Urinary Tract Infection (UTI): Causes and Treatment

urinary package Infection (UTI) Ca substance abuses and Treatmenturinary nerve nerve folder is the approximately common organ to experience transmission which occurs from neonates to geriatrics. It account for 8.3 billion doctor visit each year and represent the second al near common infection in the human body (Sumaira Zarg one and only(a)f et al.,2009). By the patterned advance of age, the attack of UTI increases in men referable to prostate en bouffantment and neurogenic bladder. Recurrent infections atomic number 18 common and will cut to irreversible monetary value of the kidneys, which result in renal hypertension and renal failure in severe cases. In fellowship, women ar to a great extent prone to develop UTI and 20% of women experience a iodin episode of UTI during their lifetime and 3% of women whitethorn have more than than than one episode of UTI per year. Pregnancy as well makes them more sensitive to infection. Catheter-associated UTI is a trenchant p roblem and bacteriuria is found in 5% of catheterised diligents (Das R N et al., 2006). Urinary packet infection refers to the front man of microbes in the urinary bundle. The frequency of pathogens varies upon hospitalization, sexual converse, and catheterization (Getenet B et al., 2011). About 150 million people atomic number 18 diagnosed for having urinary tract infection with a rattling high risk of morbidity and mortality (Raza S et al., 2011).Urinary tract infection is found more in women when comp bed with men the reason whitethorn be due to anatomical structure or be stimulate of the urothelial mucosa adherence to the muco polysaccharide lining or due to other factors (Tampekar et al., 2006). Urinary tract infection is second only to respiratory tract in acquiring microbic infections (Raza S et al., 2011).Classification of Urinary Tract InfectionUrinary tract infection whitethorn be classified as speeding urinary tract infection and lower urinary tract infection. agree to the give commit, if its bladder then its called cystitis, if the bacterium is in the kidney then its called pyelonephrites, if its in urine the term bacteriuria is employ (Getenet B et al., 2011). Manifestation of genitourinary tract infection vary from mild characteristic cystitis to pyelonephrites and finally to septicaemia. Pyelonephrites ar the sequelae of untreated or inadequately treated lower UTI and the most common name of hospital admission during pregnancy and which lead to preterm labour(Jamie et al .,2002). Urinary tract infections are further divided into complicated and unsophisticated infections. Uncomplicated infections are those with no precedent instrumentations and complicated infections are those that have code instrumentations such(prenominal)(prenominal) as indwelling, urethral catheters and it take structural and functional abnormalities (Getnet B et al., 2011). over again UTI is classified as participation acquired and hospital acquire d (nosocomial). In community acquired UTI single species of bacteria is found and the existences are Escherichia coli, P.mirabilis, Pseudomonas. Hospital acquired UTI is often due to multi do medicines large-minded strain in this similar existence but greater preponderance of Streptococci or Klebsiella is seen (Sujit K Chaudhuri., 2001).Defnition of the precise terms in Urinary Tract InfectionSignifi throw outt bacteriuriaIt is define as the presence of 100000 bacteria per mL of urine.Asymptomatic bacteriuriaIt is outlined as pregnant bacteriuria in infected patients with the absence seizure of symptomsCystitisIt is defined as a syndrome of frequency, dysuria, want in which the infection is limited to bladder and urethra.urethral syndromeIn Urethral syndrome a conventional pathogen is present and its a syndrome of dysuria, frequency in the absence of signifi atomic number 50t bacteriuria. swell pyelonephritesIt is an acute infection in one or both the kidneys.Chronic pyelone phritesIt may be due to the continuous riddance of bacteria from kidney or the recurring infection of the renal cell or due to a specific pathology of both kidneys.Relapse and reinfectionRelapse is defined has the recurrence of infection by the same organism which intiated original infection. Reinfection is defined as the recurrence of infection by a impudently organism (Roger handcart et al., 2003).Several studies have demonst considerd geographical variability of Pathogens occurrent among UTI inpatient and outpatient is limited by the predominance of gram negative organisms. The most frequent pathogen isolated is Escherichia coli which accounts for somewhat 50% to 90% of all uncomplicated infections (Tampekar et al., 2006). In complicated urinary tract infection and hospitalized patients, organisms such as Enterococcus faecalis and highly distasteful gram negative rods including Pseudomonas are most common (Getenet B et al., 2011).Aetiology and microbiologyThe most common c ausative organism of uncomplicated UTI is Escherichia coli be system more than 85% cases, followed by staphylococcus saprophyticus (coagulase-negative staphylococcus) accounting