Antenatal care coverage and early childhood mortality in Zimbabwe: new interpretations from nationally representative household surveys.

Zimbabwe has implemented universal antenatal care (ANC) policies since 1980 that have significantly contributed to improvements in ANC access and early childhood mortality rates. However, Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), two of Zimbabwe's main sources of health data and evidence, often provide seemingly different estimates of ANC coverage and under-five mortality rates. This creates confusion that can result in disparate policies and practices, with potential negative impacts on mother and child health in Zimbabwe. We conducted a comparability analysis of multiple DHS and MICS datasets to enhance the understanding of point estimates, temporal changes, rural-urban differences and reliability of estimates of ANC coverage and neonatal, infant and under-five mortality rates (NMR, IMR and U5MR, separately) from 2009 to 2019 in Zimbabwe. Our two samples z-tests revealed that both DHS and MICS indicated significant increases in ANC coverage and declines in IMR and U5MR but only from 2009 to 2015. NMR neither increased nor declined from 2009 to 2019. Rural-urban differences were significant for ANC coverage (2009-15 only) but not for NMR, IMR and U5MR. We found that there is a need for more precise DHS and MICS estimates of urban ANC coverage and all estimates of NMR, IMR and U5MR, and that shorter recall periods provide more reliable estimates of ANC coverage in Zimbabwe. Our findings represent new interpretations and clearer insights into progress and gaps around ANC coverage and under-five mortality rates that can inform the development, implementation, monitoring and evaluation of policy and practice responses and further research in Zimbabwe.

[Les personnes âgées immigrantes et leurs proches à Montréal : des vies oubliées durant la pandémie].

Malgré l'attention renouvelée de plusieurs médias sur la question des risques liés à la COVID-19 au sein de diverses communautés marginalisées au Québec, nous entendons encore très peu parler des personnes âgées immigrantes et de leurs proches. Dans cette note sur les politiques et pratiques, nous aborderons l'expérience du contexte pandémique chez les personnes âgées immigrantes montréalaises et leurs réseaux. Nous présenterons d'abord quelques données sociodémographiques sur les immigrants âgés montréalais. Nous exposerons ensuite nos constats sur les impacts de la COVID-19 sur les personnes âgées immigrantes, en particulier en ce qui concerne l'accès aux soins de la santé et aux services sociaux, la proche-aidance, l'emploi et le logement, à partir de nos travaux et de la littérature en gérontologie sociale. Nous terminerons en proposant quelques recommandations qui permettraient d'améliorer l'inclusion sociale des personnes âgées immigrantes et de leurs proches, autant en matière de politiques publiques que de pratiques sur le terrain.

Unmet healthcare needs among migrants without medical insurance in Montreal, Canada.

While access to healthcare for permanent residents in Canada is well known, this is not the case for migrants without healthcare coverage. This is the first large-scale study that examines the unmet healthcare needs of migrants without healthcare coverage in Montreal. 806 participants were recruited: 436 in the community and 370 at the NGO clinic. Proportions of individuals reporting unmet healthcare needs were similar (68.4% vs. 69.8%). The main reason invoked for these unmet needs was lacking money (80.6%). Situations of not working or studying, not having had enough food in the past 12 months, not having a medical prescription to get medication and having had a workplace injury were all significantly associated with higher odds of having unmet healthcare needs. Unmet healthcare needs were more frequent among migrants without healthcare coverage than among recent immigrants or the citizens with health healthcare coverage (69%, 26%, 16%). Canada must take measures to enable these individuals to have access to healthcare according to their needs in order to reduce the risk of worsening their health status, something that may have an impact on the healthcare system and population health. The Government of Quebec announced that all individuals without any healthcare coverage will have access to COVID-19 related health care. We hope that this right, the application of which is not yet obvious, can continue after the pandemic for all health care.

The negative self-perceived health of migrants with precarious status in Montreal, Canada: A cross-sectional study.

