Drivers of migration: why do people move?

A narrative review of e-health systems' evolution - evidence from a regional study

PURPOSE

The growing implementation of electronic health (e-health) systems has raised the importance of analyzing how these systems have been implemented in diverse regions. By employing a contextual sensitive approach and social mechanism theory, this study aims to better understand the reasons for the success and failure of e-health initiatives in the ex-Yugoslav region and derive useful insights for policymakers.

DESIGN/METHODOLOGY/APPROACH

We employ a narrative review process grounded in the social mechanism theory, extended with field experts' review, to acquire state-of-the-art information.

FINDINGS

Findings indicate that different e-health systems coexist and evolve in different contexts in different countries, with varying levels of success. The contextual differences shape the broader environment, affecting the level of preparedness and capability for e-health implementation. Top-down approaches dominate e-health implementation in most countries when it comes to design process features, and more developed countries do not rely on strong social mechanisms for implementing e-health due to the openness of their culture towards e-health innovations.

PRACTICAL IMPLICATIONS

Analyzing the milestones, challenges and functionalities of e-health systems in the region of interest can assist policymakers, academics and practitioners in making informed decisions and recommendations to enhance future e-health implementation.

ORIGINALITY/VALUE

No known studies evaluated e-health initiatives in the former ex-Yugoslav countries holistically and evolutionarily in the form of a comprehensive regional study. Further, our research endeavor is contextually specific since the health systems of these countries in the past were tied together under the federative umbrella health system and then diverged in terms of e-health development.

Albania and Kosovo-Albania Immigrants' Perceptions of Mental Well-Being and the Psychological Challenges Faced in Malaysia

Background

Immigrants who relocate to a foreign country often face numerous stressors and challenges as they try to assimilate to a new culture. This transition can often have a significant impact on their mental well-being. In this qualitative study, we aim to explore and examine the life experiences of 16 Albanian and Kosovo-Albania immigrants who have settled in Malaysia, as well as those who previously resided in Malaysia but are now living in Australia and Albania.

Objectives

This study aimed to investigate two main objectives: (i) to explore immigrants' psychological problems and how they perceive and approach mental well-being; and (ii) to identify the challenges and barriers that immigrants face in Malaysia.

Methods

The data was obtained using a qualitative phenomenological case study, using in-depth semi-structured interviews. The interviews were audio-recorded, transcribed, and thematically analysed.

Results

The study's findings indicate that immigrants' mental well-being is positively affected by inner peace, happiness, fulfilling family needs, a balanced life, and self-improvement. On the other hand, challenges related to visa and employment pass issues, difficulty in securing employment status, feeling like a foreigner, and lack of family support have a negative impact on their mental well-being.

Implications

The study's findings advocate for targeted support programmes to address the psychological challenges of Albanian immigrants. Prioritising inner peace and self-improvement benefits their mental well-being. Policymakers are encouraged to prioritise reducing employment pass difficulties and fostering an inclusive job market to improve employment opportunities for this community.

Factors Associated with Non-Adherence to Treatment Among Migrants with MDR-TB in Wuhan, China: A Cross-Sectional Study

Background

Multidrug resistant tuberculosis (MDR-TB) has attracted increasing attention in achieving the global goal of tuberculosis (TB) control. China has the second largest TB burden worldwide and has been experiencing large-scale domestic migration. This study aims to explore the effect of migrants on non-adherence to MDR-TB treatment.

Materials and Methods

A cross-sectional study was carried out in Wuhan, China. The exposure cases were migrants who were not locally registered in the residence registration system. The control cases were local residents. Non-adherence cases were patients who were lost follow-up or refused treatment. Chi-square and t-test were used to compare variables between migrants and local residents. Logistic regression models using enter method were used to determine the relationship between migration and non-adherence to treatment. Moderation and medication effects on the association between migrant status and non-adherence were also explored.

Results

We studied 73 migrants and 219 local residents. The migrants, who did not to adhere to treatment (55, 75.3%), was far higher than that of local residents (89, 40.6%). Migrants with MDR-TB had 10.38-times higher difficulty in adhering to treatment (adjusted OR = 10.38, 95% CI 4.62-25.28) than local residents. This additional likelihood was moderated by age and treatment registration group. Migration had an indirect association with non-adherence to treatment via social medial insurance (adjusted OR = 1.05, 95% CI 1.01-1.13).

Conclusion

There a significant increased likelihood of non-adherence to treatment among migrants with MDR-TB, highlighting the importance of improving treatment adherence in this population. Migration prevented migrants from gaining access to social medical insurance and indirectly reduced their likelihood of adherence to treatment.

High self-selection of Ukrainian refugees into Europe: Evidence from Kraków and Vienna

Almost eight million Ukrainians have fled their country to escape the Russian full-scale invasion. To provide empirical evidence on how beneficiaries of temporary protection who reside in the immediate proximity of Ukraine differ from those who went further and reside in Western European countries, two large-scale rapid-response surveys were conducted in Kraków, Poland, and Vienna, Austria, in spring 2022. Data include information on socio-demographic characteristics, human capital, and return intentions of 472 and 1,094 adult Ukrainian refugees in Poland and Austria, respectively. Contributing to the growing empirical evidence on consistent assortative patterns in refugee inflows into Europe, our findings show that regularities in patterns of self-selection also occur in forced migration contexts where legal routes to safety apply. According to the analysed convenience sample, a tentative conclusion is that the further Ukrainian refugees moved to the West, the more self-selected they tend to be in the key dimensions of formal educational attainment, previous employment, language skills, and urbanity. Results indicate that willingness to stay in Kraków is significantly lower than willingness to remain in Vienna. This suggests that public financial support and living conditions, rather than diaspora networks, are decisive factors in shaping the decision to stay, move to another location or return to Ukraine. The aim to start a new life elsewhere may drive the motivation to choose a more distant destination instead of a neighboring country that allows to return rather quickly. Host countries should be aware of these specific characteristics of their refugee populations and adapt their integration policies accordingly.

More than mateship: exploring how Australian male expatriates, longer-term and frequent travellers experience social support

PURPOSE

Those travelling overseas for work or leisure including male expatriates, longer-term and frequent travellers (ELoFTs) may be at heightened risk for a range of health and wellbeing issues. Social support may mediate this risk. However, from a public health perspective, little is written about how ELoFTs access health information and support and the role of their social networks in facilitating health and wellbeing outcomes. This research was part of a study examining social network processes of Australian male ELoFTs travelling, living, or working in Southeast Asia (SEA).

METHODS

Symbolic Interactionism and Grounded Theory were the conceptual framework and methodology supporting semi-structured, in-depth interviews (n = 25) conducted in Australia and Thailand with Australian male ELoFTs to SEA, aged 18 years or older.

RESULTS

Findings highlight supports that assist ELoFT transition and adjustment to country of destination or manage their transnational experience. Influential places, people, and points in the migration journey mediated engagement with social support.

CONCLUSIONS

ELoFT social networks and the support provided within them may provide a mechanism for intervention across a range of public health issues. Findings may support the development of policy and practice across industries charged with supporting successful ELoFT adjustment.