to nearly 15%.The pathogens in complicated UTI or nosocomical infections are Escherichia coli accounting 50%, Proteus, Klebsiella pneumoniae, Enterobacter, Pseudomonas aeruginosa, Staphylococci and Enterococci (Barbara et al., 2008).A very rare cause of urinary tract infection intromits anaerobic bacteria and fungi and sometimes viruses which are detected by culture and nucleic acid amplification method.Abnormalities of the urinary tract such congenital anomalies of ureter, renal stones, enlargement of prostrate in men are other causes for urinary tract infection (Roger walker et al., 2003).Pathophysiology of UTI (Barbara et al., 2008)The urinary tract holds two pairs of kidneys, ureter, bladder and urethra. Urinary tract infection are defined as infections at any level of the urinary tract which include ,Upper urinary tract infection (Pyelonephrites)Lower urinary tract infection ( Cystitis, Urethritis)Combination of above twoThe bacteria do UTIs originate from bowel flora of the host. It can be acquired via three attainable routesAscendingHaematogenousLymphatic pathmodal valuesIn females the short length of the urethra and proximity to the perirectal bailiwick lead to the colonization of bacteria. The organisms enter the bladder from urethra and multiply and can prove the ureters and ascend to the kidneys.Factors that determine the phylogeny of urinary tract infections areThe size of the inoculumsVirulence of the microorganismsCompetency of the natural host defense mechanisms.Important virulence factors of bacteria are their ability to adhere to urinary epithelial cells by fimbriae. Others include haemolysin, a cytotoxic protein recruitd by bacteria which lyses a large range of cells including erythrocytes, monocytes, and polymorph nuclear leukocytes.Clinical presentationPa in or importunate when you using bathroomFever, tiredness or shakinessAn urge to use the bathroom often and oftenPressure in the lower swell upUrine that smells bad and looks cloudy or reddishNausea or ass painLower urinary tract infection Dysuria, urgency, nocturia, increase frequency of urinationUpper urinary tract infection Fever, annex pain, vomiting malaise.Clinical investigation (Roger walker et al., 2003)Laboratory diagnosis is happy when an uncontaminated urine sample is obtained for microscopy and culture. The respective patients contain to instruct to produce mid stream urine sample (MSU) and then its collected into a sterile aliquot and then delegatered into the specimen pot and finally is submitted to the lab.DipsticksIt is a rapid testing for urinary air, nitrites, proteins and leukocyte esterase. The colour changes are assessed.MicroscopyIt is the first timber in the diagnosis of urinary tract infections. Urine is placed on a slide and then covered with a c over skulduggery and is examined under lens 40x.CultureThe patients urine is streaked in agar medium and is incubated for 24 hours at 370C and identify the single bacterial species which as initiated the particular infection.Treatment of UTINon specific treatmentUrinary tract infected patients are advised to drink a lot of fluids, this practice is on the basis that the bacteria is removed by frequent bladder emptying. Urinary analgesics such sodium citrate which will alkanize urine is utilise with antibiotics as an adjunct therapy (Roger walker et al., 2003).Pharmacological treatment of UTIantibiotics are commonly utilize in Urinary tract infections. The modes of action of antibiotics may be,Inhibition of bacterial Cell Wall SynthesisInhibition of Cytoplasmic Membrane go awayInhibition of Nucleic Acid SynthesisInhibition of Protein SynthesisControl of microbic EnzymesSubstrate Competition with an Essential Metabolite (Barar F. S. K., 2007)UTI are mainly treated with immense sp ectrum cephalosporins, Fluroquinolones, and Aminoglycosides. Cephalosporins are cell wall inhibitors which are commonly used for treating urinary tract infections caused by Gram negative organisms. It include Cefotaxime, Cephradine, Ceftazidime etcetera Flouroquinolones act by inhibiting the activity of desoxyribonucleic acid gyrase and topo isomerase which are the enzymes compulsory for bacterial DNA replication and it includes Ciprofloxacin, Ofloxacin, Enoxacin. Aminoglycoside act by inhibiting bacterial protein synthesis it include Gentamycin, Kanamycin, Amikacin etc (Farhat Ullah et al., 2009).Oral therapy in urinary tract infection is Sulphonamides example (TMP-SMX) PenicillinS which include Ampicillin, Amoxicillin- clavulanic acid. Cephalosporins example Cephalexin, Cephadrine. Tetracyclines example Doxycycline, Minocycline. Fluroquinolones example Levofloxacin, Nitrofurantine. Parentral therapy is done with Carbapenems example Imipenem-Cilastatin. Aminglycosides example Ami kacin, Gentamycin (Barbara et al., 2008).2.9 Treatments of infections of urinary tract(S.D Seth et al., 1999)Treatment of Lower Urinary Tract InfectionsSingle-dose Trimethoprim -Sulphamethoxazole (400mg+2g) are used to treat acute uncomplicated episode of cystitis.Acute urethritis can be treated with Doxycycline 100 mg twice a twenty-four hour period for 7 grand time.Single dose therapy must be certified in patients where symptoms are present for less than 10 days. In more complicated cases s take down days therapy with antibiotics should be given and alternatively broader spectrum antibiotics are used.Treatment of upper Urinary Tract Infections10-14 day course of Trimethoprim-Sulphamethoxazole, Trimethoprim in a single dose, Cephalosporins, or Aminoglycoside gives adequate therapy. If recurrence occurs then the patient should be investigated for calculi and other urologic disease.Treatment of Urinary Tract Infections during PregnancyAcute cystitis during pregnancy is treated w ith Amoxicillin, nitrofurantoin,or Cephalosporin for 4 days.Acute pyelonephtites is managed generally with Cephalosporin or extended spectrum Penicillin.Treatment for Recurrent Urinary Tract InfectionsIn this a drug capable of achieving high tissue concentration is needed.7-14 days high treatment is given.Treatment of Asymptomatic InfectionsAsymptomatic bacteriuria is confirmed by a minimum of two positive cultures. An oral therapy for 1 hebdomad with the most sensitive agent is given primarly.Treatment for Catheter Associated Urinary Tract InfectionAsymptomatic bacteriuria in catheterized patients is non treated if they are non at a high risk of sepsis.Treatment for ProstatitisThe pathogen found in this is mainly Gram Negative Bacilli. Trimethoprim- Sulphamethoxazole, Erythromycin, Ciprofloxacin can penetrate prosthetic tissue and are mostly impelling. If Cocci are found cloxacillin may be given.Chemoprophylaxis of Urinary Tract InfectionsIt is indicated to patients with a very frequent symptomatic infection. A single dose Trimethoprim-Sulphamethoxazole (80mg TMP+400 mg SMZ) or Nitrofurantoin (50 mg) is found to be effective.Drug safeguard (Michelle.A.Clark et al., 2012), (Barar F.S.K 2010).Bacteria are state to be resistant to an antibiotic if the maximal level of that antibiotic which can be tolerated by the host does not alter the bacterial growth. bacterial resistance to antibiotics may be either indwelling or Acquired.Natural resistanceNatural resistance is genetically determined and it depends upon the absence of a metabolic process which is affected by the respective bacteria.Acquired resistanceAcquired resistance is the resistance which is seen in a previously sensitive bacterial pathogen and it involves a very stable genetic change which is heritable from one extension to another generation. The common mechanism is by mutation, adaptation, or by the evolution of multiple drug resistance which is as a result of transfer of genetic material from bacteria to bacteria by transformation, transduction, or conjugation. microbic species which are normally responsive to a particular drug may develop more virulent, resistant strains due to,Genetic accommodationsSpontaneous mutations of DNADNA transfer of drug resistanceB) Altered expression of proteins in organismModification of scrape rangeDecreased accumulationEnzymtic defusingA) Genetic alterationsAcquired antibiotic is due to the temporary or permanent alteration of organisms genetic information.Spontaneous mutation of DNAChromosomal alteration occurs by insertion or substitution of one or more nucleotides indoors the genome. The mutation may be lethal to the cells. If the cells survive it will double up and transmit its mutated properties to other cells.DNA transfer of drug resistanceIt occurs due to DNA transfer from one bacterium to other. Resistance gene are plasmid mediated and can be incorporated into host bacterial DNA.B) Altered expression of proteins in organism It occurs by variety of mechanisms, such as a deficiency of or alteration in target site, increase efflux of the drug or by the expression of antibiotic inactivating enzymes.Modification of target sitesThe change in the antibiotic target site through mutation can lead to resistance. Example, S pneumonia resistance to beta lactums involves alteration in one or more of major(ip) bacterial penicillin binding protein.Decreased accumulationIf the drug is unable to attain find to the site of its action to kill the organisms resistance confers.Enzymic inactivationThe ability to degrade antibiotic agent by the pathogen can confer resistance. Antibiotic inactivating enzymes includea) beta lactamases (Hydrolytically inactivate beta lactum ring of penicillin)b) Acetyl transferases (Transfer an acetyl conference to antibiotics)c) Esterases (Hydrolyze the lactone ring of macrolides)Antibiotic toleranceThe term antibiotic tolerance is used when the antibiotic merely inhibits its multiplicat ion and growth but no perennial kills the microbial pathogen. Tolerant microbial pathogen starts to grow by and by antibiotics are stopped. stain resistanceIt is defined as a phenomenon in which bacteria resistant to one drug is resistant to another drug to which the bacteria is not exposed before.Examples are Neomycin and Kanamycin.Prevention of drug resistance (K.D Tripathy 2006)indiscriminate and prolonged use of antibiotics should be stopped it will minimise resistant strains so there will be less chance to preferentially propagateRapidly acting and narrow spectrum