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  • Title: Maternal and child health in urban Sabah, Malaysia: a comparison of citizens and migrants.
    Author: Zulkifli SN, U KM, Yusof K, Lin WY.
    Journal: Asia Pac J Public Health; 1994; 7(3):151-8. PubMed ID: 7794653.
    Abstract:
    This paper describes selected maternal and child health indicators based on a cross-sectional study of citizens and migrants in Sabah, Malaysia. A total of 1,515 women were interviewed from a multi-stage random sample of households in eight urban centers. Among the 1,411 women in the sample who had experienced a pregnancy before, 76% were local citizens and 24% were migrants. There were statistically significant differences between citizens and migrants in ethnicity, religion, education, household income, and access to treated water supply and sanitary toilet facilities. Significantly fewer migrants practiced any form of contraception and obtained any antenatal care during any pregnancy. Furthermore, citizens tended to initiate care as early as three months but migrants as late as seven months. Despite these differences, only the infant mortality rate, and not pregnancy wastage, was statistically significantly higher among migrants. Pregnancy interval was also similar between the two groups. The influence of several socioeconomic factors on pregnancy wastage and infant mortality was explored. Findings from this study conducted in urban Sabah, Malaysia, support the view that migrants, as opposed to natives, are at a disadvantage with regard to education and income and are more exposed to negative environments in Malaysia compared to their home countries. Migrants are found to have less contraceptive use and higher proportions of women who never had prenatal care. Crude birth intervals are found to be similar in both the native population and the migrant population. Migrant women who breast feed are a larger proportion. The comparison of women who used prenatal care suggests that some migrant women use prenatal care late in pregnancy and only register at child health clinics as a means of obtaining citizenship. Pregnancy wastage is similar in both groups of migrant and native women. Infant mortality is higher among births to migrant women, but the differences are not statistically significant. It is suggested that poor living conditions contribute to the higher infant mortality. Logistic models reveal that maternal educational level is a statistically significant predictor of pregnancy wastage and infant mortality. Risk of pregnancy wastage is also significantly affected by household income. Piped water supply and sanitary facilities are insignificant predictors. The lack of a relationship is interpreted as potentially a function of disparity in the time frame of variables. The authors recommend an improvement in access to health care and in living conditions. The study area is primarily rural and the population is scattered, which makes for more difficult delivery and distribution of services. Voluntary use of health care services by migrants needs to be encouraged. Government policy should shift to improving local government capacity to provide health care, improving the responsiveness of relevant public agencies, lowering health care costs, increasing service demand among the poor, promoting private sector cooperation, and encouraging migrant movement to small and intermediate sized cities.
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