Family-Focused Nursing Research in WHO Afro-Region Member States: A Scoping Review

Although family nursing research has become an important focus for over the past 20 years, the evolution and extent of family nursing research in the World Health Organization (WHO) Afro-regions is less explored. The purpose of this scoping review was to map the evidence of family-focused nursing research using the Joanna Briggs Institute Scoping Review methodology. A systematic electronic search of articles was carried out for the period January 1, 2000 to December 31, 2020. The review process culminated in 85 articles, evidencing an increase in publications particularly in 2019 (n = 12). Eighteen countries were involved, with the Southern African region contributing 52% of the studies. Family members were predominantly described as parents, siblings, and children, with the most focused area of study being family experiences (n = 52). The majority of studies (n = 59) used qualitative methodologies. Despite the recent increase in family-focused nursing research in the WHO Afro-regions, further qualitative research, including more complex methodologies and interventions are still required to build contextualized evidence-based family-focused nursing.

Are we seeing the unseen of human trafficking? A retrospective analysis of the CTDC k-anonymized global victim of trafficking data pool in the period 2010-2020

BACKGROUND

Human trafficking is considered a hidden global crime with unsubstantiated numbers. Despite the challenges in counting or measuring this crime, reports revealed the presence of around 40.3 million victims worldwide. Human trafficking results in severe detrimental impacts on both mental and physical health. Given the sensitivity and negative consequences of human trafficking on the global system and victims, and considering the scarce research in this area, our current study aimed at describing the (i) Sociodemographic profiles of anonymized victims, (ii) Means of control, and (iii) Purpose of trafficking, utilizing the largest anonymized and publicly available dataset on victims of human trafficking.

METHODS

This is a retrospective secondary analysis of the Counter-Trafficking Data Collaborative (CTDC) data pool in the period from 2010 to 2020. The utilized dataset is called the k-anonymized global victim of trafficking dataset, and it is considered the largest global dataset on victims of human trafficking. Data from the k-anonymized data pool were extracted and exported to Statistical Package for Social Sciences, SPSS® version 27.0 for Windows (IBM Corp. Version 27.0. Armonk, NY) for quality check and analysis using descriptive statistics.

RESULTS

A total of 87003 victims of human trafficking were identified in the period from 2010 to 2020. The most age category encountered among victims was 9-17 years with 10326 victims (11.9%), followed by 30-38 years with 8562 victims (9.8%). Females comprised 70% of the sample with 60938 victims. The United States (n = 51611), Russia (n = 4570), and the Philippines (n = 1988) comprised the most countries of exploitation/trafficking. Additionally, the year 2019 witnessed the greatest number of victims registered for assistance by anti-trafficking agencies with around 21312 victims (24.5%). Concerning means of control, threats, psychological abuse, restriction of the victim's movement, taking the victim's earnings, and physical abuse were the most reported means. 42685 victims (49.1%) reported sexual exploitation as the purpose of their trafficking, followed by forced labor with 18176 victims (20.9%).

CONCLUSION

Various means and methods can be used by traffickers to control the victims to be trafficked for many purposes, with sexual exploitation and forced labor being the most common ones. Global anti-trafficking efforts should be brought together in solidarity through utilizing the paradigm of protection of victims, prosecution of traffickers, prevention of trafficking, and inter-sectoral partnerships. Despite being a global concern with various reports that tried to capture the number of trafficked victims worldwide, human trafficking still has many unseen aspects that impose a significant challenge and adds to the global burden in combatting this threat.

Translating Cultural Safety to the UK

Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The 'Black Lives Matter' movement has exposed structural racism's contribution to these health inequities. 'Cultural Safety', an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be 'culturally safe'. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the 'nuts and bolts' of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation.

Evaluating land use/cover change associations with urban surface temperature via machine learning and spatial modeling: Past trends and future simulations in Dera Ghazi Khan, Pakistan

While urbanization puts lots of pressure on green areas, the transition of green-to-grey surfaces under land use land cover change is directly related to increased land surface temperature–compromising livability and comfort in cities due to the heat island effect. In this context, we evaluate historical and future associations between land use land cover changes and land surface temperature in Dera Ghazi Khan–one of the top cities in Pakistan–using multi-temporal Landsat data over two decades (2002–2022). After assessing current land use changes and future predictions, their impact on land surface temperature and urban heat island effect is measured using machine learning via Multi-Layer Perceptron-Markov Chain, Artificial Neural Network and Cellular Automata. Significant changes in land use land cover were observed in the last two decades. The built-up area expanded greatly (874 ha) while agriculture land (−687 ha) and barren land (−253 ha) show decreasing trend. The water bodies were found the lowest changes (57 ha) and vegetation cover got the largest proportion in all the years. This green-grey conversion in the last two decades (8.7%) and prospect along the main corridors show the gravity of unplanned urban growth at the cost of vegetation and agricultural land (−6.8%). The land surface temperature and urban heat island effect shows a strong positive correlation between urbanization and vegetation removal. The simulation results presented in this study confirm that by 2032, the city will face a 5° C high mean temperature based on historical patterns, which could potentially lead to more challenges associated with urban heat island if no appropriate measures are taken. It is expected that due to land cover changes by 2032, ~60% of urban and peri-urban areas will experience very hot to hot temperatures (> 31.5°C). Our results provide baseline information to urban managers and planners to understand the increasing trends of land surface temperature in response to land cover changes. The study is important for urban resource management, sustainable development policies, and actions to mitigate the heat island effect. It will further asset the broader audience to understand the impact of land use land cover changes on the land surface temperature and urban heat island effect in the light of historic pattern and machine learning approach.

Providing person-centered palliative care in conflict-affected populations in the Middle East: What matters to patients with advanced cancer and families including refugees?

Introduction

Universal health coverage highlights palliative care as an essential component of health services. However, it is unclear what constitutes person-centered care in populations affected by conflict, as they may have specific concerns in the dimensions of physical, emotional, social, and spiritual wellbeing. This study aimed to identify what matters to patients with advanced cancer and family caregivers in Jordan including refugees, to inform appropriate person-centered assessment and palliative care in conflict-affected populations.

Methods

Cross-sectional face-to-face, semi-structured interviews were conducted at two sites in Amman. Adult patients with advanced cancer and family caregivers were purposively sampled to maximize diversity and representation. Interviews were digitally audio recorded, anonymized, and transcribed verbatim for thematic analysis.

Findings

Four themes were generated from 50 patients (22 refugees; 28 Jordanians) and 20 caregivers (7 refugees; 13 Jordanians) (1). Information, communication, and decision-making. Truth-telling and full disclosure from clinicians was valued, and participants expressed concerns that information was not shared in case patients would disengage with treatment. (2) Priorities and concerns for care and support. Participants’ top priority remained cure and recovery (which was viewed as possible). Other priorities included returning to their “normal” life and their “own” country, and to continue contributing to their family. (3) Role of spirituality and Islam. Most participants had strong faith in God and felt that having faith could comfort them. For refugees whose social network was fractured due to being away from home country, prayer and Quran reading became particularly important. (4) Unmet support needs of family caregivers. Family caregivers were affected physically and emotionally by worrying about and caring for the patients. They needed support and training, but often could not access this.

Discussion

Truth-telling is highly valued and essential to achieving person-centered care and informed decision-making. This study also reveals specific concerns in conflict-affected populations, reflecting the experience of prior losses and fracturing of existing social networks and support. The role of religion is crucial in supporting refugee communities, and consideration should be paid to the needs of patients and caregivers when caring for a patient at home without access to their communities of origin and the support they accessed.

Gaps in mobility data and implications for modelling epidemic spread: A scoping review and simulation study

Reliable estimates of human mobility are important for understanding the spatial spread of infectious diseases and the effective targeting of control measures. However, when modelling infectious disease dynamics, data on human mobility at an appropriate temporal or spatial resolution are not always available, leading to the common use of model-derived mobility proxies. In this study we reviewed the different data sources and mobility models that have been used to characterise human movement in Africa. We then conducted a simulation study to better understand the implications of using human mobility proxies when predicting the spatial spread and dynamics of infectious diseases. We found major gaps in the availability of empirical measures of human mobility in Africa, leading to mobility proxies being used in place of data. Empirical data on subnational mobility were only available for 17/54 countries, and in most instances, these data characterised long-term movement patterns, which were unsuitable for modelling the spread of pathogens with short generation times (time between infection of a case and their infector). Results from our simulation study demonstrated that using mobility proxies can have a substantial impact on the predicted epidemic dynamics, with complex and non-intuitive biases. In particular, the predicted times and order of epidemic invasion, and the time of epidemic peak in different locations can be underestimated or overestimated, depending on the types of proxies used and the country of interest. Our work underscores the need for regularly updated empirical measures of population movement within and between countries to aid the prevention and control of infectious disease outbreaks. At the same time, there is a need to establish an evidence base to help understand which types of mobility data are most appropriate for describing the spread of emerging infectious diseases in different settings.

From the Global North to the Global South: preparing students for away rotations

Makerere University College of Health Sciences, Kampala, Uganda, has established partnerships with several other institutions worldwide, including the University of Brescia and "Magna Græcia" University, which have agreed to collaborate for the primary purpose of student exchange. Our aim is to comment on students' preparation for away rotations based on the authors' own experiences and opinions alongside a review of selected papers on the preparation of students for global health and ethical collaboration. Medical electives represent a unique opportunity for all medical students, not merely for those who will work in resource-limited settings due to increasing globalization. The emergence of ethical international collaborations is of paramount importance to stimulate these projects and ensure that they are implemented safely and with adequate preparation even and especially during the COVID-19 pandemic.

Unequal Access and Use of Health Care Services among Settled Immigrants, Recent Immigrants, and Locals: A Comparative Analysis of a Nationally Representative Survey in Chile

Globally, and particularly in the Latin American region, international migration continues to grow. Access and use of health care services by migrants vary according to their country of origin and residence time. We aimed to compare the access and use of health care services between international migrants (including settled migrants from Peru, Argentina, Bolivia, Ecuador; Emerging migrants from Venezuela, Dominican Republic, Colombia, Haiti; and migrants from other countries) and the Chilean population. After performing a secondary data analysis of population-based nationally representative surveys (CASEN 2011-2017), access and use patterns (insurance, complementary insurance, non-consultation, and non-treatment coverage) were described and compared among settled immigrants, recent emerging immigrants, others, and locals. Immigrants had a significantly higher uninsured population compared to locals. Specifically, in CASEN 2017, 19.27% of emerging (95% CI: 15.3-24.1%), 11.79% of settled (95% CI: 10.1-13.7%), and 2.25% of locals (95% CI: 2.1-2.4%) were uninsured. After 2013, settled and recent emerging migrants showed higher percentages of non-consultation. Collaborative and interculturally relevant strategies from human rights and equity perspectives are needed. Initiatives with a particular focus on recent immigrants can contribute to reducing the existing disparities in health care access and use with locals due to lack of insurance and treatment coverage.

A new tool for assessing the cultural adaptation of cognitive tests: demonstrating the utility of the Manchester Translation Evaluation Checklist (MTEC) through the Mini-Mental State Examination Urdu

BACKGROUND

Low- and middle-income countries contribute to the majority of dementia and mild cognitive impairment cases worldwide, yet cognitive tests for diagnosis are designed for Western cultures. Language and cultural discrepancies mean that translated tests are not always reliable or valid. We propose a model for culturally adapting cognitive tests, one step of which is to assess the quality of any translation and cultural adaptation undertaken. We developed the Manchester Translation Evaluation Checklist (MTEC) to act as a tool for quality assessment and demonstrated its use by assessing a popular cognitive test that had been adapted.

AIMS

Assess quality of the translation and cultural adaptation of the Urdu Mini-Mental State Examination developed for a Pakistani population.

METHOD

Two raters completed the MTEC for the Mini-Mental State Examination (MMSE) Urdu and compared feedback. All authors were fluent in English and Urdu and familiar with Pakistani culture.

RESULTS

Raters had 78.5% agreement across the MTEC. The MMSE Urdu was appropriately translated and retained grammar and verb tense, but three questions had spelling errors. Across 20 MMSE questions, 5 required further cultural adaptation because the questions were not understandable in daily use, comfortable to answer, relevant to the language and culture, and relevant to original concepts.

CONCLUSIONS

The MTEC highlighted errors in the MMSE Urdu and demonstrated how this tool can be used to improve it. Future studies could employ the MTEC to improve existing translated measures of health assessment, particularly cognitive tests, and act as a quality check when developing new adaptations of tests and before psychometric validation.

Migration for Better Jobs or Better Living: Shifts in China

Traditionally, studies of mobility follow two main strands: migration driven by better jobs and by better living. However, the interactions and shifts between them are rarely addressed. In the largest-scale domestic migration, millions of Chinese movers have experienced changes in migration motivations in the past ten years. Starting with migration patterns, we attempt to explore the interaction and changes in migration motivations in a dynamic way and relate them to the evolution of socio-economic contexts. Based on the latest two population censuses (2010 and 2020) in mainland China, we built an empirical model attributing migration motivations to job and living conditions, and then estimated the model by ordinary least squares (OLS) and quadratic assignment procedure (QAP) methods. The results reveal that employment is the primary and fundamental factor, though its impact is weakening. Good living is becoming significantly influential in migration willingness, and there is an interactive effect between the factors of job and living. Furthermore, we offer an explanation of the motivation evolution as being migrants' response to socio-economic status to maximize their utility. This study contributes to the migration literature from a longitudinal lens, and appeals to a continuous focus on migration evolution in the scientific research on population geography.

Emigration as a social and economic determinant of health in low-income urban Zimbabwe

Background

The negative consequences of medical professionals’ emigration on the health systems of nations are well documented in the literature. However, there is a dearth of evidence on the impact of emigration in general, on sending households’ welfare, health in particular. This study compared socio-economic characteristics, including health, of emigrants’ households with those of non-emigrants’ households in an urban setting in Harare, Zimbabwe.

Methods

A cross-sectional survey and focus group discussions were used to collect quantitative and qualitative data, respectively. Concurrent and retrospective data were collected using an interviewer-administered questionnaire. The target population were households, both emigrants' households and non-emigrants' households, and the interviewees were de facto heads of the respective households.

