Surekha A., et al. : Health status of migrant versus local workers’ children in a tea plantation.
ISSN - Print: 2277 – 1522; Online: 2277 – 3517
ORIGINAL RESEARCH ARTICLE Year: 2017 Vol: 6 Issue: 4. Oct.-Dec. Page: 336-340
DOI: 10.26727/NJRCM.2017.6.4.336-340
Comparative study of health status of migrant versus local workers’ children in a tea plantation in Tamil Nadu, South India. Surekha A1, Naveen R2, Suguna A1, Devjani G 3, Karthika M3, Farah N F1 1Assistant Professor in Community Health, 2 Associate Professor in Community Health & 3 Intern, St. John’s Medical College, Bangalore- 560034, Karnataka, India. Date of Submission Date of Acceptance
: 06-10-2017 : 20-11-2017
Date of online Publication Date of Print Publication
: 27-11-2017 : 31-12-2017
Address for correspondence : Dr Suguna, Assistant Professor, Department of Community Medicine, Mahatma Gandhi Medicine College, Pondicherry-607402. E-mail:
[email protected]
Abstract Introduction: The tea plantation industry in South India is facing a severe labour crisis leading to influx of large number of migrant workforce.Provision of good health services for migrant workers is a daunting challenge for health care providers and estate management. Objective: To compare the health, nutrition and immunization status of children of migrant workers with local children in tea plantations in Anamallai, Tamilnadu. Methodology: A cross sectional study along with a qualitative component was conducted between November and December 2014. A total of 110 children between the ages of 1-5 years attending 19 crèches through 7 estates were included. Socio demographic details, feeding practicesand immunization status were captured using an interview schedule. Anthropometric parameters and physical examination findings were documented. FGDs and indepth interviews were conducted with various stakeholders. Results: Among 110 children assessed, 64 were locals and 46 were migrants. According to the WHO classification of nutritional status, about 8% and 7% of the local and 24% and 22% of the migrant children were underweight & stunted respectively.Only 13(29.5%) of migrant children were fully immunized for age compared to 100% of the local children. Health problems like ARI, worm infestation, rachitic changes & behavioral problems were more common in migrant children. Qualitative results depict that health seeking behavior is poor among migrants. Conclusion:The high prevalence of health problems, incomplete immunization and poor nutritional status is significantly higher among children of migrant workers compared to local children. Health seeking behavior is poor among migrants. Migrant sensitive policies, information systems and specific training to the health care delivery people to reach the unreached are the challenges. Integration and synergy with all the stakeholders and self-advocacy and participation from the migrants is also needed.
Key-words: Migrant children’s health, plantation, comparative study, India. Introduction: In India 70% of the labour force is employed in the agriculture sector. Plantation being a part of agriculture directly employs more than 2 million workers in the country. India’s total export earnings of agriculture products is about 15% from crops like tea, coffee and rubber.1 India is one of the largest producer and consumer of tea in the world. India’s tea plantations are largely grouped into 2 regions – North East India and South India. Assam and West Bengal are the important states in North East India. Tamil Nadu and Kerala are the important southern states.2 The tea planting industry in southern India accounts for 66,050 planters and employs a population of about 2.46 lakh as labor.3The tea plantation
industry in South India is facing a severe labour crisis, leading to influx of large number of migrant workforce.4 Provision of good health and health services for people here is a daunting challenge for the health care providers and policy makers. In India, migrant labour makes enormous contribution to national economy (10% of GDP) and development but the migrants remain on the periphery of society with few citizen rights.1 The National Commission on Rural Labour in India (NCRL, 1991) estimates more than 10 million circular migrants in the rural areas alone in the country.5 Studies and field evidences suggest that children accompanying their parents in the 0-14 age group may constitute one third of the total migrant population and 336
National Journal of Research in Community Medicine│Oct-Dec 2017│ Vol 6 │Issue 4│
Surekha A., et al. : Health status of migrant versus local workers’ children in a tea plantation.
put the number of migrant children below 14 years close to 6 - 9 million.6 Migrants carry with them a health risk and public health implication due to their epidemiological profile, their exposure to infectious agents, their genetic and lifestyle rated risk factors and culture based health beliefs.7,8 Anthropometric standards by WHO are most reliable tools to assess child nutritional status everywhere in world regardless of ethnicity, socio-economic status, and type of feeding.9 With this background, the present study was conducted to compare the health, nutrition and immunization status between local and migrant children (1 to 5 years) of estates in tea plantations of Anamallai, Tamilnadu.
stretchable tape fixed to a vertical wall, with the participant standing on a firm/level surface and it was measured to the nearest 0.5 cm. Recumbent length (for children less than 24 months of age) was measured by using an infant measuring board. Mid arm circumference was measured using non stretchable tape. The children were dressed in light underclothing and without any shoes during the measurement. The same measuring equipmentwas used throughout the study.The WHO growth standards were used to interpret the anthropometric data.9 Indicators used for determining under nutrition were categorised as under weight (weight for age), wasting (weight for height) and stunting (height for age). Anthropometry was put into categories based on WHO growth charts. This was followed by a thorough head to toe general and systemic examination.
Methodology: A cross sectional study along with a qualitative component in order to capture the reasons for the poor health was carried out among the children attending crèches in 7 tea estates of plantations in Anamallai, Tamilnadu. In the present study, people who moved to the area within the past one year or less have been considered as “migrants”. The assessment has been focused on the tea plantation workers of Anamallai in South India. Majority of the migrant population in this area is from Jharkhand, Assam and a few families from Karnataka. The study was approved by the Institutional Ethics Committee. The study was done during the period of November and December, 2014. The study population comprised of children between the ages of 1-5 years. Permission was obtained from the concerned authorities. The plantation act (1951) mandates the provision of creche facilities by the estate management for workers, to care for their children under five years, while they are at work All the 19 crèches with around 20-30 located in the 7 estates were visited. Children who were critically ill or were unavailable during the interviews, family circumstances and who were on vacation were excluded from the study. A verbal and written informed consent was obtained from the crèche teachers and mother. An interview schedule was developed to capture data regardingsocio demographic details, immunization status, feeding practices and information pertaining to migration. Fully immunized children means, a child who has received BCG, three doses of DPT, OPV and measles before one year of age.The Strengths and Difficulties Questionnaire (SDQ) 13 was used to assess behavioral problems among children. Anthropometric measurements of the children were documented.The data included weight, recumbent length (for children less than 24 months of age), height (for children more than 24 months of age and mid arm circumference. Weight was measured to the nearest 0.1 Kg and Salter weighing machine was used for weight measurement. Height was measured against a non-
A qualitative study was also conducted by means of focused group discussion with both local and migrant mothers of children under 5 years of age and in depth interviews with the village health nurse (VHN), crèche teachers, both local and migrant mothers of children under 5 years of age.The Focus group discussions covered topics of breast feeding, exclusive breast feeding, pre lacteal feeds, weaning, facilities available at the crèche, special food available at the crèche for children with severe acute malnutrition (SAM), about immunization and the difficulties encountered by both the migrant and the local population. Participants were purposively selected to provide a representative configuration under the objectives of our study. Statistics and analysis of the data: The data wereentered and coded in Microsoft Excel and analyzed using SPSS version 16 for proportions, frequencies and associations. Measures of central tendency, dispersion and chi square tests and regression analysis were used to analyze the data. We considered p value of