BACKGROUND: Knowledge about the health impacts of the absence of health insurance for migrants with precarious status (MPS) in Canada is scarce. MPS refer to immigrants with authorized but temporary legal status (i.e. temporary foreign workers, visitors, international students) and/or unauthorized status (out of legal status, i.e. undocumented). This is the first large empirical study that examines the social determinants of self-perceived health of MPS who are uninsured and residing in Montreal. METHODS AND FINDINGS: Between June 2016 and September 2017, we performed a cross-sectional survey of uninsured migrants in Montreal, Quebec. Migrants without health insurance (18+) were sampled through venue-based recruitment, snowball strategy and media announcements. A questionnaire focusing on sociodemographic, socioeconomic and psychosocial characteristics, social determinants, health needs and access to health care, and health self-perception was administered to 806 individuals: 54.1% were recruited in urban spaces and 45.9% in a health clinic. 53.9% were categorized as having temporary legal status in Canada and 46% were without authorized status. Regions of birth were: Asia (5.2%), Caribbean (13.8%), Europe (7.3%), Latin America (35.8%), Middle East (21%), Sub-Saharan Africa (15.8%) and the United States (1.1%). The median age was 37 years (range:18-87). The proportion of respondents reporting negative (bad/fair) self-perception of health was 44.8%: 36.1% among migrants with authorized legal status and 54.4% among those with unauthorized status (statistically significant difference; p<0.001). Factors associated with negative self-perceived health were assessed using logistic regression. Those who were more likely to perceive their health as negative were those: with no diploma/primary/secondary education (age-adjusted odds ratio [AOR]: 2.49 [95% CI 1.53-4.07, p<0.001] or with a college diploma (AOR: 2.41 [95% CI 1.38-4.20, p = 0.002); whose family income met their needs not at all/a little (AOR: 6.22 [95% CI 1.62-23.85], p = 0.008) or met their needs fairly (AOR: 4.70 [95% CI 1.21-18.27], p = 0.025); with no one whom they could ask for money (AOR: 1.60 [95% CI 1.05-2.46], p = 0.03); with perception of racism (AOR: 1.58 [95% CI 1.01-2.48], p = 0.045); with a feeling of psychological distress (AOR: 2.17 [95% CI 1.36-3.45], p = 0.001); with unmet health care needs (AOR: 3.45 [95% CI 2.05-5.82], p<0.001); or with a health issue in the past 12 months (AOR: 3.44 [95% CI 1.79-6.61], p<0.001). Some variables that are associated with negative self-perceived health varied according to gender: region of birth, lower formal education, having a family income that does not meet needs perfectly /very well, insalubrious housing, not knowing someone who could be asked for money, and having ever received a medical diagnosis. CONCLUSIONS: In our study, almost half of immigrants without health insurance perceived their health as negative, much higher than reports of negative self-perceived health in previous Canadian studies (8.5% among recent immigrants, 19.8% among long-term immigrants, and 10.6% among Canadian-born). Our study also suggests a high rate of unmet health care needs among migrants with precarious status, a situation that is correlated with poor self-perceived health. There is a need to put social policies in place to secure access to resources, health care and social services for all migrants, with or without authorized status.

Migrant families with children in Montreal, Canada and transnational family support: a protocol for a focused ethnography.

INTRODUCTION: There is a gap in research regarding transnational family support (emotional, practical, spiritual, informational and financial) as a resource for migrant families with children. From the perspective of migrant families and their family back home, the objectives of this study are to (1) identify the types and ways that transnational family support is provided to migrant families in Canada; (2) assess for patterns in the data that may suggest variations in the nature of this support (eg, by migration status, time in Canada, children's ages, family circumstances) and over time and (3) explore the impact (positive and negative) in receiving and providing transnational support, respectively. METHODS AND ANALYSIS: A focused ethnography is planned. We will recruit 25-35 migrant families with children with different migration histories (eg, economic or forced migration from a mix of countries) and family circumstances (eg, single parenthood, families living with extended family, families with children in the home country) living in Montreal, Canada. Families will be recruited through community organisations. Data will be gathered via semistructured interviews. To capture the perspective of those providing support, family members in the home country for each migrant family will also be recruited and interviewed through communication technology (eg, WhatsApp). Data collection will also involve observation of 'transnational interactions' between family members in Montreal and those back home. Data will be thematically analysed and results reported in a narrative form with an in-depth description of each theme. ETHICS AND DISSEMINATION: Ethical approval was obtained from the sciences and health research ethics committee at the University of Montreal. Study results will be shared through traditional forums (publication, conference presentations) and via other knowledge dissemination/exchange activities (eg, 'lunch and learn conferences' and seminars) through the research team's research centres and networks to reach front-line care-providers who interface directly with migrant families.

"Nature is there; its free": Urban greenspace and the social determinants of health of immigrant families.

In this article, we draw on a 2012 Montreal-based study that examined the embodied, every day practices of immigrant children and families in the context of urban greenspaces such as parks, fields, backyards, streetscapes, gardens, forests and rivers. Results suggest that activities in the natural environment serve as a protective factor in the health and well-being of this population, providing emotional and physical nourishment in the face of adversity. Using the Social Determinants of Health model adopted by the World Health Organization (WHO, 1998), we analyze how participants accessed urban nature to minimize the effects of inadequate housing, to strengthen social cohesion and reduce emotional stress. We conclude with a discussion supporting the inclusion of the natural environment in the Social Determinants of Health Model.

Action research for the health and safety of domestic workers in montreal: using numbers to tell stories and effect change.

In 2007, a Filipina organization in Quebec (PINAY) sought the help of university researchers to document the workplace health and safety experiences of domestic workers. Together, they surveyed 150 domestic workers and produced a report that generated interest from community groups, policy-makers, and the media. In this article, we-the university researchers-offer a case study of community-university action research. We share the story of how one project contributed to academic knowledge of domestic workers' health and safety experiences and also to a related policy campaign. We describe how Quebec workers' compensation legislation excludes domestic workers, and we analyze the occupational health literature related to domestic work. Striking data related to workplace accidents and illnesses emerged from the survey, and interesting lessons were learned about how occupational health questions should be posed. We conclude with a description of the successful policy advocacy that was possible as an outcome of this project.

Intersection of Canadian policy parameters affecting women with precarious immigration status: a baseline for understanding barriers to health.

Canadian federal policy provides a framework for the immigration and health experiences of immigrant women. The official immigration category under which a migrant is admitted determines to what degree her right to remain in the country (immigration status) is precarious. Women immigrants fall primarily into the more dependent categories and they experience barriers to access to health services arising from this precarious status. Federal immigration and health policies create direct barriers to health through regulation of immigrants' access to services as well as unintended secondary barriers. These direct and secondary policy barriers intersect with each other and with socio-cultural barriers arising from the migrant's socioeconomic and ethno-cultural background to undermine equitable access to health for immigrant women living in Canada.