Results

A sample of 279 households was determined; however, 268 heads of households, a response rate of 96%, were achieved. The majority of the respondents were females (52%). Emigrants’ households were more likely to access private compared to government health care facilities, than non-emigrants’ households [P = 0.001]. Emigrants' households were also more likely to report higher incomes than non-emigrants’ households [P < 0.05] and were having more meals per day and better access to education. Emigrants' households were also more likely to report positive lifestyles than non-emigrants’ households. Only 13.8% of emigrants' households reported a negative shift in lifestyle, compared to 25.2% non-emigrants' households.

Conclusions

Emigration was found to have a positive relationship with health seeking, income, education, and number of meals a household had. It is clear from the findings that emigration during the hard economic times in Zimbabwe is beneficial; it cushions households from the ravages of poverty. Yet emigration robs the nation of its professional able-bodied people. It is, therefore, recommended that the government optimises the reported positive effects, whilst expeditiously working on improving the economy with the view of reversing the observed migration streams.

Challenges of undocumented immigrants in Canada and the USA during the COVID-19 pandemic: a review

Purpose

Pandemics pose challenges to all groups of people and all aspects of human lives. Undocumented migrants are likely to face more challenges during global pandemics. The purpose of this paper is to explore the possible challenges of undocumented immigrants in Canada and the USA in the ongoing COVID-19 pandemic.

Design/methodology/approach

From existing literature, the authors examined the challenges of undocumented migrants in Canada and the USA and suggested recommendations to address those challenges at both policy and national levels.

Findings

The undocumented status of some international immigrants makes them vulnerable in their host nations. They face myriad challenges in their host countries, spanning from economic, health, social isolation and employment challenges, and these are further exacerbated during pandemics such as the ongoing COVID-19. The provision of culturally sensitive and safe policies may support this particular population, especially in times of crisis like the COVID-19 pandemic.

Originality/value

This paper provides critical insights into the possible intersections that worsen the vulnerability of undocumented migrants in pandemic crises like COVID-19. Further, this review serves to initiate the discourse on policy and interventions for undocumented immigrants during pandemics or disease outbreaks.

From farm to the city? Understanding the motives of entrepreneurial Javanese migration to an Indonesian outer island

This article examines the migration motives of entrepreneurial Javanese migrants residing in the regional town of Kupang, East Nusa Tenggara—a relatively resource-poor province in Eastern Indonesia. These migrants had generally worked in agriculture in their hometowns in Java but have engaged in and/or set up informal businesses since their arrival in Kupang. Drawing on a mixed-methods approach (household survey [n = 344]; in-depth interviews [n = 28]) in 2020, we identified the diverse underlying motives of Javanese entrepreneurial migration to Kupang. Most Javanese respondents emphasised the importance of a combination of factors, including their low levels of education in Java, greater opportunities to improve their quality of life, and tolerant and welcoming locals in Kupang. Associated with these factors, others migrated to escape the difficulties of agricultural work and the need to earn more income to fund their children’s education now and in the future. Our article offers new insights into how changing social and economic conditions in rural Java are increasingly driving migration to the rapidly growing urban clusters in Indonesia’s outer islands, leading to changing urban form, economic trajectories, and social relations.

Distance-Dependent Migration Intention of Villagers: Comparative Study of Peri-Urban and Remote Villages in Indonesia

Rural-to-urban migration disturbs essential factors of rural development, including labor forces, land ownership, and food production. To avoid late responses to emigration, scholars have begun investigating earlier stages of rural emigration. However, prior studies have focused on a single spatial entity only while also leaning toward trends in developed countries. Therefore, this study fills gaps by focusing on the differences in migration intention between villages in less developed settings. In observing the differences, this research takes peri-urban and remote villages as cases located at different distances from their nearest urban destination. This study treats migration intention as the dependent variable while using single-indicator place attachment and multi-indicator information sources as the independent variables. This work applies the Mann–Whitney U, ANOVA, and Brown–Forsythe tests on three hypotheses. This research also uses SEM-PLS to investigate the correlation model of the observed variables for each case. The results show that information sources negatively affect migration intentions in peri-urban settings. Remote rural areas also show similar results for the information sources variable; however, place attachment in remote settings significantly contributes to migration intention. These results show that place attachment and information sources contribute differently, depending on the distance to the urban area. We argue that access to public services and infrastructure contributes to the results. The findings suggest that an increased availability of information sources impedes the formation of migration intentions. Thus, this study suggests the necessity of improving rural infrastructure and public services to improve information literacy. It helps the government control rural emigration while fulfilling its obligation for rural development. It also offers better rural livelihoods during the development progress, providing economic incentives for villagers to stay in villages.

U.S. bound journey of migrant peoples InTransit across Dante's Inferno and Purgatory in the Americas

Rapid rise of population migration is a defining feature of the 21st century due to the impact of climate change, political instability, and socioeconomic downturn. Over the last decade, an increasing number of migrant peoples travel across the Americas to reach the United States seeking asylum or cross the border undocumented in search of economic opportunities. In this journey, migrant people experience violations of their human rights, hunger, illness, violence and have limited access to medical care. In the 'Divine Comedy', the Italian poet Dante Alighieri depicts his allegorical pilgrimage across Hell and Purgatory to reach Paradise. More than 700 years after its publication, Dante's poem speaks to the present time and the perilious journey of migrant peoples to reach safehavens. By exploring the depths and heights of the human condition, Dante's struggles resonate with the multiple barriers and the unfathomable experiences faced by migrant peoples in transit across South, Central, and North America to reach the United States. Ensuring the safety of migrant peoples across the Americas and elsewhere, and attending to their health needs during their migratory paths represent modern priorities to reduce social injustices and achieving health equity.

Sub-Saharan Africa's international migration constrains its sustainable development under climate change

Sub-Saharan Africa (SSA) is seen as a region of mass migration and population displacement caused by poverty, violent conflict, and environmental stress. However, empirical evidence is inconclusive regarding how SSA's international migration progressed and reacted during its march to achieving the Sustainable Development Goals (SDGs). This article attempts to study the patterns and determinants of SSA's international migration and the cause and effects on sustainable development by developing a Sustainability Index and regression models. We find that international migration was primarily intra-SSA to low-income but high-population-density countries. Along with increased sustainability scores, international migration declined, but emigration rose. Climate extremes tend to affect migration and emigration but not universally. Dry extremes propelled migration, whereas wet extremes had an adverse effect. Hot extremes had an increasing effect but were insignificant. SSA's international migration was driven by food insecurity, low life expectancy, political instability and violence, high economic growth, unemployment, and urbanisation rates. The probability of emigration was mainly driven by high fertility. SSA's international migration promoted asylum seeking to Europe with the diversification of origin countries and a motive for economic wellbeing. 1% more migration flow or 1% higher probability of emigration led to a 0.2% increase in asylum seekers from SSA to Europe. Large-scale international migration and recurrent emigration constrained SSA's sustainable development in political stability, food security, and health, requiring adequate governance and institutions for better migration management and planning towards the SDGs.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11625-022-01116-z.

