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Wang L, Chao J, Wu Y, Zhang N, Bao M. Social integration and utilization of national basic public health services among China's internal migrants with chronic diseases: A structural equation modelling approach. Heliyon 2024; 10:e25797. [PMID: 38352800 PMCID: PMC10862671 DOI: 10.1016/j.heliyon.2024.e25797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
Internal migrants with chronic diseases (IMCDs) are a specific subgroup of the internal migrants, but few studies have focused on health service utilization among this group. Social integration is an essential element in the maintenance of health and well-being in migrants. However, the measurement of social integration remains inconsistent. This study aimed to measure social integration more comprehensively and evaluate the association between social integration and National Basic Public Health Services (NBPHS) utilization among IMCDs in China, thereby providing theoretical support for health promotion among IMCDs. The data of this study were obtained from the China Migrants Dynamic Survey (CMDS) in 2017. A total of 9272 internal migrants who self-reported hypertension and/or type 2 diabetes were included in the analysis. Four factors were extracted through exploratory factor analysis to measure the social integration of IMCDs: psychological identity, community involvement, social security, and sociocultural adaptation. The results show the IMCDs underutilized NBPHS, with 26.80 % stating that they have not used any of the services in the NBPHS. We confirmed the positive association between social integration and NBPHS use among IMCDs. The social integration of IMCDs in developed regions was relatively worse than in developing regions, further exacerbating the underutilization of NBPHS in developed regions. Therefore, targeted government measures and supportive policies are necessary, especially in developed regions, to encourage IMCDs to participate in social organizations and community activities and stimulate their active participation in the NBPHS.
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Affiliation(s)
- Leixia Wang
- Health Management Research Center, School of Public Health, Southeast University, Nanjing, Jiangsu, 210096, China
| | - Jianqian Chao
- Health Management Research Center, School of Public Health, Southeast University, Nanjing, Jiangsu, 210096, China
| | - Yanqian Wu
- Health Management Research Center, School of Public Health, Southeast University, Nanjing, Jiangsu, 210096, China
| | - Na Zhang
- Health Management Research Center, School of Public Health, Southeast University, Nanjing, Jiangsu, 210096, China
| | - Min Bao
- Health Management Research Center, School of Public Health, Southeast University, Nanjing, Jiangsu, 210096, China
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Khalifa A, Ssekubugu R, Lessler J, Wawer M, Santelli JS, Hoffman S, Nalugoda F, Lutalo T, Ndyanabo A, Ssekasanvu J, Kigozi G, Kagaayi J, Chang LW, Grabowski MK. Implications of rapid population growth on survey design and HIV estimates in the Rakai Community Cohort Study (RCCS), Uganda. BMJ Open 2023; 13:e071108. [PMID: 37495389 PMCID: PMC10373715 DOI: 10.1136/bmjopen-2022-071108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE Since rapid population growth challenges longitudinal population-based HIV cohorts in Africa to maintain coverage of their target populations, this study evaluated whether the exclusion of some residents due to growing population size biases key HIV metrics like prevalence and population-level viremia. DESIGN, SETTING AND PARTICIPANTS Data were obtained from the Rakai Community Cohort Study (RCCS) in south central Uganda, an open population-based cohort which began excluding some residents of newly constructed household structures within its surveillance boundaries in 2008. The study includes adults aged 15-49 years who were censused from 2019 to 2020. MEASURES We fit ensemble machine learning models to RCCS census and survey data to predict HIV seroprevalence and viremia (prevalence of those with viral load >1000 copies/mL) in the excluded population and evaluated whether their inclusion would change overall estimates. RESULTS Of the 24 729 census-eligible residents, 2920 (12%) residents were excluded from the RCCS because they were living in new households. The predicted seroprevalence for these excluded residents was 10.8% (95% CI: 9.6% to 11.8%)-somewhat lower than 11.7% (95% CI: 11.2% to 12.3%) in the observed sample. Predicted seroprevalence for younger excluded residents aged 15-24 years was 4.9% (95% CI: 3.6% to 6.1%)-significantly higher than that in the observed sample for the same age group (2.6% (95% CI: 2.2% to 3.1%)), while predicted seroprevalence for older excluded residents aged 25-49 years was 15.0% (95% CI: 13.3% to 16.4%)-significantly lower than their counterparts in the observed sample (17.2% (95% CI: 16.4% to 18.1%)). Over all ages, the predicted prevalence of viremia in excluded residents (3.7% (95% CI: 3.0% to 4.5%)) was significantly higher than that in the observed sample (1.7% (95% CI: 1.5% to 1.9%)), resulting in a higher overall population-level viremia estimate of 2.1% (95% CI: 1.8% to 2.4%). CONCLUSIONS Exclusion of residents in new households may modestly bias HIV viremia estimates and some age-specific seroprevalence estimates in the RCCS. Overall, HIV seroprevalence estimates were not significantly affected.
