Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta Georgia, USA.
CARE India Solutions for Sustainable Development, Patna Bihar, India.
J Glob Health. 2022 Feb 5;12:04008. doi: 10.7189/jogh.12.04008. eCollection 2022.
India holds the world's largest burden of chronic and acute child undernutrition. Poverty and systemic inequities are basic causes of undernutrition that also drive households to engage in circular migration for livelihood. Short-term, temporary movement of the whole family, including young children, is common; yet, the nutritional implications of recurrent movements beginning in early life has not been studied. We sought to estimate the association of repeat and early life migration with stunting and wasting outcomes among circular migrant children under three.
Using a stratified cluster design, we conducted two waves of primary data collection among 2564 randomly selected circular migrant children under three years of age temporarily residing across 1156 brick kilns in Bihar, India. We conducted multilevel modeling to estimate the association of the number of migration episodes and age at first migration with stunting (<-2 standard deviations (SD) height-for-age z scores (HAZ)) and wasting (<-2 SD weight-for-height z-scores (WHZ)) and examined the determinants of nutrition status among migrant children, including diet, illness, food security and the health environment.
The overall prevalence of stunting was 51.6%. Among children who were either born during migration or first migrated before six months of age, those who experienced multiple episodes of migration were more likely to be stunted compared to those who migrated once (adjusted odds ratio (aOR) = 2.10; 95% confidence interval (CI) = 1.30-3.41). Children were over three times as likely to be wasted in the summer compared to the winter (aOR = 3.28; 95% CI = 2.68-4.01); in the summer, the overall prevalence of wasting was 38.8%. Public health access indicators such as interaction with frontline health workers at the destination was low (5.3%), whereas feeding indicators such as exclusive breastfeeding among 0-5 months was high (81.1%).
Policy efforts should ensure continuity of social protection and welfare entitlements between home and destinations for circular migrant families, with an explicit focus on rural-to-rural movement.
印度是全球儿童慢性和急性营养不良负担最重的国家。贫困和系统性不平等是营养不良的根本原因，也是导致家庭从事循环迁移以维持生计的原因。短期、全家（包括幼儿）的临时流动很常见；然而，从生命早期开始反复迁移对营养的影响尚未得到研究。我们旨在估计反复和生命早期迁移与三岁以下循环移民儿童发育迟缓的关系。
使用分层聚类设计，我们在印度比哈尔邦的 1156 个砖窑中随机选择了 2564 名临时居住的三岁以下循环移民儿童进行了两次初级数据收集。我们进行了多水平建模，以估计迁移次数和首次迁移年龄与发育迟缓（身高年龄 z 分数（HAZ）<-2 标准差）和消瘦（身高体重 z 分数（WHZ）<-2 标准差）的关联，并检查了移民儿童营养状况的决定因素，包括饮食、疾病、粮食安全和健康环境。
发育迟缓的总体患病率为 51.6%。在那些在迁移期间出生或在六个月之前首次迁移的儿童中，与那些只迁移一次的儿童相比，经历多次迁移的儿童更有可能发育迟缓（调整后的优势比（aOR）=2.10；95%置信区间（CI）=1.30-3.41）。与冬季相比，夏季儿童消瘦的可能性高出三倍（aOR=3.28；95%CI=2.68-4.01）；在夏季，消瘦的总体患病率为 38.8%。公共卫生服务的可及性指标（例如在目的地与基层卫生工作者的互动）较低（5.3%），而喂养指标（例如 0-5 个月的纯母乳喂养）较高（81.1%）。
政策努力应确保循环移民家庭在原籍地和目的地之间享有社会保护和福利权益的连续性，明确关注农村到农村的迁移。
