–14 (n = 152). These subjects were also reminded once (15). A web-link was set up (www. tns-gallup.no/polio2014) and the survey was advertised on social media, resulting in 23 additional responders. From the 1,408 persons who completed and returned the ques- tionnaire, those who stated that they were born outside Norway www.medicaljournals.se/jrm Country of origin Asia Middle East Burundi Madagascar Eritrea Ethiopia Gambia India Iran Cambodia Korea Afghanistan Vietnam Myanmar Syria Tunisia Morocco Iraq Lebanon Western immigrants with polio (n = 32) Continent n of origin Country of origin n 1 USA 1 Europe 1 1 1 1 Germany England Denmark Sweden Switzerland 5 2 2 5 6 1 Austria Island Kosovo Belgium Bosnia Scotland Netherlands Unknown foreign country 1 1 1 2 2 1 1 2 1 1 1 2 1 3 2 1 5 1 2 1 2 1 1 2 1

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