Immigration and social exclusion : examining health inequalities of immigrants through acculturation lenses

Over the last three decades, the number of people migrating from developing to developed countries has been increasing in stepwise fashion as a result of insecurity, war and poverty. Such mass population movement has resulted in dramatic demographic transformations of most developed countries (Organisation for Economic Co-operation and Development 2007). The latest demographic data indicate that about 4 million new immigrants entered OECD countries on a permanent basis in 2005, an increase of 10 per cent from 2004 (Organisation for Economic Co-operation and Development 2007). In Australia, the 2006 census data indicate that more than one in five Australians (22.2 per cent) were born overseas, a pattern that has remained constant since 1996. The overseas-born population increased in number between 1996 and 2006 by 13 per cent, from around 3.9 million to 4.4 million (Australian Bureau of Statistics 2007d). Although a considerable proportion of Australian residents born overseas (including refugees and humanitarian entrants) come from countries recently affected by war and political unrest (Australian Bureau of Statistics 2007d), at a global level, migration for family reunion is the dominant reason for the inflows, and labour immigration is expanding, while humanitarian migration (including refugees and asylum seekers) has been declining (Organisation for Economic Co-operation and Development 2007)

The need for the right socio-economic and cultural fit in the COVID-19 response in sub-Saharan Africa : examining demographic, economic political, health, and socio-cultural differentials in COVID-19 morbidity and mortality

The coronavirus disease (COVID-19) has spread quickly across the globe with devastating effects on the global economy as well as the regional and societies’ socio-economic fabrics and the way of life for vast populations. The nonhomogeneous continent faces local contextual complexities that require locally relevant and culturally appropriate COVID-19 interventions. This paper examines demographic, economic, political, health, and socio-cultural differentials in COVID-19 morbidity and mortality. The health systems need to be strengthened through extending the health workforce by mobilizing and engaging the diaspora, and implementing the International Health Regulations (2005) core capacities. In the absence of adequate social protection and welfare programs targeting the poor during the pandemic, sub-Saharan African countries need to put in place flexible but effective policies and legislation approaches that harness and formalise the informal trade and remove supply chain barriers. This could include strengthening cross-border trade facilities such as adequate pro-poor, gender-sensitive, and streamlined cross-border customs, tax regimes, and information flow. The emphasis should be on cross-border infrastructure that not only facilitates trade through efficient border administration but can also effectively manage cross-border health threats. There is an urgent need to strengthen social protection systems to make them responsive to crises, and embed them within human rights-based approaches to better support vulnerable populations and enact health and social security benefits. The COVI-19 response needs to adhere to the well-established ‘do no harm’ principle to prevent further damage or suffering as a result of the pandemic and examined through local lenses to inform peace-building initiatives that may yield long-term gains in the post-COVID-19 recovery efforts

Good practice in microfinance: the challenges of a poverty focus in an evolving industry

The awarding of the 2006 Nobel Peace prize to Grameen Bank founder Muhammad Yunus has further highlighted how microfinance has come to be regarded as a significant and effective tool in making finance available to the poor. However, much debate still centres on both how microfmance should be delivered and its effectiveness measured. Microfinance funding is not something that should be undertaken lightly, and an awareness of all the cogent issues is essential for any donor looking to undertake effective microfinance programming. This chapter will outline some of the key arguments in the contested debate on effective microfinance programming. It will focus on a discussion of poverty and impact assessments and argues that the effective funding of microfinance is dependent on the ability of an NGO to recognise the many forms which micro finance can take and direct their funding accordingly.<br /

Associations of womens position in the household and food insecurity with family planning use in Nepal.

BACKGROUND: Women in Nepal have low status, especially younger women in co-resident households. Nepal also faces high levels of household food insecurity and malnutrition, and stagnation in uptake of modern family planning methods. OBJECTIVE: This study aims to understand if household structure and food insecurity interact to influence family planning use in Nepal. METHODS: Using data on married, non-pregnant women aged 15-49 with at least one child from the Nepal 2011 Demographic and Health Survey (N = 7,460), we explore the relationship between womens position in the household, food insecurity as a moderator, and family planning use, using multi-variable logistic regressions. We adjust for household and individual factors, including other status-related variables. RESULTS: In adjusted models, living in a food insecure household and co-residing with in-laws either with no other daughter-in-laws or as the eldest or youngest daughter-in-law (compared to not-co-residing with in-laws) are all associated with lower odds of family planning use. In the interaction model, younger-sisters-in-law and women co-residing with no sisters-in-law in food insecure households have the lowest odds of family planning use. CONCLUSION: This study shows that household position is associated with family planning use in Nepal, and that food insecurity modifies these associations-highlighting the importance of considering both factors in understanding reproductive health care use in Nepal. Policies and programs should focus on the multiple pathways through which food insecurity impacts womens reproductive health, including focusing on women with the lowest status in households

Cash transfers and the social determinants of health : a conceptual framework

Cash transfers (CTs) can play a significant role in tackling the social determinants of health (SDoH), but to date there is a lack of conceptual framework for understanding CTs linkages to the SDoH. This article proposes a framework that identifies the linkages between CTs and SDoH, discusses its implications, and argues for active involvement of health promoters in CT design, implementation and evaluation. The development of the framework followed two stages: evidence review and stakeholder involvement. The evidence review entailed a systematic literature search to identify published and unpublished impact evaluation studies of CTs in sub-Saharan Africa. Critical reflection on the evidence synthesized from the literature formed the basis for the development of the framework. Interviews with CT policy makers, managers and development partners were also carried out to help refine the framework. Interviews were audio-recorded and transcripts were analysed using thematic framework analysis. The study finds that there is limited recognition of SDoH in CT policy making and implementation. The evidence reviewed, however, points to strong impacts of CTs on SDoH. The framework thus conceptualizes how CTs work to influence a broad range of SDoH and health inequities. It also highlights how CT architecture and contexts may influence program impacts. The proposed framework can be used by policy makers to guide CT design, adaptation and operations, and by program managers and researchers to inform CTs’ evaluations, respectively. The framework suggests that to optimize CT impact on SDoH and reduce health inequities, health promoters should be actively engaged in terms of the programs design, implementation and evaluation

