COVID-19 VACCINE IN AFRICA

By: Rebecca Walker, Nicholas Maple & Jo Vearey

Researching Migration & Coronavirus in Southern Africa (MiCoSA)
June 2021

This occasional paper is the start of a series that explores the impacts of COVID-19 and ensuing responses on migration and the wellbeing of migrant and mobile communities in Africa. This paper provides insight into how vaccine nationalism is impacting the rollout of vaccination programs, including the inclusion or exclusion of migrant groups. The paper demonstrates that

“the vast majority of international migrants, refugees, asylum seekers and IDPs are being excluded from state-based vaccine roll-out programmes either via formal policy directives or through various forms of de facto exclusion, such as barriers to access healthcare at the local and national level. These forms of exclusion are likely to have far-reaching public health implications across the continent, affecting both citizens and migrants alike.”

Page 3, “Migrants & the COVID-19 Vaccine Roll-out in Africa: Hesitancy and Exclusion”

To view the other papers in the series, see http://www.mahpsa.org/micosa

About MiCoSa

The Migration and Coronavirus in Southern Africa Coordination Group (MiCoSA) is hosted by the Migration and Health Project Southern Africa (maHp) at the African Centre for Migration & Society (ACMS), Wits University, Johannesburg. MiCoSA is an informal network of migrant-led organisations, non-governmental organisations, international organisations, civil society, activists, lawyers, researchers, government officials and policy advisors. Through an online platform and virtual meetings, MiCoSA brings together national and SADC regional partners who are concerned with the health and well-being of asylum-seekers, refugees and migrants during the current Coronavirus pandemic. To date, MiCoSA has over 150 members; to join this network, please email coronavirusmigration+join@googlegroups.com

Sequential screening for depression in humanitarian emergencies: a validation study of the Patient Health Questionnaire among Syrian refugees

This study utilized data from a cross-sectional survey done with Syrian refugees in a camp in Greece. The goal was to determine if a sequential screening process would be able to accurately assess the number of patients with major depressive disorder (MDD) in the population. While the initial data was collected through the eight-item Patient Health Questionnaire (PHQ-8), this validation study simulated the use of the two-item Patient Health Questionnaire (PHQ-2) as well. The PHQ-2 was used to first screen the data of patients who scored less than 2 on the PHQ-2, who were then ruled out for MDD symptoms. The other patients’ answers were then used in the PHQ-8. The findings were analyzed to see if the two-part process would be able to accurately and efficiently determine who would be most at risk for symptoms of MDD. 

The conclusion of this study was that “The benefits of the sequential screening approach for the classification of MDD presented here are twofold: preserving classification accuracy relative to the PHQ-2 alone while reducing the response burden of the PHQ-8. This sequential screening approach is a pragmatic strategy for streamlining MDD surveillance in humanitarian emergencies.” 

World Migration Report 2020

The International Organization for Migration has just published its 2020 World Migration Report. Read and download it here!

Chapter 7 of the report (“Migration and Health: Key issues, governance and current knowledge gaps”) was written by MHADRI steering committee members Jo Vearey (Vice Chair), Charles Hui (Chair) and Kolitha Wickramage (Secretariat).

“The World Migration Report 2020 presents key data and information on migration as well as analysis of complex and emerging migration issues. Some of the topics covered in the report include human mobility and environmental change, migrants’ contributions in an era of disinformation, children and unsafe migration, migration and health, among others.”

The Director General of the IOM addresses the goals of the report (and indeed of the IOM as an agency) in his foreword:

“As the United Nations’ migration agency, IOM has an obligation to demystify the complexity and diversity of human mobility. The report also acknowledges IOM’s continuing emphasis on fundamental rights and its mission to support those migrants who are most in need. This is particularly relevant in the areas in which IOM works to provide humanitarian assistance to people who have been displaced, including by weather events, conflict and persecution, or to those who have become stranded during crises.”

“Likewise, IOM remains committed to supporting Member States as they draw upon various forms of data, research and analysis during policy formulation and review processes. Indeed, this is reflected in IOM’s Constitution where the need for migration research is highlighted as an integral part of the Organization’s functions. The World Migration Report is a central component of this important function.

In this era of heightened interest and activity towards migration and migrants, we hope this 2020 edition of the World Migration Report becomes a key reference point for you. We hope it helps you to navigate this high-profile and dynamic topic during periods of uncertainty, and that it prompts reflection during quieter moments. But most importantly, we hope that you learn something new from the report that can inform your own work, be it in studies, research and analysis, policymaking, communication, or migration practice.”

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Seasonal migration and health in India: Constraints for research and practice

Divya Ravindranath and Divya Varma

Ideas for India for more evidence-based policy (Published March 2019)

Seasonal migrants in India engage in temporary informal work in work environments that actively flout labour laws on wages, work hours, and living conditions. The most significant impact of this is on the health outcomes of workers and their children. In this note, Varma and Ravindranath describe the roadblocks in conducting in-depth enquiries into migrants’ health status and healthcare-seeking behaviour, and designing and implementing health programmes conducive to their needs.

Read full article here

How Labour Conditions at Construction Sites are Leading to Higher Rates of Child Malnutrition

Divya Ravindranath, Sep 27 2019

This commentary focuses on female workers in construction sites in India, and the impact of mothers’ work on the health and nutrition of their children. The sector provides good opportunities for work, but it also affects children’s health outcomes.

“A study of 131 migrant children living at various construction sites in Ahmedabad showed that half of the children surveyed were underweight (low weight for age), 41% were stunted (low height for age) and 22% were wasted (low weight for height). According to the National Family Health Survey (2015-’16), 35.5% of children under the age of five in the country are underweight, 38.4% are stunted, 21% are wasted.”