antibiotics should be preferred. Broad spectrum is used when a proper one cannot be determinedWhen prolonged therapy is needed use combination of Anti microbial agentsTreatment should be intensively done for the infections by organism which develops resistance Example, Staphylococcus aureus.Evaluation of urinary tract pathogen and principles of antibiotic dosing (Michelle.A.Clark et al., 2012), (Sharma H L et al 201 1)The traditional way for the evaluating urinary tract pathogens is urine culture and antibiotic susceptibility testing. The major drawback of current microbiological compendium is time lapse of more than a day (Vesna Ivancic et al., 2008). The five grand characteristic which influence frequency of dosing of all antibiotics are, stripped inhibitory concentration (MIC)It is the lowest concentration of antibiotic that inhibit bacterial growth. To have effective therapy the clinically obtainable germicide concentration should be greater than MIC.Minimum bactericidal concentration (MBC)It is the lowest concentration of antibiotic agent that results in 99.9% decline in colony count after incubation.Concentration drug-addicted sidesplitting effect CDKEAntibiotics are most effective when higher blood concentration is reached periodically. These bactericidal antibiotics are said to be concentration -dependent killing (CDK). In drugs whose killing action is CDK the extent and rate of ki lling increases with increase in drug concentration. Examples Amino glycosides, Fluroquinolones.Time dependent killing effect TDKEAntibiotics are most effective when the blood concentrations are maintained above the minimum inhibitory concentration for the maximum long duration possible. These bactericidal antibiotics exhibit time -dependent killing (TDK). In drugs whose killing action is (TDK) the activity of antibiotics continue as long as blood serum concentration are maintained above the minimum inhibitory concentration. Examples Vancomycin, Beta Lactums.Post -antibiotic effect PAEA suppression of bacterial growth which is continual after a brief exposure to antibiotics agents is said to be post-antibiotic effect. In post antibiotic effect the suppression or inhibition of bacterial growth is found even when the bacterial agent is no interminable present or its concentration is very less than MIC. Examples of drugs which show world-shattering PAE are Tetracycline, Amino glyco sides.The aetiology of UTI and the antibiotic susceptibility of uropathogens have been ever-changing over the past decade. The extensive uses of antibiotics have invariably resulted in the development of resistance which has become major problem in new-fangled years. Antibiotic treatment which are of shorter duration than required, and the treatment administered without considering antibiotic and organism aesthesia as resulted in more resistance in bacterial strains (Mohammed Akram et al., 2007), (Eshwarappa M et al., 2011). To find out the most effective empirical treatment, investigating the epidemiology of UTI is a fundamental approach to guide the expected interventions (Getnet B et al., 2011). Since the distribution of microbial pathogens and their susceptibility is variable regionally and it is necessary to have a friendship of uropathogens and sensitivity in a particular setting (Muhammed Naeem et al., 2010).The selection of antimicrobial agents require the side by side( p) knowledge,The organisms identityThe organisms susceptibility to particular agentThe site of the infectionPatient factorsThe safety of the agentThe cost of therapyHowever, in critically ill patients need immediate treatment i.e. the therapy is initiated soon after specimens for laboratory analysis have been obtained before the culture result and selection of drug is influenced by the site of infection and patients history or by the association of particular organismPrevention and prophylaxis (Roger Walker et al).Cranberry juiceIt has been thought secure for the prevention of urinary tract infections. The benefit of drinking cranberry juice or else of antibiotics has reduced resistance of bacteria.Antibiotic prophylaxisIt is indicated to patients who are having reinfections. If the reinfection is after sexual sexual intercourse then after intercourse a single dose of antibiotics is taken. In other cases low dose is beneficial.Patient counselling of UTIDrinking band of clear liq uids will keep urine diluted.Good personal hygienics following urination and bowel movements. Cleaning self front to back from vagina to anus.Urinate frequently to wash out bacteria that may be present, avoid holding urine for prolonged periods of time.Urinate after intercourse to wash out bacteria that may have been introduced into the urethra.Avoid exhausting tight jeans, wet bathing suites.Present scenario of UTINew studies reveal that the risk of urinary tract infection is high among boys who has not circumcised and had a microscopical urethral meatus.Another line of UTI research has indicated that women who are non-secretors of certain blood group antigens may be more prone to recurrent urinary tract infections because the cells lining the vagina and