Child health outcomes among central American refugees and immigrants in Belize

The purpose of this study was to investigate the effect of international migration, including refugee status, upon child health outcomes. Data were drawn from a survey conducted in 1989 in three settlements in Belize, Central America, that have a high proportion of refugees and economic immigrants living side-by-side with the local population. In two of the settlements, the entire population of mothers with children under 6 was interviewed; in the third settlement a two-thirds random sample was interviewed. Health history data were obtained for 255 children of 134 mothers, from whom sociodemographic data were also collected. The majority of children were born to Salvadoran or Guatemalan mothers, but native and naturalized Belizeans in the survey communities were included for comparison purposes. Migration, the exposure variable, was characterized by mother's residency/refugee legal status, nationality, and duration of time in country. Socioeconomic and proximate control variables were included as suggested by the Mosley-Chen framework. Despite normal birthweight averaging 3374 g, a large proportion of children are at the lowest percentiles of the weight-for-age curves (44% below the tenth percentile for the international reference population). A high incidence of diarrheal and respiratory illnesses (30% and 47% of children, respectively, having frequent episodes), and 50% of children with measles vaccination appropriate for age, indicate a population with high potential morbidity. Logistic regression was used to model the effects of migration on weight-for-age and frequency of diarrheal and respiratory tract episodes independent of socioeconomic and proximate factors, as suggested by the Mosley-Chen framework. Once these socioeconomic and proximate variables were controlled for, migration contributed little to the models. It appears that the poverty of migrants--irrespective of legal status, origin, or length of time in country--may override migration. Also, study findings suggest that the children of refugees and immigrants have intense health needs even in a relatively benign social environment, as do the children of native Belizeans. The study affirmed the utility of the Mosley-Chen framework, and further tests in other migration contexts are suggested. Current efforts of government and non-governmental programs to direct public health measures towards whole settlements rather than to groups defined by legal status should be supported. Policies that decrease socioeconomic marginalization by integrating refugees and immigrants into the local labor force, educational facilities, and health services may contribute to improved child health.