Migration, Remittances and Nutrition Outcomes of Left-Behind Children: A National-Level Quantitative Assessment of Guatemala

Aggressive behaviors and associated factors in Chinese left-behind adolescents: a cross-sectional study

BACKGROUND

To examine whether the levels of aggressive behaviors and other individual and contextual variables differ between left-behind adolescents (LBA) and not left-behind adolescents (NLBA) and explore associations between aggression and other constructs among them.

METHODS

A cross-sectional study was conducted and 4530 school adolescents aged 9-18 years in north and south of China were randomly selected. The levels of aggressive behavior, personality and family and classroom environment were compared between LBA and NLBA and also the associated factors of aggression.

RESULTS

The total scores of aggressive behaviors were 6.33 ± 6.35 (Mean ± SD) in LBA and 5.78 ± 6.16 (Mean ± SD) in NLBA. Multiple linear regression models revealed that neuroticism and psychoticism were positively associated with aggressive behaviors for LBA with similar results of NLBA. Cohesion was negatively associated with aggressive behaviors, and conflict and achievement had positive effects in NLBA. Organization had a negative effect in LBA. Uncertainty and dissatisfaction had positive effects on aggression both in LBA and NLBA.

CONCLUSION

This study found a slightly higher level of aggressive behaviors in LBA comparing with NLBA. Personality was the mainly associated factor of aggression, but class-based interventions were more practical for aggressive behaviors in Chinese LBA.

Through our own eyes and voices: The experiences of those "left-behind" in rural, indigenous migrant-sending communities in western Guatemala

Migration from Central America to the United States has become a strategy to escape economic poverty, exclusionary state policies and violence for people of Mayan descent. Under the principles Community Based Participatory Research, we explored the health concerns of Indigenous Mayans in rural migrant-sending communities of Guatemala using their own visual images and narratives through a Social Constructivist lens. Half of households in the study region have at least one member emigrated to the United States, making many "transnational families." Focus groups and photographs and narratives from 20 Photovoice participants, aged 16-65, revealed significant health challenges related to conditions of poverty. Drivers of immigration to the United States included lack of access to healthcare, lack of economic opportunity, and an inability to pay for children's education. Health implications of living in communities "left-behind" to immigration centered around changes in societal structure and values. Mental health challenges, sadness and loss were experienced by both children and adults left behind. An increase in substance use as a coping mechanism is described as increasingly common, and parental absence leaves aging grandparents raising children with less guidance and supervision. Lack of economic opportunity and parental supervision has left young adults vulnerable to the influence of cartel gangs that are well-established in this region. Findings from this study provide insight into challenges driving immigration, and the health impacts faced by rural, Indigenous communities left behind to international immigration. Results may inform research and interventions addressing disparities and strategies to cope with economic and health challenges.

Fathers' Migration and Nutritional Status of Children in India: Do the Effects Vary by Community Context?

BACKGROUND

Due to international and internal migration, millions of children in developing countries are geographically separated from one or both of their parents. Prior research has not reached a consensus on the impacts of parental out-migration on children's growth, and little is known about how community contexts modify the impact of parental out-migration.

OBJECTIVE

We aim to assess the overall impacts of fathers' previous and current migration experiences on children's nutritional status in India and how the impacts are shaped by community socioeconomic contexts and community gender norms.

METHODS

Using data from the Indian Human Development Survey collected in 2011-2012, we estimated community fixed-effect regression models predicting the nutritional status of children (ages 10-15) and examined the interactions among fathers' migration, child's gender, and community contexts.

RESULTS

The results showed that children of returned migrants had lower height and Body Mass Index (BMI) than children of non-migrants. Fathers' current absence was associated with lower height and BMI for adolescents in communities with high levels of socioeconomic development but not for those in communities with low levels of development. Fathers' current absence due to migration was especially harmful for girls in communities with strict norms of female seclusion.

CONTRIBUTION

Our findings highlight that the effects of father's out-migration on children are conditioned by the level of communities' socioeconomic development and community gender contexts, which helps to reconcile the previously mixed findings on the effects of parental migration on child outcomes.

The association between parental migration and early childhood nutrition of left-behind children in rural China

BACKGROUND

More than one-third of children under 3 years old are left behind at home due to parental migration in rural China, and we know very little about early childhood nutrition of left-behind children (LBC) because of the dearth of research. This study examined the association between parental migration and early childhood nutrition of LBC in rural China.

METHODS

We used repeated cross-sectional data of rural children aged 6-35 months who participated in two surveys in six counties of northern and southern China in 2013 and 2016 respectively. The length, weight, and hemoglobin concentration were measured by trained health-care workers blinded to parental migration status. Stunting, underweight, wasting, and anemia were identified with the standards recommended by WHO. Generalized linear regressions and multivariate logistic regressions were employed to explore the association between parental migration and these nutritional outcomes at each time point.

RESULTS

Two thousand three hundred thirty-six and 2210 children aged 6-35 months were enrolled in 2013 and 2016, respectively. The results show a reduction of the risks of stunting, underweight, and wasting from 2013 (16.4, 8.5, and 3.5%, respectively) to 2016 (12.1, 4.0, and 1.5%, respectively) but highlight a constantly and alarmingly high risk of anemia among these children (44.8% in 2013 and 43.8% in 2016). Children with migrant fathers performed as well as or better than those with non-migrants on these indicators. Children with migrant parents performed slightly worse in 2013, but equal or slightly superior in 2016 on these indicators compared with children with non-migrants and migrant fathers. Children aged 6-17 months with migrant parents had a significantly lower risk of anemia than those living with their mothers or with both parents (43.1% vs. 63.6% and 61.5 in 2013, and 42.5 vs. 60.1 and 66.2% in 2016), even after controlling for children's sociodemographic characteristics.