The disparity in mental health between two generations of internal migrants (IMs) in China : evidence from a nationwide cross-sectional study

Background: Internal migrants (IMs) are a large, vulnerable population in China and are mostly driven by national economic reform. IMs who were born before and after 1980, when the general social and economic reform began to appear in China, are considered to be two separate generations. The generational differences in mental health across IMs remain undocumented. In this study, the intergenerational disparity in IMs’ mental health, using data from a national cross-sectional study, was assessed. Methods: Cross-sectional data from the “National Internal Migrant Dynamic Monitoring Survey 2014” were used. IMs were divided into the “old” or “new” generation, based on their date of birth (before 1980 vs. from 1980 onwards). Mental health includes psychological distress, which was measured using the Kessler Screening Scale for Psychological Distress (K6), and perceived stress, which was measured with the Perceived Stress Scales (PSS-4). Two-level Generalized Linear Mixed Models were performed so as to assess the generation gap and associated factors of each group’s mental health. IM demographics, migration characteristics, and social integration indicators were controlled for when assessing the intergenerational disparity in mental health. Results: A total of 15,999 IMs from eight different cities participated in the survey. New generation migrants accounted for 61.5% (9838/15,999) of the total sample. After controlling for participants’ characteristics, new generation migrants had higher psychological distress scores (βad = 0.084, 95% CI: (0.026,0.193) and higher perceived stress scores (βad = 0.118, 95% CI: 0.029, 0.207) than the older generation. For both generations, factors associated with good mental health included high levels of social integration, personal autonomy, and life satisfaction, as well as self-rated good physical health. For the new generation, the mental health of urban-to-urban IMs (βad = 0.201, 95%CI: 0.009, 0.410) for the K6, βad = 0.241, 95% CI: 0.073, 0.409 for the PSS-4), IMs with a longer migration duration (βad = 0.002, 95% CI: (0.000, 0.003) for the PSS-4) and IMs with a higher annual income (βad = 0.124, 95% CI: (0.029, 0.218) for the K6) was significantly poorer than their counterparts. Conclusions: New-generation migrants’ mental health is worse compared to older IMs. An array of services for addressing these generation-specific needs may facilitate the promotion of mental health among IMs in China

Wasting and associated factors among children under 5 years in five South Asian countries (2014-2018) : analysis of demographic health surveys

Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent demographic and health surveys (2014–2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0–23 months (25%) as compared to 24–59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0–23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24–59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0–59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age

Past drivers of and priorities for child undernutrition in South Asia : a mixed methods systematic review protocol

BACKGROUND: South Asia has one of the largest proportions of undernourished children in the world, especially stunting, wasting, and underweight as well as micronutrient deficiencies such as the deficiency of iron, vitamin A, and zinc. Undernutrition continues to pose a major threat to this region's economic and social growth. This systematic review aims to assess the drivers and identify priorities for child undernutrition in South Asia. It aims to appraise, synthesise, and summarise literature to create an evidence base that looks at multiple faces of macro and micro child undernutrition in South Asia. METHODS: A systematic review of published and grey literature on child undernutrition, including macro and micronutrient deficiencies, in South Asia covering the period January 2000 to September 2019 will be undertaken. Studies with all relevant study designs and those published in English will be considered for inclusion. Five academic databases will be searched: CINAHL, EMBASE, PubMed, PsycINFO, and Scopus, in addition to various grey literature sources. The analysis will incorporate a narrative synthesis, meta-ethnography or a meta-analysis as appropriate, depending on the nature of the retrieved data. Quality of the included studies will be assessed by validated tools. The UNICEF conceptual framework on child undernutrition will be used to frame findings. DISCUSSION: This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. The protocol gives an insight into the scope and parameters for the systematic review to be carried out. SYSTEMATIC REVIEW REGISTRATION: The protocol was registered by the PROSPERO international prospective register of systematic reviews, reference CRD42018112696

Factors associated with stunting among children under 5 years in five South Asian countries (2014-2018) : analysis of Demographic Health Surveys

South Asia continues to be the global hub for child undernutrition with 35% of children still stunted in 2017. This paper aimed to identify factors associated with stunting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent Demographic and Health Surveys (2014–2018) was combined of five countries in South Asia. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. The common factors associated with stunting in three age groups were mothers with no schooling ([adjusted odds ratio (AOR) for 0–23 months = 1.65; 95% CI: (1.29, 2.13)]; [AOR for 24–59 months = AOR = 1.46; 95% CI: (1.27, 1.69)] and [AOR for 0–59 months = AOR = 1.59; 95% CI: (1.34, 1. 88)]) and maternal short stature (height < 150 cm) ([AOR for 0–23 months = 2.00; 95% CI: (1.51, 2.65)]; [AOR for 24–59 months = 3.63; 95% CI: (2.87, 4.60)] and [AOR for 0–59 months = 2.87; 95% CI: (2.37, 3.48)]). Study findings suggest the need for a balanced and integrated nutrition strategy that incorporates nutrition-specific and nutrition-sensitive interventions with an increased focus on interventions for children aged 24–59 months