Original article Assessment of health hazards and associated factors among the returned migrants living at Bati Woreda, Oromia Zone, Amhara National Regional State Bereket Yonas1, Abera Kumie2 Abstract Background: Migration is a demographic event which serves as a coping mechanism of poverty alleviation in developing countries, including Ethiopia. The living condition of migrants in economically attractive countries, however, is having a devastating effect. The health risk of Ethiopian migrants to neighboring countries is not well documented. Objective: This study aimed to assess hazards and associated factors among returned migrants living at Bati Woreda, Amhara National Regional State. Methods: A quantitative cross-sectional survey with a sample size of 390 returnees was made in five kebeles of the woreda using a structured questionnaire in April 2011. Health hazard was defined as a health outcome that occurred during the process of migration involving travelling, staying in the destination, or getting back home. The quantitative data was entered and cleaned using Epi Info Version 3.5.1. Descriptive statistics was performed to present socio- demographic data. Multivariate logistics regression analysis using AOR with 95% CI was used to assess the relative importance of associated factors. The qualitative data was collected using focus group discussions and in-depth interviews using semi-structured question guide. Open Code Version 3.4 was used to select codes, categories and themes for the qualitative data using the thematic analysis. Results: The overall magnitude of health hazards was 41%: diarrhea 31.6% and malaria 10.5% were the leading acute illnesses. After controlling the possible confounders in binary multivariate logistic regression, push factors related to age >35 years [AOR (95%CI) =3.48 (1.73,7.02)], the ability to read and write in educational status [AOR (95%CI) = 2.49 (1.17,5.30)], being jobless and a housewife [AOR (95%CI) = 2.17(1.29,3.64)] and AOR (95%CI) =5.28 (2.17,12.83)], respectively, and presence of better employment opportunities and living conditions as a pull factors [AOR (95%CI) = 8.61(3.16,23.47) and [AOR (95%CI) = 6.35 (1.89,21.36)], respectively, were determinants of health hazards. Conclusion: Migrants were highly exposed to health hazards because of the illegal routes of the movement. Socio- economic variables with respect to age, education and unemployment were predictors of the migration phenomenon. Providing safety protection from potential health hazards before leaving the country, proper social and psychological rehabilitation of returnees is recommended. [Ethiop. J. Health Dev. 2013;27(1):55-63] Introduction escalation of more than double the number for the same Migration is a process that involves movement of people period in 2007; and 400 people had died or were missing, (spatial mobility) from one geographical location to in the process according to the report of the United another. Thereby changing residence by crossing Nations High Commissioner for Refugees (UNHCR). predefined boundaries (1, 2). The actual number of casualties was likely higher, as many individuals are lost at sea and never found. About Migration, both voluntary and forced, is increasing all two-thirds of the arrivals in Yemen were Somalis and over the world. People are moving in larger numbers one-third Ethiopians. The Ethiopians that survived the faster and further than at any other time in history. Lack crossing, however, faced increased challenges compared of policies needed to make migration a healthy and to Somalis since: they were considered illegal and socially productive process has contributed to the growth subjected to deportation without regard to their right of migration related health risks (3). Patterns of migration asylum claims (5). are affected by factors such as geographical, and economical, environmental and political crises. However, From September 2009 to August 2010, International poverty and the desire for a better life still continue to be Organization for Migration (IOM) assisted the voluntary significant drivers of population movement (4). return of more than 3,781 Ethiopian illegal migrants stranded in the Middle East, Libya, Somaliland, Punt During the first five months of 2008, more than 20,000 land, Tanzania and Europe. In August 2010 alone, IOM people arrived by sea in Yemen. This was on an 1Addis Ababa, Ethiopia, P.O. Box 46176, Cell phone +251-911-183376, e-mail: [email protected]; 2Addis Ababa University, School of Public Health, Faculty of Medicine, P.O. Box 9086, Fax- +251 115 517701, Cell phone +251 911 882912, e-mail: [email protected] 56 Ethiop. J. Health Dev. assisted more than 600 illegal migrants to return home in Eligibility of study participants for this study was: safety and dignity from Yemen (6). • Returned migrants who came from Djibouti, Somalia, Yemen and Saudi Arabia which are Health risks due to migration are multiple and the degree targeted destinations of migrants from the study area. of severity is high given the deprivation of access to • Migrants who returned within September 1st 2009 to health and other social services in the recipient countries. August 31st, 2010 after considering the Ethiopian full Migrants reflect health condition characteristic of their calendar year that could minimize the possibility of place of origin and carry several of these conditions when recall bias by the respondents. they move from one place to another (7-9). Physical violence in the form of trauma and torture are commonly Sample Size Determination: observed during the movement of refugees, displaced and Sample size was initially calculated with a 40% disadvantaged migrant populations (10-14). prevalence of HIV/AIDS, among migrant (17). However, in order to maximize the benefit of the largest sample Socio-demographic composition of migrating population size, the prevalence rate of health hazard on returned describes the relative importance of poverty in push migrants was assumed to be 50%. With a 95% countries. However, demographically disaggregated confidence level and 5% margin of error, the minimum information on African migrants whose motive is sample size was determined by using the formula for a searching jobs is limited. According to the IOM, females single proportion calculated as 422 including 10% non- make up a significant percentage of the migrant response. population. The number of African women leaving their countries either as autonomous or dependent migrants is Sampling Technique: increasing (15). Since the number of all returned migrants from the specified countries during the specified period was 390; Every year, thousands of Somalis and Ethiopians risk all returned migrants were included in the survey. their lives crossing the Gulf of Aden to Yemen. Hoping Returned migrants were identified with the assistance of to escape the conflict and extreme poverty in their own neighborhoods, kebele representatives and health countries, the desperate migrants are regularly abused extension workers. Accordingly, the number of returned and sometimes killed by the brutal smugglers who are migrants from the selected five kebeles, where IOM is paid to get them across (5). The relationship between operating, was 100 from Kurkura, 89 from Jeldeti, 65 health risks and migration is not adequately studied to from Mammed, 54 from Hato and 82 from Garero. impact health policies in Ethiopia (16). This study investigates migration factors, socio-demographic Data Collection Procedure: information, health hazards, and determinants in the Structured and pre-tested questionnaire were prepared in returned migrants living at Bati Woreda. English to collect quantitative study from returned migrants. The questionnaire was translated to Amharic Methods then back to English to ensure the consistency of Study Setting: language. A data collection team comprising 9 personnel The study took place in Bati Woreda, Oromia Zone, (the principal investigator, 5 data collectors and 3 Amhara National Regional State. Bati town is the capital supervisors) was established and recruited from of the Woreda, located in Northeast of Ethiopia, about government employed health extension workers1. Data 417 Km from Addis Ababa. Bati Woreda has 23 kebeles, collectors were trained for two days on techniques of data and this study was carried out in five selected collection and management. Data was collected from all (operational areas of IOM) rural kebeles where the returned migrants through face-to-face interview. returned migrants were living together with their siblings and parents. For the qualitative study, two focus group discussions, one of men and the other of women, and two in-depth Study Design: interviews were conducted using a semi-structured A cross-sectional study using quantitative and qualitative question guide with purposely selected participants who methods of data collection was employed. Thematic had spent one year and above in one of the specified analysis was used for the qualitative study in order to countries and those who have travelled to multiple describe health hazards related determinants among the countries. The principal investigator was the moderator returned migrants. The study was carried out in April and research team supervisors served to collect the 2011. information by using tape recorders and taking writers notes. Study Population: The study populations were all returned migrants from abroad and living at the time of the study in the selected 1 five kebeles, namely: