Impact of Migration on Non Communicable Disease Risk Factors: Comparison of Gulf Migrants and their Non Migrant Contemporaries in the District of Origin in Kerala, India

Review Article

Austin J Public Health Epidemiol. 2016; 3(3): 1038.

# Impact of Migration on Non Communicable Disease Risk Factors: Comparison of Gulf Migrants and their Non Migrant Contemporaries in the District of Origin in Kerala, India

Begam NS* and Mini GK

Department of Public Health and Epidemiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Kerala

*Corresponding author: Shamim Begam N, Department of Public Health and Epidemiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Achutha Menon Centre for Health Science Studies (AMCHSS), Trivandrum, Kerala 695011, India

Received: March 29, 2016; Accepted: April 28, 2016; Published: May 02, 2016

## Abstract

Introduction: We assessed the prevalence of Non-Communicable Disease (NCD) risk factors between gulf migrant workers and non-migrant workers of Malappuram district, Kerala.

Methods: Using a multistage cluster sampling technique, 191 migrant and 193 non-migrant men between 25-65 years of age were selected. Data on NCD risk factors were collected using World Health Organization (WHO) steps protocol. Multivariate analysis was used to find the relation between migration and NCD risk factors.

Results: Prevalence of current tobacco use was 21.4% among migrants and 16.6% among non migrants, current alcohol use was 8.9% among migrants and 12.4% among non migrants, physical inactivity was 26.7% among migrants and 23.8% among non migrants, poor diet habit was 86.9% among migrants and 76.2% among non migrants, history of chronic diseases was 37.5% among migrants and 21% among non migrants, working 7 days /week was 35% among migrants and 1% among non migrants, working >8hrs/day was 76.9% among migrants and 33.1% among non migrants, sleeping less than 6hrs / day was 41.3% among migrants and 14% among non migrants. Prevalence of hypertension was 59.7% among migrants and 29.8% among non migrants (p= <0.001) (adjusted or 2.5, 95% CI=1.38-4.46), abdominal obesity was 79.5% among migrants and 44.5% among non migrants (p= <0.001) (adjusted or 2.4, 95% CI=1.35-4.31). Among migrant hypertensive 43.5% were aware, 33.9% were on treatment and 12.2% achieved adequate control, the corresponding figures for non migrants were 56.9%, 53.4%, and 48.3% respectively.

Conclusion: Majority of the risk factors were significantly higher among gulf migrants than non-migrants, which calls for urgent intervention to reduce these risk factors in this population.

Keywords: Migrant workers; Non communicable diseases; Risk factors; Malappuram; Kerala; India

## Introduction

The high incidence of Non Communicable Diseases (NCDs) and its risk factors is very much related to growing changes to unhealthy life styles, ageing and rapid urbanization [1,2]. Each of these risk factor increases the risk for NCDs through independent mechanisms [3]. In spite of being related to each other the occurrence of one risk factor makes way for another leading to greater risk for developing NCDs [4]. It has been evident that the major risk factors associated with NCDs are tobacco use, harmful alcohol intake, unhealthy diet (low fruits and vegetable consumption) and low physical activity. These are well modifiable through life style changes and primary prevention methods giving a greatest impact on reducing NCD mortality and morbidity [5,6]. Prevention, early detection and management of these risk factors would be an effective option in controlling these NCD and to reduce the disease burden [7]. The global risk report states that threat of chronic NCDs is rated above the current global financial crisis and the probable cost has been estimated from $250 billion to$1 trillion [8]. Studies suggest that despite repeat calls for action, the NCD burden is increasing and remaining unattended in developing countries [9]. World health Organization has declared NCDs as a growing threat globally especially in developing countries [10]. NCDs are responsible for maximum number of deaths in working age group globally affecting more of younger age group in poor countries than in the rich countries [11]. Migration is an important, current global issue that affects health in complex ways and has been proved as an important factor in developing NCDs and its risk factors [12]. Globally there is an acceleration of international migration at 2.9 % of annual growth rate and differentiation of migration with different types of migration like labour migration, asylum seekers and refugees. These factors increase the complexity of the situation calling for an immediate attention of the concerned authorities [12]. Research findings in countries of origin of key migrant categories in the affluent countries confirms the high and growing prevalence of NCDs such as Cardiovascular Diseases (CVD), diabetes and it’s risk factors [13]. Chronic anxiety, homesickness and isolation are leading to stress related health issues among migrants. Migrants are not addressed well in health studies, and their health issues remain mostly unreported [12,13].

For the last four decades, workers from the Indian subcontinent are migrating to Arabian Gulf as a result of poverty, perceived wage differences and constant demand for cheap labour [14]. Kerala state reported the highest flow of labour migration from the country until recently. Gulf countries accounts for 96% of the total international migrants from Kerala [14]. About 95% of gulf migrants from Kerala are males. Very little attention has been given to the adaptation and survival of migrants in the host country and associated health impacts [14,15]. Studies conducted in United States (US) and Europe among the migrant Indians show high prevalence of NCDs and their risk factors compared to the native population [16-19].

A comparative study done between migrant and non migrant Gujarat is reports that the NCD risk factors such as high Body Mass Index (BMI), blood pressure, lipids, non-esterified fatty acids, and high calorie diet were high among migrants [16]. A study done on migrant Asian Indians living in the United Kingdom (UK) found higher levels of obesity, blood pressure, total cholesterol, blood glucose, and insulin resistance higher than their siblings in Punjab [17]. Indian immigrants were found to have high incidence of overweight, with minimal exercise and activity profiles while in the host country as per studies in the US [18]. High prevalence of adverse body fat patterning, dyslipidaemia and insulin resistance beginning at a young age have been consistently reported in Asian Indians irrespective of their geographic locations [19]. Along with the ethnic predisposition, lifestyle changes after migration resulted in an early onset and high prevalence rates of diabetes and metabolic syndrome among Asian Indians in United States [20].

Considering the high vulnerability to the non communicable disease risk factors due to the forced adaptation to the lifestyles, living and working environments of the host country, it is significant to explore a comparative study on the NCD risk factors and its determinants among migrants and non migrants. The present study compares the prevalence of NCD risk factors among gulf migrant workers and non migrant workers of Malappuram district in Kerala, India.

## Methodology

The study was done in Malappuram district which is one of the districts with high gulf migrant population in Kerala State [14]. Since majority of migrants were men, for the present study women were not included [14]. This was a community based cross sectional study among adult men aged 25-64 years. Using a multi stage cluster sampling method- Among the 15 block panchayats of Malappuram district, Tanur was randomly selected. Out of the total nine gramapanchayats of Tanur Block, four were randomly selected [21]. In the third stage, five wards (the ward is the smallest geographical unit of the decentralized government in Kerala) were randomly selected from the selected panchayats as the study area. Two clusters of 10 individuals each were identified for both gulf migrant workers and non-migrant workers from each of these selected wards. The first household was selected randomly and remaining was continuously surveyed. For all the clusters the same process was repeated (Figure 1). The study was conducted during July to September 2013 which was the vacation time in gulf countries because of the Ramadan festival. Most of the gulf migrant workers had come on vacation which helped us to obtain the gulf migrants easier.