Migration and health in developing countries

Einleitung / Introduction

The government of Burundi introduced a novel self-injectable family planning method. The government integrated the new contraceptive product into the standard package of services but acknowledges that it will take some time until health workers are familiar with the new product in order to provide effective guidance to women on how to administer the self-injectable. So far, specialized professionals have continued to be in charge of administering injectables in the communities. Despite free service provision, contraceptive demand may persist at a low level due to the risk of social isolation associated with contraception utilization. The reason for this is that the specialized staff come from outside the communities to deliver any contraceptive method. As non-community members they are easily identified by villagers as contraceptive service providers which makes it likely that other community members infer the contraceptive status of a women. Women are ashamed and afraid of being seen by others when seeking family planning services because contraception is socially condemned on cultural and religious grounds. Women who use contraception risk social isolation and rejection by friends and neighbors if their actions become known to others.

Methode / Method

In the context of a large-scale field experiment, the government aims to examine the demand effects of, in a first step, tasking community health volunteers, who are typically members of the communities, with providing the self-injectable in the homes of women. Only if this step proves successful, women will ultimately be trained in self-administering the new product. The advantage of administering the contraceptive injection through the community volunteer (and not the specialized staff) is the associated privacy because home visits of volunteers take place on a regular basis for a variety of matters. The experimental sample is composed of 138 health centers which are equally split into the treatment and control group through a randomized allocation procedure. The National Health Information System (NHIS) is the primary source of data which includes information on the quantity of each contraceptive delivered on a monthly basis at the health center level.

Ergebnisse / Results

While penetration of the recently introduced contraceptive method was shown to be statistically similar across the two groups in the baseline period, our results point to a significantly higher uptake among health centers in the treatment group after training was rolled out. We find that the number of Sayana Press injections administered in treated health centers was, on average, 62% larger than that experienced by the control counterparts in the period since the start of the intervention (April 2022) until the last month with available information (August 2023).

Authors

Arndt Reichert

Einleitung / Introduction

Diabetes is a rapidly growing public health concern, reaching an epidemic proportion globally. Socioeconomic inequalities in health are well known, however, evidence on inequalities for diabetes and its risk factors across major socio-economic groups are unknown in rural populations of low- and middle-income countries such as India. This study aimed to assess the inequalities in the prevalence of diabetes and its risk factors by gender and socio-economic position in a rural district of northern India.

Methode / Method

Data from a large cross-sectional survey of 38,441 participants (aged ≥20 years) from Solan District, Himachal Pradesh, India, selected using representative, community-based sampling from 2013 to 2014 were analysed to assess the socio-economic inequalities in the prevalence of diabetes and its risk factors. Diabetes was defined as self-reported or diagnosed if the fasting blood glucose was ≥126 mg/dl. The socioeconomic indicators of the individual were education and occupation, and at the household level, the household income and wealth index of household assets. Standardized measurements were taken for height, weight, and waist circumference, and validated tools were used to assess physical activity, smoking, and alcohol use. Inequalities were assessed using the slope index of inequality, relative index of inequality, and concentration index (regression-based indices used to illustrate the magnitude of one’s socio-economic position as a source of inequalities in health).

Ergebnisse / Results

Overall, 3.4% (n=1309) of the rural population reported having diabetes. The inequalities in the prevalence of diabetes and risk factors varied by gender and the measures of socio-economic status (education, occupation, income, and wealth index) used. We observed a negative concentration index for the prevalence of diabetes (-0.14), impaired glucose tolerance (-0.11), high body mass index (BMI: ≥30Kg/m2) (-0.032) and waist circumference (>102 for men, >88 for women) (-0.14), insufficient physical activity (-0.05), smoking (-0.20), and alcohol use (-0.049) with increasing education level, i.e., diabetes and its risk factors were concentrated more among people with lower levels of education (p <0.05). However, at the household level concentration index for the prevalence of diabetes, high BMI, and high waist circumference were positively associated with greater wealth index: 0.18, 0.21, 0.14, respectively (p <0.05).

Zusammenfassung / Conclusion

Our data show a variable relationship between socioeconomic status and prevalence of diabetes and its risk factors in rural India, suggesting a shift in the prevalence of diabetes risk factors among disadvantaged rural populations. Strategies to prevent and control diabetes must focus on targeting higher-risk groups (based on sex and socioeconomic status) in rural population as observed in this study.

