One of the most important social phenomena in the global context is the flow of immigration from developing countries, motivated by economic and employment related issues. Discrimination can be approached as a health risk factor within the immigrant population's working environment, especially for those immigrants at greater risk from social exclusion and marginalisation. The aim of this study is to research perceptions of discrimination and the specific relationship between discrimination in the workplace and health among Spain's immigrant population. A qualitative study was performed by means of 84 interviews and 12 focus groups held with immigrant workers in five cities in Spain receiving a large influx of immigrants (Madrid, Barcelona, Valencia, Alicante and Huelva), covering representative immigrant communities in Spain (Romanians, Moroccans, Ecuadorians, Colombians and Sub-Saharan Africans). Discourse narrative content analysis was performed using pre-established categories and gradually incorporating other emerging categories from the immigrant interviewees themselves. The participants reported instances of discrimination in their community and working life, characterised by experiences of racism, mistreatment and precarious working conditions in comparison to the Spanish-born population. They also talked about limitations in terms of accessible occupations (mainly construction, the hotel and restaurant trade, domestic service and agriculture), and described major difficulties accessing other types of work (for example public administration). They also identified political and legal structural barriers related with social institutions. Experiences of discrimination can affect their mental health and are decisive factors regarding access to healthcare services. Our results suggest the need to adopt integration policies in both the countries of origin and the host country, to acknowledge labour and social rights, and to conduct further research into individual and social factors that affect the health of the immigrant populations.

Word count abstract: 150Word count main text: 3,618 (including in-text citations); 3,460 (without) ABSTRACT BackgroundHousehold service work has been largely absent from occupational health

Results: Participants described poor working conditions, low pay, and health hazards. Perception of hazards appeared related to gender and job sector.

ObjectiveTo analyze the relationship of legal status and employment conditions with health indicators in foreign-born and Spanish-born workers in Spain.MethodsCross-sectional study of 1,849 foreign-born and 509 Spanish-born workers (2008–2009, ITSAL Project). Considered employment conditions: permanent, temporary and no contract (foreign-born and Spanish-born); considered legal statuses: documented and undocumented (foreign-born). Joint relationships with self-rated health (SRH) and mental health (MH) were analyzed via logistical regression.ResultsWhen compared with male permanently contracted Spanish-born workers, worse health is seen in undocumented foreign-born, time in Spain ≤3 years (SRH aOR 2.68, 95% CI 1.09–6.56; MH aOR 2.26, 95% CI 1.15–4.42); in Spanish-born, temporary contracts (SRH aOR 2.40, 95% CI 1.04–5.53); and in foreign-born, temporary contracts, time in Spain >3 years (MH: aOR 1.96, 95% CI 1.13–3.38). In females, highest self-rated health risks are in foreign-born, temporary contracts (aOR 2.36, 95% CI 1.13–4.91) and without contracts, time in Spain >3 years (aOR 4.63, 95% CI 1.95–10.97).ConclusionsContract type is a health determinant in both foreign-born and Spanish-born workers. This study offers an uncommon exploration of undocumented migration and raises methodological issues to consider in future research.

This study allowed us to describe the dimensions of precarious employment in immigrant workers.

BackgroundWe assessed the effects of a three-year national-level, ministry-led health information system (HIS) data quality intervention and identified associated health facility factors.MethodsMonthly summary HIS data concordance between a gold standard data quality audit and routine HIS data was assessed in 26 health facilities in Sofala Province, Mozambique across four indicators (outpatient consults, institutional births, first antenatal care visits, and third dose of diphtheria, pertussis, and tetanus vaccination) and five levels of health system data aggregation (daily facility paper registers, monthly paper facility reports, monthly paper district reports, monthly electronic district reports, and monthly electronic provincial reports) through retrospective yearly audits conducted July-August 2010–2013. We used mixed-effects linear models to quantify changes in data quality over time and associated health system determinants.ResultsMedian concordance increased from 56.3% during the baseline period (2009–2010) to 87.5% during 2012–2013. Concordance improved by 1.0% (confidence interval [CI]: 0.60, 1.5) per month during the intervention period of 2010–2011 and 1.6% (CI: 0.89, 2.2) per month from 2011–2012. No significant improvements were observed from 2009–2010 (during baseline period) or 2012–2013. Facilities with more technical staff (aβ: 0.71; CI: 0.14, 1.3), more first antenatal care visits (aβ: 3.3; CI: 0.43, 6.2), and fewer clinic beds (aβ: -0.94; CI: −1.7, −0.20) showed more improvements. Compared to facilities with no stock-outs, facilities with five essential drugs stocked out had 51.7% (CI: −64.8 -38.6) lower data concordance.ConclusionsA data quality intervention was associated with significant improvements in health information system data concordance across public-sector health facilities in rural and urban Mozambique. Concordance was higher at those facilities with more human resources for health and was associated with fewer clinic-level stock-outs of essential medicines. Increased investments should be made in data audit and feedback activities alongside targeted efforts to improve HIS data in low- and middle-income countries.

Our results suggest that undocumented immigrants' situation may not fit the model of precarious employment exactly. However, the model's dimensions can be expanded to better represent undocumented immigrants' situation, thus strengthening the general model. Precarious employment in this group can be defined as <>, as it affects their working and social lives. If these workers continue to be exposed to such precarious conditions, the impact on their health may increase.

This first step allowed us to identify some of the general factors influencing the health and safety of immigrant workers in Spain. This information will be used in a longterm, ongoing research project [Project Immigration, Work and Health (Proyecto Inmigración, Trabajo y Salud [ITSAL]), which aims to evaluate occupational health problems in inmigrants working in Spain through both qualitative and quantitative methods.