Effects of a sport-based positive youth development program on youth life skills and entrepreneurial mindsets

Sport-based life skills interventions offer compelling pathways to understanding the role of physical activity and sport on youth psychosocial and other development outcomes. This is because of evidence that shows the benefits of sport programs to health and well-being of youth, and more lately other areas such as academic achievement and various life skills such as teamwork, leadership and goal setting. However, much of the research in this area of youth development is largely descriptive, with limited capacity to infer causal relationships and application across contexts. Therefore, this study examines the effects of a sport-based intervention program on life skills and entrepreneurial mindsets of youth from three African countries (n = 146, average age = 15.9 years, female = 48.6%). Half of the recruited participants were assigned to a three-week life skills intervention program and the remaining half to a sport-only control program. Both groups completed a demographic information questionnaire, Life Skills for Sport Scale and the General Enterprising Tendency v2 test. Two-way mixed ANOVAs showed significant post-intervention changes in life skills for both groups but changes in entrepreneurial mindsets for the intervention group only. This demonstrates the relevance of sport-based interventions to youth development outcomes in different contexts and the transformative potential of youth sport reported in previous studies. The findings have important implications for intentional and targeted delivery of programs to enhance specific youth development outcomes.

Systemic and Individual Factors That Shape Mental Health Service Usage Among Visible Minority Immigrants and Refugees in Canada: A Scoping Review

There exists considerable research which reports that mental health disparities persist among visible minority immigrants and refugees within Canada. Accessing mental health care services becomes a concern which contributes to this, as visible minority migrants are regarded as an at-risk group that are clinically underserved. Thus, the purpose of this review is to explore the following research question: "what are the barriers and facilitators for accessing mental health care services among visible immigrants and refugees in Canada?". A scoping review following guidelines proposed by Arksey and O'Malley (International Journal of Social Research Methodology 8(1): 19-32, 2005) was conducted. A total of 45 articles published from 2000 to 2020 were selected through the review process, and data from the retrieved articles was thematically analyzed. Wide range of barriers and facilitators were identified at both the systemic and individual levels. Unique differences rooted within landing and legal statuses were also highlighted within the findings to provide nuance amongst immigrants and refugees. With the main layered identity of being a considered a visible minority, this yielded unique challenges patterned by other identities and statuses. The interplay of structural issues rooted in Canadian health policies and immigration laws coupled with individual factors produce complex barriers and facilitators when seeking mental health services. Through employing a combined and multifaceted approach which address the identified factors, the findings also provide suggestions for mental health care providers, resettlement agencies, policy recommendations, and future directions for research are discussed as actionable points of departure.

The determination of intercultural sensitivity and ethnocentrism levels among nurses and nursing students: A border of city, Turkey

AIM

The current study is a descriptive-comparative study and aims to determine intercultural sensitivity and ethnocentrism levels among nurses and nursing students.

METHOD

The study was conducted with 207 nurses working at a State Hospital and 211 nursing students studying at a University between November 30, 2019, and January 20, 2020. The data were collected using a descriptive characteristics form, the Intercultural Sensitivity Scale, and the Ethnocentrism Scale.

FINDINGS

It was found that both nurses and nursing students (73.4% and 60.7%, respectively) struggled to communicate with foreign patients and experienced problems with cultural differences (49.8% and 22.7%, respectively). A statistically significant negative correlation was found for the nurses and nursing students in terms of their intercultural sensitivity and ethnocentrism scores (p < .05).

PRACTICAL IMPLICATION

Nurses and student nurses should interact with people from different cultures to improve refugee health care.

Health effects in people relocating between environments of differing ambient air pollution concentrations: A literature review

People who relocate to a new environment may experience health effects from a change in ambient air pollution. We undertook a literature review of studies of such relocations and health effects and report the results as a narrative analysis. Fifteen articles of heterogeneous designs met the inclusion criteria. Four short-term (relocation duration less than six months) and three long-term (relocation duration six months or greater) studies reported evidence of the effect of relocation on physiological outcome, biomarkers or symptoms. All had potential weaknesses of design or analysis but, as a whole, their results are broadly consistent in suggesting short-term adverse effects of air pollutants or their reversibility. One long-term study provided evidence that changes in air pollution exposure during adolescence have a measurable effect on lung function growth. Four cohort studies were also identified that used relocation to strengthen evidence of air-pollution-exposure relationships by using a design that incorporates effective randomization of exposure or the use of relocation to improve exposure classification. However, three studies of relocation during pregnancy provided limited evidence to conclude an effect of relocation-related change in exposure on pregnancy outcome. Overall, most relocation studies are consistent with short- or long-term adverse effects of air pollution on biological function or mortality, but many studies of change in exposure have design weaknesses that limit the robustness of interpretation. We outline principles for improved design and analysis to help strengthen future studies for the insights they can provide from their quasi-experimental designs, including on the nature and timing of functional changes of relocation-related changes in exposure to ambient air pollution.

Effect of comorbidities and risk conditions on death from COVID-19 in migrants in Mexico

BACKGROUND

Comorbidities increase the risk of death for patients with COVID-19, however, little is known about how it affects the prognosis of migrants who contract the virus. Therefore, this article aims to determine which comorbidities and risk conditions are associated with the probability of death among migrants infected with COVID-19 in Mexico.

METHODS

We use a sample of migrants with a positive diagnosis for COVID-19 (N = 2126) registered in the public database published in the National Epidemiological Surveillance System of the Mexican Ministry of Health; the technique used was a Probit regression.

RESULTS

The findings show that most of the comorbidities commonly associated with death from COVID-19 in the native-born population were actually not significant when present in migrants infected with COVID-19. Additionally, migrants have lower comorbidities than locals. The results further indicate that the factors related to the death of migrants infected with COVID-19 are: age, intubation, nationality group, pneumonia and the Health Care Management of Patients.

CONCLUSIONS

In contrast to preceding studies with native-born populations with COVID-19, where pre-existing diseases aggravated the diagnosis of COVID-19 and sometimes led to death, in the case of migrants, only pneumonia was the significant comorbidity associated with mortality among migrants diagnosed with COVID-19.

Geographical Access to Child and Family Healthcare Services and Hospitals for Africa-Born Migrants and Refugees in NSW, Australia; A Spatial Study

Background: African-born migrants and refugees arriving from fragile states and countries with political and economic challenges have unique health needs requiring tailored healthcare services and support. However, there is little investigation into the distribution of this population and their spatial access to healthcare in Australia. This paper reports on research that aimed to map the spatial distribution of Africa-born migrants from low and lower-middle-income countries (LLMICs) and refugees in New South Wales (NSW) and access to universal child and family health (CFH) services and hospitals. Methods: We analysed the Australian Bureau of Statistics 2016 Census data and Department of Social Services 2018 Settlement data. Using a Geographic Information System mapping software (Caliper Corporation. Newton, MA, USA), we applied data visualisation techniques to map the distribution of Africa-born migrants and refugees relative to CFH services and their travel distance to the nearest service. Results: Results indicate a spatial distribution of 51,709 migrants from LLMICs in Africa and 13,661 refugees from Africa live in NSW, with more than 70% of the total population residing in Sydney. The Africa-born migrant and refugee population in Sydney appear to be well served by CFH services and hospitals. However, there is a marked disparity between local government areas. For example, the local government areas of Blacktown and Canterbury-Bankstown, where the largest number of Africa-born migrants and refugees reside, have more uneven and widely dispersed services than those in Sydney’s inner suburbs. Conclusion: The place of residence and travel distance to services may present barriers to access to essential CFH services and hospitals for Africa-born refugees and migrants. Future analysis into spatial-access disadvantages is needed to identify how access to health services can be improved for refugees and migrants.