CONCLUSIONS

Parental migration may be not detrimental and even beneficial to early childhood nutrition of LBC in rural China. Continued nutritional support is needed for all rural children, especially interventions for preventing micronutrient deficiency. Programs for LBC are recommended to continue to focus on nutrition but pay more attention to other important health issues.

Migration and investments in the health of children left behind: the role of remittances in children's healthcare utilization in Cambodia

Remittances, financial support from family members who have migrated for work, are an increasingly important source of income for households left behind in many lower- and middle-income countries. While remittances have been shown to affect the health status of children left behind, evidence is very limited as to whether and how they affect children's healthcare utilization. Yet, this is an important consideration for policymakers seeking to improve equitable access to quality care in settings where migration is common. I examine whether children under age five whose household receives remittances are more likely to utilize higher quality healthcare providers than those without remittances in Cambodia, a country with high rates of migration and a pluralistic health system. The analysis includes 2230 children reporting recent illness in three waves of the Cambodia Socio-Economic Survey with data on migration, remittances and children's health expenditures. I use mixed-effects and fixed-effects regression analysis to estimate the effect of remittances on children's likelihood of entering care with a formally trained provider, and among those attending a formally trained provider, likelihood of using a public-sector facility. Treatment expenditures are lower among households with remittances, while transportation expenditures do not vary significantly by remittance status. In mixed-effects and fixed-effect regression models, children who receive remittances have a lower likelihood of utilizing qualified providers (adjusted OR = 0.66, 95% confidence interval 0.44-0.98), though this effect is attenuated in fixed-effects models, and there is no association between remittances and attending a public-sector facility. These findings underscore that remittances alone are not sufficient to increase children's utilization of qualified providers in migrant-sending areas, and suggest that policymakers should to address barriers to care beyond cost to promote utilization and equity of access to higher quality care where remittances are a common source of income.

Health impacts of parental migration on left-behind children and adolescents: a systematic review and meta-analysis

BACKGROUND

Globally, a growing number of children and adolescents are left behind when parents migrate. We investigated the effect of parental migration on the health of left behind-children and adolescents in low-income and middle-income countries (LMICs).

METHODS

For this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL, the Cochrane Library, Web of Science, PsychINFO, Global Index Medicus, Scopus, and Popline from inception to April 27, 2017, without language restrictions, for observational studies investigating the effects of parental migration on nutrition, mental health, unintentional injuries, infectious disease, substance use, unprotected sex, early pregnancy, and abuse in left-behind children (aged 0-19 years) in LMICs. We excluded studies in which less than 50% of participants were aged 0-19 years, the mean or median age of participants was more than 19 years, fewer than 50% of parents had migrated for more than 6 months, or the mean or median duration of migration was less than 6 months. We screened studies using systematic review software and extracted summary estimates from published reports independently. The main outcomes were risk and prevalence of health outcomes, including nutrition (stunting, wasting, underweight, overweight and obesity, low birthweight, and anaemia), mental health (depressive disorder, anxiety disorder, conduct disorders, self-harm, and suicide), unintentional injuries, substance use, abuse, and infectious disease. We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs) using random-effects models. This study is registered with PROSPERO, number CRD42017064871.

FINDINGS

Our search identified 10 284 records, of which 111 studies were included for analysis, including a total of 264 967 children (n=106 167 left-behind children and adolescents; n=158 800 children and adolescents of non-migrant parents). 91 studies were done in China and focused on effects of internal labour migration. Compared with children of non-migrants, left-behind children had increased risk of depression and higher depression scores (RR 1·52 [95% CI 1·27-1·82]; SMD 0·16 [0·10-0·21]), anxiety (RR 1·85 [1·36-2·53]; SMD 0·18 [0·11-0·26]), suicidal ideation (RR 1·70 [1·28-2·26]), conduct disorder (SMD 0·16 [0·04-0·28]), substance use (RR 1·24 [1·00-1·52]), wasting (RR 1·13 [1·02-1·24]) and stunting (RR 1·12 [1·00-1·26]). No differences were identified between left-behind children and children of non-migrants for other nutrition outcomes, unintentional injury, abuse, or diarrhoea. No studies reported outcomes for other infectious diseases, self-harm, unprotected sex, or early pregnancy. Study quality varied across the included studies, with 43% of studies at high or unclear risk of bias across five or more domains.

INTERPRETATION

Parental migration is detrimental to the health of left-behind children and adolescents, with no evidence of any benefit. Policy makers and health-care professionals need to take action to improve the health of these young people.

FUNDING

Wellcome Trust.

Effects of the 2008 global financial crisis on population health

We compare the transmission channels through which the 2008 global financial crisis affected health. We find that postponing or skipping visits to the doctor after falling ill and stopping buying regular medication had the strongest negative effects on health, followed by a reduced consumption of staple foods, utilities being cut, being forced to move, and having to sell assets. In comparison, experiencing cuts in TV, phone, and internet services, as well as delaying payments for utilities had relatively weaker negative impacts. In contrast, having a household head or household member lose a job also had negative effects on health status, although this effect was relatively lower. Finally, a reduced flow of remittances had the weakest negative effect.

Biological aspects of human migration and mobility

This paper reviews how migration, both geographical and social, impacts on variation in some human biological traits. Migration and mobility are considered in relation to anthropometric traits and indices, psychometric traits, health, disease and nutrition, temperature regulation and metabolism, mental health and gene flow. It is well known that migration is important in disease transmission but, as this paper demonstrates, migration can have both positive and negative impacts on both donor and recipient populations for a wide range of human traits.