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Affiliation(s)
- Aleya Khalifa
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
- ICAP, Columbia University, New York, New York, USA
| | - Robert Ssekubugu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Global and Sexual Health, Karolinska Institutet, Stockholm, Sweden
| | - Justin Lessler
- Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Maria Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John S Santelli
- Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Susie Hoffman
- Department of Epidemiology, Columbia University, New York, New York, USA
- HIV Centre for Clinical and Behavioural Studies, Columbia University Irving Medical Centre, New York, New York, USA
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Joseph Ssekasanvu
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Kathryn Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Pescarini JM, Goes EF, Pinto PFPS, Dos Santos BPS, Machado DB, Abubakar I, Rodrigues LC, Brickley EB, Smeeth L, Barreto ML. Mortality among over 6 million internal and international migrants in Brazil: a study using the 100 Million Brazilian Cohort. LANCET REGIONAL HEALTH. AMERICAS 2023; 20:100455. [PMID: 36890851 PMCID: PMC9986634 DOI: 10.1016/j.lana.2023.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 03/03/2023]
Abstract
Background To understand if migrants living in poverty in low and middle-income countries (LMICs) have mortality advantages over the non-migrant population, we investigated mortality risk patterns among internal and international migrants in Brazil over their life course. Methods We linked socio-economic and mortality data from 1st January 2011 to 31st December 2018 in the 100 Million Brazilian Cohort and calculated all-cause and cause-specific age-standardised mortality rates according to individuals' migration status for men and women. Using Cox regression models, we estimated the age- and sex-adjusted mortality hazard ratios (HR) for internal migrants (i.e., Brazilian-born individuals living in a different Brazilian state than their birth) compared to Brazilian-born non-migrants; and for international migrants (i.e., people born in another country) compared to Brazilian-born individuals. Findings The study followed up 45,051,476 individuals, of whom 6,057,814 were internal migrants, and 277,230 were international migrants. Internal migrants had similar all-cause mortality compared to Brazilian non-migrants (aHR = 0.99, 95% CI = 0.98-0.99), marginally higher mortality for ischaemic heart diseases (aHR = 1.04, 95% CI = 1.03-1.05) and higher for stroke (aHR = 1.11, 95% CI = 1.09-1.13). Compared to Brazilian-born individuals, international migrants had 18% lower all-cause mortality (aHR = 0.82, 95% CI = 0.80-0.84), with up to 50% lower mortality from interpersonal violence among men (aHR = 0.50, 95% CI = 0.40-0.64), but higher mortality from avoidable causes related to maternal health (aHR = 2.17, 95% CI = 1.17-4.05). Interpretation Although internal migrants had similar all-cause mortality, international migrants had lower all-cause mortality compared to non-migrants. Further investigations using intersectional approaches are warranted to understand the marked variations by migration status, age, and sex for specific causes of death, such as elevated maternal mortality and male lower interpersonal violence-related mortality among international migrants. Funding The Wellcome Trust.
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Affiliation(s)
- Julia M. Pescarini
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Emanuelle F. Goes
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Daiane B. Machado
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Ibrahim Abubakar
- Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - Laura C. Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth B. Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Health Data Research (HDR), London, UK
| | - Mauricio L. Barreto
- Centre of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Spencer G, Dankyi E, Thompson J, Acton F, Kwankye SO. The Health Experiences of Young Internal Migrants in Ghana-Identifying Priorities for Sustainable Health Promotion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15229. [PMID: 36429947 PMCID: PMC9690152 DOI: 10.3390/ijerph192215229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
The Sustainable Development Goals underscore the importance of migration to the achievement of health, and global migration presents both opportunities and challenges for the development of health promotion. Despite such recognition, very little work has focused on health promotion with young migrants, including how migration shapes opportunities for positive health. This paper reports findings from a qualitative study that sought to advance knowledge of the health experiences of young internal migrants in Ghana (n = 14) and considers ways to harness these perspectives in the development of sustainable health promotion solutions. Methods included community consultations, participatory workshops and interviews with young migrants aged 14-21 years. Findings highlighted how the social determinants of health affected young migrants' opportunities to support their health. Our analysis highlights how a lack of access to adequate food, shelter and health services often resulted in the adoption of alternative health practices, including the use of herbal remedies. Supporting positive livelihoods as part of tackling the social determinants of health is crucial to mitigate the impacts of poverty and inequalities on young migrants' health practices and outcomes. We conclude by considering how to advance relevant health promotion with young migrants living in contexts of vulnerability.
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Affiliation(s)
- Grace Spencer
- Faculty of Health, Education Medicine and Social Care, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Ernestina Dankyi
- Centre for Social Policy Studies, University of Ghana, Legon, Accra LG 1181, Ghana
| | - Jill Thompson
- Health Sciences School, University of Sheffield, Sheffield S10 2HQ, UK
| | - Faye Acton
- Faculty of Health, Education Medicine and Social Care, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Stephen Owusu Kwankye
- Regional Institute for Population Studies, University of Ghana, Legon LG 1181, Ghana
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