“The journey will be relaxed. You will watch television. Just like a VIP”: Misinformation, secrecy, and the information behaviour of repatriated migrants in Bangladesh

This paper explores the information behaviour of repatriated migrants in Bangladesh in the context of their irregular migration. Using an exploratory qualitative research design, semi-structured interviews were conducted with eight repatriated migrants in Bangladesh. This study provides insights into the culturally situated, complicated information behaviour of repatriated migrants in Bangladesh. The findings of this study show that repatriated migrants did not seek any information in the context of their irregular migration. It is evident that factors such as unrealistic perceptions and expectations about life abroad, desperate desire to relocate to another country, and trust in smugglers and their agents played a key role in their information seeking in the context of their irregular migration. The study revealed that some participants were unaware of the risk of taking an irregular journey and deceived by the misinformation shared by their smugglers and their agents. Some interviewees even claimed not to attempt to move to Malaysia if they were aware of the heavy risks associated with the move. The concepts of “migration as gambling” and “Aladdin’s lamp” emerged in this study have some implications for local informational program development aiming to educate vulnerable rural population about the risk of irregular migration and connect them with reliable migrational information sources. The study identified some information grounds such as the Bazaar and Betel fields, which might be useful in offering informational programs at those grounds. The findings related to the information behaviour of repatriated migrants have potential implications for research in various disciplines, including library and information science, migrational studies, geography, and psychology.

Health Impact of Drying Aral Sea: One Health and Socio-Economical Approach

Once one of the largest saline lakes, the Aral Sea, was recognized as a significant environmental disaster as the water level decreased dramatically. Water level decrease increases water salinity, affecting biodiversity. Exposed lake beds become the source for fine dust picked up by the dust storms and spread across a long distance, affecting people’s health in surrounding areas. This review paper attempts to evaluate the potential links between the Aral Sea shrinking and the existing health issues in the case of Kazakhstan. The literature-based research revealed that the population of the Aral Sea basin region has been suffering from exposure to various pollutant residues for a long time. There is an apparent increase in morbidity and mortality rates in the region, especially in people suffering from chronic illness. Furthermore, the catastrophic desiccation of the Aral Sea has led to the sharp deterioration in living conditions and negative trends in the socio-economic situation of the region’s population. While the dust storms spread the polluted salts from the exposed bottom across the Aral Sea region, specific contaminants define the relevance and importance of public health problems linked to the basin rather than the Aral Sea drying process. There is, however, no clear evidence that associated dust storms are the only primary source of the deterioration of people’s health. Moreover, One Health approach seems to play a crucial role in achieving better outcomes in the health of people and the health of the environment.

Healthcare-related expenditures among immigrants and non-immigrants living with HIV in colombia

The perception that immigrants represent a burden to national health systems can hinder the development of policies for their inclusion in health coverage. In order to inform the development of such policies, data on the healthcare needs and healthcare spending for immigrants is required. The objective of this article is to compare the clinical characteristics and healthcare-related expenditures of Venezuelan immigrants and non-migrants living with HIV in Colombia. We analysed data from the Colombian High-cost Diseases Fund from February 1, 2018 to January 31, 2019, identifying the hospital and non-hospital expenditures per patient for Venezuelan immigrants and non-migrant patients, in both the state-subsidised and the contributory coverage schemes. We employed binomial negative regression models to compare expenditures between the two groups. In the contributory scheme, the average annual per-capita expenditure for immigrants was USD $ 859.07 (SD: ± $793.37) for non-hospital care. For non-migrants, the average costs were 1,796.53. In the state-subsidised scheme expenditures were higher on average, but still lower for immigrants than for non-migrants. After adjusting by clinical and sociodemographic characteristics, non-hospital per capita expenditures were lower for immigrants as compared with non-migrants (25,37% lower in the state-subsidised scheme, and 33,75% lower in the contributory scheme). Hospital expenditures were also lower, but the small sample size limited analysis. To conclude, Venezuelan immigrants living with HIV do not represent a major economic burden to the health system in Colombia. Further studies are required in order to understand if the lower healthcare expenditures of this population are the result of limitations in healthcare access, of clinical characteristics that were not assessed in this study, or of other unmeasured aspects.

Models of Maternal Healthcare for African refugee women in High-Income Countries: A Systematic Review

OBJECTIVE

To explore models of maternal healthcare for African refugee women and their acceptability, cost and associated outcomes.

DESIGN

A systematic review and content analysis SETTING: High-income countries PARTICIPANTS: African refugee women REVIEW METHODS: Seven databases were searched to identify peer-reviewed literature using defined keywords and inclusion criteria. Two authors independently screened the search findings and the full texts of eligible studies. The quality of the included studies was appraised, and the findings were analysed using a template.

RESULTS

Nine studies met the criteria. Four studies were qualitative, two quantitative and three studies used mixed methods. Four models of care were identified: midwifery-led care, hospital-based integrated care, primary care physician-led integrated care and a holistic refugee-specific primary healthcare model (one-stop shop). Issues affecting care delivery were identified as communication barriers, low health literacy, high transport costs and low engagement of refugee women in their care.

KEY CONCLUSIONS

The lack of evidence regarding the impact of care models on the maternal healthcare outcomes of African refugees highlights the need to improve care evaluations. These results reinforce the importance of education and interventions to build refugee women's health literacy and strength-based communication approaches supported by multidisciplinary, multilingual and highly trained teams of health professionals. There is also a need to involve African refugee women in shared decision making.

IMPLICATIONS FOR PRACTICE

The findings suggest the need for universal access to a woman-centred whole-of-system care approach for African refugees that emphasises culturally competent, safe, respectful and compassionate multi-professional care and greater economic security to cover costs.

Urban nexus and transformative pathways towards resilient cities: A case of the Gauteng City-Region, South Africa

Challenges emanating from rapid urbanisation require innovative strategies to transform cities into global climate action and adaptation centres. We provide an analysis of the impacts of rapid urbanisation in the Gauteng City-Region, South Africa, highlighting major challenges related to (i) land use management, (ii) service delivery (water, energy, food, and waste and sanitation), and (iii) social cohesion. Geospatial techniques were used to assess spatio-temporal changes in the urban landscapes, including variations in land surface temperatures. Massive impervious surfaces, rising temperatures, flooding and heatwaves are exacerbating the challenges associated with rapid urbanisation. An outline of the response pathways towards sustainable and resilient cities is given as a lens to formulate informed and coherent adaptation urban planning strategies. The assessment facilitated developing a contextualised conceptual framework, focusing on demographic, climatic, and environmental changes, and the risks associated with rapid urbanisation. If not well managed in an integrated manner, rapid urbanisation poses a huge environmental and human health risk and could retard progress towards sustainable cities by 2030. Nexus planning provides the lens and basis to achieve urban resilience, by integrating complex, but interlinked sectors, by considering both ecological and built infrastructures, in a balanced manner, as key to resilience and adaptation strategies.

