Factors are associated with perceived higher quality health among people that have migrated within Bangladesh

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Taj Uddin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6440902/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The purpose of this study is to examine the factors associated with perceiving quality of health among individuals who have migrated within Bangladesh, focusing on social support, education, food availability, occupation, and environmental conditions. Data were taken from the Bangladesh Environment and Migration Survey (BEMS) involving 1,754 migratory families. Perceived quality of health was assessed with social and emotional support, education, food availability, occupation, and perceived changes in cyclone severity. The analyses were conducted utilizing Stata software with weighted data and the chi-squared test. The study found, majority of the respondents perceived quality health after migration. Most of the migrants reported quality health after receiving emotional and social support from the community. Those who had better educational status or not, improved their health status after migration. Bivariate chi square analyses revealed that professional occupation reported the highest quality health perceived versus other occupation (p<.001). On the environmental aspects, both perceived quality health regardless of experienced cyclone severity changes. Contrary to common belief, this study finds a weaker relationship between education, food shortages or social support and quality health after migration. These findings have important implications for understanding perceived quality of health, suggesting that other factors associated with the control variables, may play a more significant role. A major limitation of this study is to use a cross-sectional data that restricts the ability to infer causal relationships between migration and perceiving quality health. Sociology migration health social support occupation environment Figures Figure 1 I. INTRODUCTION Migration has become a pressing issue in South Asian countries like Bangladesh where internal migration driven by a range of social, economic, and environmental factors, has become increasingly significant in recent years. Migration is a common phenomenon worldwide and it often seen as a pathway to better opportunities and improved living conditions [ 1 ]. Whether the benefits of migration are realized can depend on numerous factors such as social support, educational background, and environmental shifts, including climate events like cyclones, which are common in Bangladesh[ 2 ] [ 3 ]. One potential measure of success post-migration could be perceived quality of health. In exploration, this study investigates the determinants of perceived health quality among people who have migrated within Bangladesh, examining how support systems and environmental conditions collectively impact perceiving quality health where migration is increasingly recognized as a determinant of health [ 4 ]. Bangladesh is a developing nation; it has seen substantial rural-to-urban and interregional migration, especially, the density of the capital city, Dhaka, is increasing rapidly because of internal migration. Migratory families experience significant changes in their social environment, which affects both physical and mental well-being. Factors before, during, and after migration in the social environment can positively or negatively impact well-being. For example, Carling [ 5 ] highlighted that support from family and community networks can mitigate the stress associated with relocation and improve mental health outcomes for migratory individuals. This research explores whether social support received or not, correlate with perceived health quality among migratory individuals in Bangladesh. Environmental vulnerability is a big issue for migration in the context of Bangladesh. Particularly, cyclones impose significant health risks, with implications for both immediate physical well-being and longer-term mental health stability. This study captures effects of cyclone severity among migrated people and assesses its association with health outcomes after migration. Understanding the impact of environmental stressors on health can inform targeted interventions aimed at enhancing resilience and well-being in vulnerable communities [ 6 ]. Occupational and educational factors also play a vital role in shaping health outcomes. Employment opportunities vary significantly for migratory individuals, with occupations ranging from agriculture to professional work, each carrying different health risks. Studies have shown that physical demands of certain occupations can lead to adverse health effects, while professional jobs may offer relatively better health outcomes due to less physically demanding work environments [ 7 ]. Education, often linked to health and economic stability, provides migratory people with the resources to navigate post-migration challenges. This study explores how occupation and educational attainment interact with health outcomes, emphasizing the role of human capital in promoting well-being among migratory populations. This study aims to investigate these diverse factors to better understand health quality among migratory individuals within Bangladesh. Specifically, it examines the impact of social support, education, occupation, and environmental perceptions on post-migration health status. By assessing these variables, this research will seek to inform policies that can address health disparities among migratory individuals. Insights gained from this study could support the development of targeted interventions, such as enhanced social support networks, educational opportunities, and occupational health initiatives that promote the well-being of migratory populations across Bangladesh. II. LITERATURE REVIEW Migration within Bangladesh, primarily driven by socioeconomic and environmental factors, has gained attention for its impact on the well-being of migratory populations, especially in terms of health. Researchers have highlighted several factors influencing