urethra may allow bacteria to attach more easily.Scientists have worked out an effective new approach to treat urinary tract infections (UTIs) by dumping antibiotics. It involves so-called FimH antagonists, which are non antibiot ic compounds and would not contribute to the growing problem of pathogens resistant to antibiotics.Barriers to integration Refugees in new countriesBarriers to integration Refugees in new countriesBackground 1.1 Settlement of Refugees in AustraliaAustralia has been cave in refugees for more than a century. As per official records, settlement history begins in 1839, recording the arrival of Lutherans. Nevertheless, Australias modern approach to refugee settlement began with a new national refugee policy in 1977. It has, now, become a designated relocation country for refugees and it receives a designated number of refugees on annual basis as on the agreement with UNHCR. According to the best estimates available, 2009-10 was the year in which Australia, since becoming an independent nation, passed the 750,000 mark in its intake of refugees and human-centered entrants.In recent years, the incidents of persecution, conflict, generalized violence and human rights violation have si gnificantly increased in Democratic Re public of the Congo, Mali, Syria, Iran, Afghanistan, Sri Lanka, and the border between Sudan and South Sudan. surprisingly Australia has reduced its Refugee and Humanitarian political platform to 13, 750 places while there is a considerable possibility between resettlement needs and available places worldwide.At this point, it is important to acknowledge current refugee settlement issues in Australia. In general, settlement issues rejoin into four main categories as followsIn addition to these main categories, if we go further deeper into the setting, it is obvious to see another horizon of challenges fall into following areasFamily and YouthLegal and Financial federation RelationsSecuring a meaningful occupation is a truly challenging task among refugees mainly because of their neediness of knowledge about Australian work place culture, no prior work experience in Australia, inadequate processs to support employment transitions, discrim ination, racism, lack of English proficiency, inability to get access to job market, and problems in recognizing overseas skills, experience and qualification.Finding an affordable house becomes a good issue due to the competition in private rental market. letting and retaining the house have equal consideration as finding the house. dissimilitude and racism appear again as opposing factors. Moreover, financial ruin of refuges, size of families, their lack of Australian rental history, and unawareness about occupation rights and responsibilities can be said as reasons for housing difficulties during their settlement.Educational barriers are different system of education, different languages, inadequate induction and support, high analphabetism among refugee communities, disruption of schooling for younker people and enrollment found on age rather than knowledge. Inconsistency in policies and practices results in ignoring needs of young people with disrupted education.Health is sues are normally caused by family insularity, their prior experience and trauma, lack of social networks and consequent isolation. All of the above issues (Employment, lodgment and Education) negatively affect the health and mental wellbeing of these communities. We can find out a great demand for interpreters in health sector since they are often required in counseling and consultation.Integrational conflicts and cultural shocks attempt to constipation family relations and peoples values. For an example, younger ones adapt more quickly and it leads to mis accord and confusion within families. Parenting becomes more challenging. Cultural clashes affect spousals relationships in a negative way and ends up in separation and divorces. Domestic violence and family breakdowns seem to be common in refugee communities. On the other hand, there are serious concerns about unaccompanied minor league and single mothers with many children. When it comes to youth, due to their prior refu gee experience, limited education or work experience, cultural dislocation and pass of established social networks lead them to frustration. Resulting frustration has its own dangerous consequences such as involving in banned activities.Most of the refugees who come from war torn countries see the police as an oppressive authority. This viewpoint often creates misunderstanding between police and refugee communities. racism does its part to damage this relationship worse than we assume. Refugees are in need for legal advices regarding their visa process, financial arrangements and documentations. Cultural incompetency of legal advisers and refugees lack of knowledge of legal systems can be highlighted under this area.Community relations between refugee communities and host communities are influenced by myth about refugees, cultural misunderstanding, discrimination and racism. These factors prevent both communities to create wider interactions for better