The article highlights various reasons why children are in this condition. Mothers do not have time or comfortable environments to breastfeed exclusively, and can also have difficulty finding the time to wean at the proper age. Mothers don’t have access to affordable, healthy food, so older children eat a lot of packaged food. The water in construction sites is often contaminated and not potable. Utilizing health services means taking time off work, which results in a loss of wages.

The author argues that NGO’s can be one way to help alleviate the situation, but they can be difficult to access as well. Dr Ravindranath’s main recommendation is that “it is also critical to view the role of parental work environment and migration as factors contributing to undernutrition. Policies and interventions designed to address undernutrition must consider these as key factors without which such children would continue to be denied a chance of improved nutrition and better health.”

Read full commentary here

The Health of Nepali Migrants in India: A Qualitative Study of Lifestyles and Risks

(Featured image shows first two themes out of a total five from this research)

Authors: Pramod R. Regmi, Edwin van Teijlingen, Preeti Mahato, MSc; Nirmal Aryal, Navnita Jadhav, Padam Simkhada, Quazi Syed Zahiruddin, and Abhay Gaidhane

International Journal of Environmental Research and Public Health, https://doi.org/10.3390/ijerph16193655, (Published Sep 2019).

Current research on Nepali migrant workers in India neglects work, lifestyle, and health care access in favor of focusing on sexual health. This article aims to gain a broader sense of migrant workers’ health by conducting focus groups and interviews. The researchers analyzed their data and determined five different themes:

  1. Accommodation
  2. Lifestyle, networking, and risk-taking behaviours
  3. Work environment
  4. Support from local organisations
  5. Health service utilisation

This qualitative study demonstrates that health risks for Nepali migrant workers’ emerge because of a wide range of factors. The authors recommend a larger quantitative study to gain more insight.

Read the full article here.

Major depressive disorder prevalence and risk factors among Syrian asylum seekers in Greece

Danielle N. Poole, Bethany Hedt-Gauthier, Shirley Liao, Nathaniel A. Raymond, & Till Bärnighausen

BMC Public Health, https://doi.org/10.1186/s12889-018-5822-x, (Published July 2018).

This research provides necessary information on the mental health (specifically major depressive disorder or MDD) of refugees from Syria, as this information has not been collected or analyzed thoroughly as of yet. The researchers surveyed 135 Syrian refugees in a camp in Greece, specifically screening for MDD. The authors found that 44% of participants had symptoms of major depression. They found that women had an increased likelihood of MDD, and that time spent in the camp had a trend towards increased risk of depression.

“The development of depression during the asylum process is likely to undermine individual and societal functioning, which are essential for the survival and eventual resettlement of forced migrants. Depression is also likely to lead to adverse acculturation outcomes.”

To read the full article, click here.

‘And when a certain health issue happen, they try to cover it’: Stakeholder perspectives on the health of temporary foreign workers and their families

Bukola Salami, RN, PhD; Kathleen Hegadoren, RN, PhD; Anna Kirova, PhD; Salima Meherali, RN, MN, PhD; Christina Nsaliwa, PhD; & Yvonne Chiu, LLD

Social Work in Health Care, https://doi.org/10.1080/00981389.2017.1379458 (Published Sep 2017).

Like our other recent highlighted articles, this one again focuses on Alberta, Canada. This research was an exploratory study into the health and wellbeing of temporary foreign workers (TFWs) in the province.

They asked two primary research questions:

  • “What are the perspectives of stakeholders on the health and well-being of TFWs and their families in Alberta?”
  • “What do they see as potential threats to child and family health in this population?”

The authors found that stakeholders perceive TFWs as experiencing several different types of specific health challenges: mental health, family health, and occupational health. They also found that workers confront barriers in accessing mental health services as well as the fact that income and social status are social determinants of health.

If you wish to read the rest of the article, click here. Institutional access restrictions apply.

Transnationalism, parenting, and child disciplinary practices of African immigrants in Alberta, Canada

Dominic A. Alaazi, Bukola Salami, Sophie Yohani, Helen Vallianatos, Philomina Okeke-Ihejirika, Christina Nsaliwa

Child Abuse and Neglect, https://doi.org/10.1016/j.chiabu.2018.09.013 (Published December 2018)

This article focuses on the parental disciplinary practices of African migrants in Alberta, Canada. The authors themselves are members of the immigrant community and so were better able to research these practices in a supportive and reflexive manner.

“We found that African immigrant parents used corporal discipline, persuasive discipline, and a hybrid of the two, as well as emerging practices involving transnational fostering and emotional isolation of children who persistently misbehaved. These practices, in their totality, appeared to be influenced by the transnational experiences of parents and precepts that are traceable to Canada’s legal and educational systems.”

Child discipline is a controversial subject, and these authors nuance the topic of discipline in African immigrant households by examining how parents negotiate new environments and expectations by adjusting practices as needed.

Read the full article here. (Note that institutional restrictions on access apply).

Access and utilization of mental health services for immigrants and refugees: Perspectives of immigrant service providers

Bukola Salami RN, PhD; Jordana Salma RN, PhD; Kathleen Hegadoren RN, PhD

International journal of Mental Health Nursing https://onlinelibrary.wiley.com/doi/full/10.1111/inm.12512 (Published 09 July 2018)

This paper focuses on migrant services for mental health in Alberta, Canada. The authors argue that health providers perceive several challenges to access and utilization of services, including stigma, language barriers, and cultural ideas about mental health. Service providers adopt different strategies to better provide for their patients in response to these different barriers. Read the full paper here