Authors

Kavita Singh, Heidelberg University, Germany

Manuela De Allegri, Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany

Einleitung / Introduction

Persons with a direct migration background made up a share of around 17% of the total German population in the year 2020. Not much is known about migration-related determinants of health-related quality of life (HrQoL) of persons with direct migration background. This study aimed to analyze the associations between HrQoL, sociodemographic, and migration-related characteristics of persons with direct migration background in Germany.

Methode / Method

The sample of this study was based on four waves (2014, 2016, 2018, and 2020) of the migration samples (M1 and M2) of the German Socioeconomic Panel (SOEP). The SF-12 was used to measure HrQoL using its mental (MCS) and physical (PCS) component summary scores. Missing information was replaced by multiple imputation by chained equations with predictive mean matching. Associations between HrQoL and sociodemographic and migration-related characteristics were examined using multilevel mixed-effects linear regressions.

Ergebnisse / Results

The mean MCS and PCS scores of persons with direct migration background (n = 4122) were 51.81 and 51.57, respectively. Being employed was statistically significantly associated with both, a higher MCS (+1.95) and PCS (+2.82). The country of birth was not associated with the MCS score. Being born in Russia was associated statistically significantly with a lower PCS score compared with Romania, Kazakhstan, and non-east European countries. A longer period since migration to Germany was negatively associated with both MCS and PCS scores (both with p < 0.001). A steady relationship before migration was associated with a higher MCS score (+0.87, p = 0.001), yet a lower PCS score (−2.19, p < 0.001). Not feeling German and experiencing disadvantages due to origin were negatively associated with the MCS (both with p < 0.001). The oral ability in the German language was positively associated with the PCS score (p < 0.001).

Zusammenfassung / Conclusion

Besides employment and country of birth, the time since migration to Germany, and the relationship status before migration may be determinants of HrQoL of persons with a direct migration background. Furthermore, connectedness with Germany, disadvantages due to origin and oral ability in the German language, representative of integration in Germany, can be potential determinants of HrQoL.

Authors

Thomas Grochtdreis, Universitätsklinikum Hamburg-Eppendorf

Hans-Helmut König, Universitätsklinikum Hamburg-Eppendorf

Judith Dams, Universitätsklinikum Hamburg-Eppendorf

Einleitung / Introduction

While a large literature studies the healthy immigrant effect, this finding might not hold for the growing number of refugees who are fleeing from conflict. Conflict is shown to have many potentially negative helth effects on those exposed to it. Studying the case of Canada, a country with a large yearly inflow of immigrants (refugees and others), this paper uses multiple waves of Statistics Canada’s Canadian Community Health Survey linked with the Longitudinal Immigration Database, as well as conflict data from the Uppsala Conflict Data Program /International Peace Research Institute in Oslo Armed Conflict Dataset, to examine the effect of to pre-migration conflict on the post-migration mental and physical health outcomes of immigrants to Canada.

Methode / Method

We estimate the following general model using a logit (as well as a linear probability) model: Y_it= β_0+β_1 immigrant_i+ β_2 immigrant_i*conflict_i+ β_3 X_it+ ε , where Y is our health outcome measure of individual i at time t, immigrant is an indicator variable that takes a value of 1 when a person is an immigrant, and 0 when the person is Canadian born, conflict is our individual measure of conflict before migration, and X is a vector of demographic and socioeconomic controls. This allows us to compare immigrants who were exposed to conflict before immigration to both Canadian born individuals and immigrants who were not exposed to conflict.

Ergebnisse / Results

Our findings at this point provide evidence that those immigrants that migrated during or immediately after a major conflict are less likely to report high levels of physical health. We do not find evidence of such an effect when examining mental health. While unexpected, this finding might arise due to differences in reoporting behaviour and we are currently conducting robustness analyses to test the robustness of our results.

Zusammenfassung / Conclusion

While our paper uses Canadian data since it allows to link administrative immigration data to outcomes from a large population health survey, our findings are of general interest as health systems in many developped countries are confronted with a growing number of refugees.

Authors

Dörte Heger, RWI - Leibniz-Institut für Wirtschaftsforschung

Andrea Craig, UBC Okanagan

Ryan Compton, University of Manitoba

Karl Skogstad, Lakehead University