Health impacts of parental migration on left-behind children and adolescents: a systematic review and meta-analysis

Abstract

SummaryBackgroundGlobally, a growing number of children and adolescents are left behind when parents migrate. We investigated the effect of parental migration on the health of left behind-children and adolescents in low-income and middle-income countries (LMICs).MethodsFor this systematic review and meta-analysis we searched MEDLINE, Embase, CINAHL, the Cochrane Library, Web of Science, PsychINFO, Global Index Medicus, Scopus, and Popline from inception to April 27, 2017, without language restrictions, for observational studies investigating the effects of parental migration on nutrition, mental health, unintentional injuries, infectious disease, substance use, unprotected sex, early pregnancy, and abuse in left-behind children (aged 0–19 years) in LMICs. We excluded studies in which less than 50% of participants were aged 0–19 years, the mean or median age of participants was more than 19 years, fewer than 50% of parents had migrated for more than 6 months, or the mean or median duration of migration was less than 6 months. We screened studies using systematic review software and extracted summary estimates from published reports independently. The main outcomes were risk and prevalence of health outcomes, including nutrition (stunting, wasting, underweight, overweight and obesity, low birthweight, and anaemia), mental health (depressive disorder, anxiety disorder, conduct disorders, self-harm, and suicide), unintentional injuries, substance use, abuse, and infectious disease. We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs) using random-effects models. This study is registered with PROSPERO, number CRD42017064871.FindingsOur search identified 10 284 records, of which 111 studies were included for analysis, including a total of 264 967 children (n=106 167 left-behind children and adolescents; n=158 800 children and adolescents of non-migrant parents). 91 studies were done in China and focused on effects of internal labour migration. Compared with children of non-migrants, left-behind children had increased risk of depression and higher depression scores (RR 1·52 [95% CI 1·27–1·82]; SMD 0·16 [0·10–0·21]), anxiety (RR 1·85 [1·36–2·53]; SMD 0·18 [0·11–0·26]), suicidal ideation (RR 1·70 [1·28–2·26]), conduct disorder (SMD 0·16 [0·04–0·28]), substance use (RR 1·24 [1·00–1·52]), wasting (RR 1·13 [1·02–1·24]) and stunting (RR 1·12 [1·00–1·26]). No differences were identified between left-behind children and children of non-migrants for other nutrition outcomes, unintentional injury, abuse, or diarrhoea. No studies reported outcomes for other infectious diseases, self-harm, unprotected sex, or early pregnancy. Study quality varied across the included studies, with 43% of studies at high or unclear risk of bias across five or more domains.InterpretationParental migration is detrimental to the health of left-behind children and adolescents, with no evidence of any benefit. Policy makers and health-care professionals need to take action to improve the health of these young people.FundingWellco...

The association between parental migration and early childhood nutrition of left-behind children in rural China

“…The present study broadly supports the previous findings that parental migration was not significantly detrimental to child nutrition [13,16,22,36] and even confirm the benefits of paternal migration on early childhood nutrition of rural children [13,37,38], despite contrary results found in other studies [5,18,39]. A decreasing difference in early childhood nutrition between children with various parental migration statuses was shown in recent years, and in the survey in 2016, no significant differences in risks of stunting, underweight, and wasting were detected between them.…”

“…In addition, some studies identified a higher risk of anemia among left-behind than non-left-behind children [16,17], but other work found no such difference [14]. A recent systematic review and metaanalysis of these studies done from 1994 to September 2018, 82% of which were conducted in China, found that, compared with non-left-behind children, left-behind children had a significantly increased risk of wasting and stunting, but a similar risk of underweight and anemia [18].…”

“…In addition, despite numerous studies existing, some notable gaps in our knowledge remain. Firstly, most studies on nutrition of left-behind children focused on school-age children and few included infants and young children [18]. The findings from school-age children cannot be simply generalized to younger children because of the considerable differences in growth trajectories and living environment.…”

Adolescents left behind by migrant workers: a call for community-based mental health interventions in Nepal

“…Compared with children of non-migrants, left-behind children and adolescents had a 52% increased risk of depression, 70% increased risk of suicidal ideation and 85% increased risk of anxiety. 6 A global school-based student health survey among Nepali adolescents aged 13-17 years showed that lower perceived parental engagement was significantly associated with higher odds for suicide attempt and anxiety in both boys and girls. 7 These findings suggest a need for focused mental health-related interventions aimed at left-behind adolescents.…”

Health of migrants: simple questions can improve care

“…The most imminent and relevant global issue that is closely linked to world health is probably climate change. 2 Climate change has direct negative local effects (eg, droughts, flooding, and famine) and supraregional repercussions (eg, migration). Although the biggest por tion of medical resources is allocated to the socalled developed world, most of the affected people live in low income and middleincome regions.…”