The Sustainability of EU Labor Immigration in Terms of Poverty Inequalities and Employment

The basic feature of developed economies is a high economic growth rate, which creates the preconditions for a high living standard of population based on high incomes from economic activities. Development processes in advanced economies also include changes in demographic development, resulting in population structure changes, as well as labor force structure changes caused by birth rates reduction and life expectancy increase and an aging process. Due to the high standard of living in European developed countries, they are becoming attractive to less developed countries, having a surplus of labor that migrates to work with a vision of increasing living standards and quality of life. The workforce does not always find full employment here in terms of qualifications, leading to social inequalities between the domestic population and immigrants for whom the social situation poses a risk of poverty. The goal of the article is to determine the specifics of inequalities between the domestic and immigrant population in terms of social status in individual EU countries. Immigrants coming out of the EU are significantly at higher risk of poverty. In most EU countries, the employment rate in the group “nationals” is lower than in the group “foreign” from the EU.

Forced evictions and their social and health impacts in Southern Somalia: a qualitative study in Mogadishu Internally Displaced Persons (IDP) camps

BACKGROUND

Forced evictions are common in conflict-affected settings. More than 500 internally displaced persons (IDPs) are evicted daily in Mogadishu. Context specific research is necessary to inform responsive humanitarian interventions and to monitor the effectiveness of these interventions on IDPs health.

OBJECTIVE

This study explored the causes of forced evictions and their health impacts among IDPs in southern Somalia.

METHODS

We used a qualitative approach, conducting 20 semi-structured interviews, six key informant interviews and four focus group discussions. We used maximum variation sampling to include a wide range of participants and used the framework approach and Nvivo software to analyse the data.

RESULTS

In this context, landlords often rented land without proper tenure agreements, resulting in risk of forced evictions. Informal tenure agreements led to fluctuations in rent, and IDPs were evicted because tenancy laws were inadequate and failed to protect IDP rights. IDP settlements often increased the value of land by clearing scrub, and landlords often sought to profit from this by evicting IDPs at short notice if a buyer was found for the land. The effect of eviction on an already marginalised population was wide ranging, increasing their exposure to violence, loss of assets, sexual assault, disruption of livelihoods, loss of social networks and family separation. Evicted IDPs reported health issues such as diarrhoea, malaria, pneumonia, measles and skin infections, as well as stress, anxiety, psychological distress and trauma.

CONCLUSION

Forced evictions remain one of the biggest challenges for IDPs as they exacerbate existing vulnerabilities. Prioritizing implementation of legal protection for IDP tenure rights is necessary to prevent unlawful evictions of IDPs. Humanitarian agencies should aim to respond more effectively to protect evictees and provide support to prevent poor health outcomes. Further quantitative research is needed to further examine the relationship between forced evictions and health outcomes.

Beyond the Intention: Individual-Level Determinants and Intergenerational Differences of Floating Populations' Actual Settlement Choices in Dongguan, China

The migration process and patterns of floating populations have received continuing attention from scholars and policymakers. In China, however, studies have been focused on the settlement intention of floating populations based on sampling surveys and yielded inconsistent findings. Drawing upon 18,178,167 authentic individual samples of floating populations in Dongguan city, this study contributes to the literature by examining the effect of individual characteristics on the actual resident actions of floating populations, and revealing both the heterogeneity and continuity of their urban residence among four generations (i.e., during the 1960s, 1970s, 1980s, and 1990s). The results show that the proportion of actual resident actions is lower than that reported by previous studies on settlement intentions, and that male, married, middle-aged, more educated, and long-residing members are more likely to choose to stay in Dongguan. Compared to their predecessors, the 1990 cohort reveals significant heterogeneities in their actual settlement choices. The study draws broad implications from the analysis, calling for the equalization of public welfare in Chinese cities and the encouragement of floating populations to sustain long-term residence in the destination cities.

Realigning Health Systems Strategies and Approaches; What Should African Countries Do to Strengthen Health Systems for the Sustainable Development Goals?

The African region is experiencing peculiar demographic, economic, social and environmental challenges that place pressures on the health systems. While the need to explore ways to address identified health systems challenges is far from easy, there are substantial evidence that having robust frameworks and metrics to direct efforts and priorities of countries could be rewarding. In view of persisting regional health systems' challenges the World Health Organization African regional office proposed the adoption of a comprehensive health system strengthening action framework that provides an opportunity to translate global health policy into operational strategies for Africa's health sector policies, strategies and operations. The adoption of the action framework could support the realization of regional health objectives and priorities, and guide movement toward sustainable developments in countries.

Exploring Connections—Environmental Change, Food Security and Violence as Drivers of Migration—A Critical Review of Research

Migration, whether triggered by single events, such as violent conflict, or by long term pressures related to environmental change or food insecurity is altering sustainable development in societies. Although there is a large amount of literature, there is a gap for consolidating frameworks of migration-related to the interaction and correlation between drivers. We review scientific papers and research reports about three categories of drivers: Environmental Change (EC), Food Security (FS), and Violent Conflict (VC). First, we organize the literature to understand the explanations of the three drivers on migration individually, as well as the interactions among each other. Secondly, we analyse the literature produced regarding Colombia, Myanmar, and Tanzania; countries with different combinations of the driving factors for migration. Although we find that many correlations are explained in the literature, migration is mostly driven by structural vulnerabilities and unsustainable development paths in places that have a low resilience capacity to cope with risk. For example, food insecurity, as a product of environmental changes (droughts and floods), is seen as a mediating factor detonating violent conflict and migration in vulnerable populations. The paper contributes to the literature about multi-driven migration, presenting an overview of the way in which different driver combinations trigger migration. This is important for determining the best governance mechanisms and policy responses that tackle forced migration and improve the resilience of vulnerable communities as well as sustainable development.

Leveraging the urban-rural divide for epigenetic research

Urbanization coincides with a complex change in environmental exposure and a rapid increase in noncommunicable diseases (NCDs). Epigenetics, including DNA methylation (DNAm), is thought to mediate part of the association between genetic/environmental exposure and NCDs. The urban-rural divide provides a unique opportunity to investigate the effect of the combined presence of multiple forms of environmental exposure on DNAm and the related increase in disease risk. This review evaluates the ability of three epidemiological study designs (migration, income-comparative and urban-rural designs) to investigate the role of DNAm in the association between urbanization and the rise in NCD prevalence. We also discuss the ability of each study design to address the gaps in the current literature, including the complex methylation-mediated risk attributable to the cluster of forms of exposure characterizing urban and rural living, while providing a platform for developing countries to leverage their demographic discrepancies in future research ventures.

Migration under Climate Change in Southern Africa: A Nexus Planning Perspective

Population increase is exacerbating resource insecurities due to increased demand for already depleted resources. Coupled with climate change, they are the main drivers of both intra-(rural-urban and urban-urban) and inter-migration (from one country to the other). We carried out a systematic review of literature, focusing on available options to ensure water and food security, as well as improve the socio-economic environment, highlighting the drivers of migration in southern Africa. The aim was to develop informed adaptation strategies and build resilience in the advent of accelerated migration. We developed a migration conceptual framework based on the nexus between water, food and socio-economic interlinkages. Urban areas in southern Africa are under immense pressure to accommodate climate refugees from resource stressed rural areas, a situation that is impacting on agricultural production. Most urban areas are exceeding their ecological thresholds to support the built environment, causing some socio-ecological challenges. Nexus planning can inform adaptation planning on permissible migration that are aligned with regional goals such as regional integration, poverty reduction and improved livelihoods. This would also contribute to the region's achievements of the Sustainable Development Goals. Furthermore, through the identification of synergies and trade-offs, nexus planning can inform regional adaptation strategies for positively managing migration leading to sustainable outcomes.