understanding between them. Without a positive cooperation from local anesthetic community, it is difficult to succeed in settlement.All these main categories and areas of settlement issues repeatedly highlight a gap between refugee communities and local community. And a detachment between refugees and local systems is also visible. These gap and detachment practically become great barriers for a silent integration and successful settlement of refugees in Australia.1.3 Problem digestestablish on our background research on the settlement of refugees in Australia, we developed our initial problem tree. It was used as a draft during apt consultations. Its insightfulness helped us finding missing pieces if information and guided us to further research. Obviously the gap between refugee communities and local community in concert with local systems directly or either indirectly poses challenges to almost every problem we identified. Therefore, we identified community isolation as our focal problem. citation wit h refugee experts who have refugee backgrounds as well as remarkable experience from works with refugees settling in Victoria, particularly in South East of Melbourne, gave us clear picture of current settlement issues. Some of the case studies based on City of Greater Dandenong showed us a multiple dimensions of already identified problems. Our finalized problem tree, after sorting out the problems, is given below. common misunderstanding was identified a crucial factor to discrimination. Some of the politicians and media hunt down an important role in creating a negative image for refugees. For an example, if a refugee is accused to be involved in a crime scene, they fool away the news by highlighting the background of this particular refugee community and keystone a red color on the rest of the community without considering the consequences. In fact, these sort of careless actions widen the gap between local community and refugee communities. It is evident to see lack of conf idence among refugees mainly due to cultural alienation, past refugee experience, language incompetency and lack of knowledge of local context and local systems. Considering the cultural alienation, it is happened to be the outcome of difference between the remarkable characteristics of different cultures. Australians can be identified with individualism, lack of social coherency and materialism whereas most of the refugee communities can be characterized as collectivist societies. coarse understanding is necessary to promote better understanding of these differences and that requires considerably a long time.Among the effects of community isolation, identity crisis is something which has profound effect even on other effects either directly or indirectly. But, normally, it doesnt get enough attention from settlement programs. Acculturation means that members of one cultural group adopt the beliefs and behaviors of a dominant group. It can be reciprocal but in case of refugees it is only one way. It causes loss of separate ethnic identification. People feel a sense of impotency as a result. Psychosocial repercussions heavily damage human personality. As a result, refugees look at perceived curses, it can be either certain or even imagined, in their lives and recognize it may require resources we dont have. It includes threats to their social status, social esteem, acceptance within the society and threat to their self-worth. In long time, all these effects create social differ which is not good for both local community and refugee communities. 1.4 Objective AnalysisAt the end of the objective analysis, we came up with positive results, but not for each of the identified problem statements. We left a question mark for racism as it cant be directly addressed. cipher is going to accept that they are racist. Therefore, we decided to better leave it entirely in the objective tree and reduce its impact indirectly from promoting public understanding. Objecti ve tree was adjusted with some rearrangements with optimistic conditions.Alternative analysis pointed out the ongoing programs and projects by AMES, state government and other service providers in the area of employment, housing, language, education and future promises to improve current refugee and humanitarian programs. At this point, it is important to acknowledge Community Guides Program, Luv-A-Duck project and Ucan3 Youth Program of AMES as well as its support to social enterprises such as Sorghum Sisters, Cultural Cooks and Global Caf, and support for community initiatives. We noticed lack of attention on the refugees rights and their cultural rigorousness.It was finally decided to promote community engagement by increasing the level of confidence among refugees and creating social tweet with public understanding. Community Engagement will create cultural validity for refugee communities by providing them greater opportunities for social networking. Mutual understanding betw een local community and refugee communities would have positive impact in long-term and that would whence bring social harmony in the City of Greater Dandenong.