Children in Immigrant Families: Advocacy Within and Beyond the Pediatric Emergency Department

In the United States, 1 in 4 children lives in an immigrant family. State and national policies have historically precluded equitable access to health care among children in immigrant families. More recently, increasingly restrictive policies, political rhetoric, and xenophobic stances have made immigrant families less able to access health care and less comfortable in attempting to do so, thus increasing the likelihood that patients will present to the emergency department. Once in the emergency department, language, cultural, and health literacy barriers make providing high-quality care potentially challenging for some families. Emergency care professionals can therefore glean critical insight regarding inequities from clinical work to inform advocacy and policy changes at institutional, community, regional, and national levels.

Mass migration to Europe: an opportunity for elimination of hepatitis B virus?

People from low-to-middle income countries have been migrating to western Europe on a large scale in recent years. Data indicate that the number of first-time asylum applications by non-EU members increased from 290 000 in 2011 to more than 1·3 million in 2015. During the peak period of migration, The Global Health Sector Strategy on Viral Hepatitis was adopted by WHO. Viral hepatitis, and particularly hepatitis B virus (HBV), is an important disease because of its high prevalence and associated mortality. In some cases, HBV can be carried by refugees arriving from regions of high and intermediate prevalence. Refugees with HBV might not show clinical symptoms and not be diagnosed in destination countries with a low prevalence, where screening is not regularly done. Although transmission to the host population is low, dedicated surveillance and tailored public health policies are required. It is important to note that some of the countries that receive many migrants do not have a universal HBV vaccination programme. In this Viewpoint, we argue that the current large-scale movement from regions with high or intermediate HBV prevalence should be taken as an opportunity to achieve viral hepatitis elimination targets, by establishing a well prepared infrastructure for HBV screening, vaccination, and treatment.

Asylum seekers' and Refugees' Changing Health (ARCH) study protocol: an observational study in Lebanon and Denmark to assess health implications of long-distance migration on communicable and non-communicable diseases and mental health

INTRODUCTION

By end of 2018, the European Union countries hosted approximately 2.5 million refugees and Lebanon alone hosted more than 1 million. The majority of refugees worldwide came from Syria. The prevailing study design in published studies on asylum seekers' and refugees' health leaves a number of fundamental research questions unanswerable. In the Asylum seekers' and Refugees' Changing Health (ARCH) study, we examine the health of a homogeneous group of refugees and asylum seekers in two very different host countries with very different migration histories. We aim to study the health impact of the migration process, living conditions, access to healthcare, gene-environment interactions and the health transition.

METHODS AND ANALYSIS

ARCH is an international multisite study of the health of adult (>18 years old) Syrian refugees and asylum seekers in Lebanon and Denmark. Using a standardised framework, we collect information on mental and physical health using validated scales and biological samples. We aim to include 220 participants in Danish asylum centres and 1100 participants in Lebanese refugee camps and settlements. We will use propensity score weights to control for confounding and multiple imputation to handle missing data.

ETHICS AND DISSEMINATION

Ethical approval has been obtained in Lebanon and Denmark. In the short term, we will present the cross-sectional association between long-distance migration and the results of the throat and wound swab, blood and faeces samples and mental health screenings. In the longer term, we are planning to follow the refugees in Denmark with collection of dried blood spots, mental health screenings and semistructured qualitative interviews on the participant's health and access to healthcare in the time lived in Denmark. Here, we present an overview of the background for the ARCH study as well as a thorough description of the methodology.

Migrant Health Burden: Where Do We Stand?

This Special Issue of the International Journal of Environmental Research and Public Health contains a collection of extended papers that describe many important aspects of the “migrant health burden” and focus on new realities and solutions in the healthcare of migrants and refugees.

Epidemiology and treatment outcome of MDR and pre-XDR TB in international migrants at two reference centers in the North of Italy: a cross-sectional study coordinated by Stop TB Italia Onlus

OBJECTIVE

We evaluated the epidemiology and treatment outcomes of multi-drug-resistant (MDR) and pre-extensively-resistant (pre-XDR) tuberculosis (TB) in migrants at two TB reference centers in Italy.

STUDY DESIGN

Patient selection criteria for the present study were as follows: age ≥18 years, international migrants (i.e., person who lives in a country other than his/her country of origin), MDR or pre-XDR-TB based on drug-susceptibility test findings, full availability of microbiological, radiological and clinical data. Non-intersecting populations between the two centers were selected. The primary outcome was the proportion of patients with a successful (i.e., cured and treatment completed) treatment outcome.

METHODS

A retrospective cross-sectional study was conducted, from 01/Jan/2000 to 01/Jan/2015, at the Regional TB Reference Centre of Lombardy Region, Villa Marelli Institute/ASST Niguarda Ca' Granda (Milan, Italy) and at the Reference Center for MDR-TB and HIV-TB, Eugenio Morelli Hospital ASST (Sondalo, Italy). All data were made anonymous. Qualitative and quantitative variables were collected in an ad hoc electronic database. The statistical software used for all computations was STATA version 15 (StataCorp, Texas, USA).

RESULTS

Overall, 116 MDR-TB and pre-XDR-TB cases were recorded: 82 (70.7%) MDR-TB and 34 (29.3%) pre-XDR-TB patients, respectively. The majority (53.5%) were from the World Health Organization European Region (excluding EU/EEA) and 75 (64.5%) were male. Median (interquartile range) age was 32 (26-39) years. TB/HIV coinfection was found in 12 (10.3%) patients. Pulmonary TB was diagnosed in 107/116 (92.2%) patients. Resistance to fluoroquinolones and second-line injectables was detected in 22/116 (19.0%) and 12/107 (11.2%) patients, respectively. Overall treatment success was reached in 95/116 (81.9%) cases.

CONCLUSION

Pre-XDR-TB in migrants coming from high-endemic countries represents a matter of concern; therefore, prevention and control activities targeted to high-risk populations are needed to progress toward TB elimination.

Overcoming challenges in the diagnosis and treatment of parasitic infectious diseases in migrants

Introduction: Recent increases in population movements have created novel health challenges in many areas of the World, and health policies have been adapted accordingly in several countries. However, screening guidelines for infectious diseases are not standardized and generally do not include comprehensive screening for parasitic infections.Areas covered: Malaria, Chagas disease, leishmaniasis, amebiasis, filariases, strongyloidiasis, and schistosomiasis are reviewed, focusing on the challenges posed for their diagnosis and management in vulnerable populations such as migrants. The methodology included literature searches in public databases such as PubMed.gov and Google Scholar and search of the US National Library of Medicine online database of privately and publicly funded clinical studies (ClinicalTrials.gov) until November 2019.Expert opinion: Parasitic infections which may remain asymptomatic for prolonged periods, leading to chronic infection and complications, and/or may be transmitted in non-endemic areas are ideal candidates for screening. Proposed strategies to improve diagnosis in vulnerable groups such as migrants include facilitating access to healthcare in a multi-dimensional manner considering location, individual characteristics, and timing. Limitations and availability of specific diagnostic techniques should be addressed and focus on drug and vaccine development for these neglected infections should be prioritized through collaborative initiatives with public disclosure of results.