quality health among migratory populations, including social support, education, occupation, and environmental stressors. This literature review examines these factors, drawing from existing research to provide a foundation for understanding determinants of health quality among migratory individuals within Bangladesh. Social support is one of the well documented protective factors for health, particularly in the context of migration [ 8 ]. Social networks provide emotional, material, and monetary support, which can mitigate the negative impacts of relocation and socioeconomic instability. Household head who migrated with other households or a bigger community described the maintenance or re-establishment of social ties that seemed to be linked with a more positive migration experience with possible implications for mental health and wellbeing [ 9 ]. Aneshensel [ 10 ] suggested that social support acts as a buffer against stress, fostering resilience among vulnerable populations in Bangladesh. In particular social support plays an essential role for migratory people who are often cut off from their traditional support systems [ 1 ]. Similarly, emotional support has been shown to alleviate stress and promote mental well-being, essential for navigating the complexities of post-migration life [ 2 ] ). Additionally, Parrenas [ 2 ] explored that out-migration could have some beneficial effects on emotional health, by reconstructing local gender relations and increasing left-behind women’s autonomy and decision-making power. Education is another critical factor that impacts migratory population’s health outcomes. Higher levels of education are often associated with improved health, as they provide individuals with better access to resources and opportunities. Maron et al.[ 7 ] indicated that education can enhance resilience by equipping migratory individuals with knowledge and skills that facilitate adaptation to new environments. In Bangladesh, educational disparities are significant and the level of education sometimes determine a person’s ability to access health services like finding a stable employment, and navigate post-migration challenges [ 1 ]. Education mitigates the effects of migration on health by promoting economic stability and enabling families to make informed health-related decisions [ 3 ]. Occupation status of a migratory individual indicate a certain view of health outcomes. Occupations involving manual labor, such as agriculture, expose individuals to greater physical risks and strain, which can lead to adverse health effects. In Bangladesh, many migratory household head engage in labor-intensive jobs, which may exacerbate health disparities due to poor working conditions and limited access to healthcare [ 7 ] [ 2 ]. On the other hand, professional employment often provides safer working conditions and access to health benefits, contributing to better health outcomes. Study shown that individuals in physically demanding jobs face higher risks of chronic illnesses and injuries, highlighting the importance of employment opportunities that support health and well-being for migratory families [ 10 ]. Environmental factors, particularly climate-related risks, are another dimension perceived health among migratory individuals in Bangladesh. Bangladesh's geographical susceptibility to natural disasters, such as cyclones, adds an environmental layer of vulnerability for migratory populations [ 6 ]. Research has shown that exposure to severe weather events can lead to physical injuries, mental health issues, and long-term stress, which collectively impact overall well-being [ 3 ]. For instance, people who migrate to cyclone-prone regions face increased risks to both their mental and physical health. The experience of natural disasters induces trauma and stress, further exacerbating health issues among populations already facing economic hardships [ 11 ]. Food security is another crucial determinant of health outcomes of migratory families. Previous research has shown that access to sufficient and nutritious food is essential for maintaining physical and mental well-being for migrants [ 7 ]. While each factor has an individual effect on perceived health among migratory facilities, they also intersect. For example, one study found that social support systems may offset some of the adverse effects of low educational attainment and physically demanding occupations, while education equips individuals to adapt to environmental changes and occupational challenges [ 1 ]. Moreover, environmental stressors, like cyclones, interact with socioeconomic vulnerabilities, demonstrating that a multifaceted approach is required to address health disparities among migratory individuals [ 2 ] [ 3 ]. The relationship between migration and health status of migratory persons are very important issue to study. Especially in Bangladesh, thousands of families are migrated within country every year and this moving impacts their health status positively or negatively at multiple levels [ 12 ]. Thus, this study focused on perceiving health status as its dependent variable, and some of the environmental, social, educational, and occupational determinants are its independent variables. Because all of those independent factors are much more influential in perceiving health after migration within Bangladesh. In summary, perceiving health after migration of a migratory individual are interdependent on many factors like social support, education, occupation, and environmental conditions after migration [ 3 ]. This study findings suggests that those factors are pivotal determinants of health among migratory populations. The relationship with these factors shapes health outcomes, whether they perceived good or bad health after their migration within Bangladesh. III. METHODS This study utilized secondary data from the Bangladesh Environment and Migration Survey (BEMS) [ 13 ], which focuses on migratory households within Bangladesh. The study used a sample size of 1,754, which is substantial and provides a robust representation of the population, allowing for more reliable and meaningful correlations. The dataset provides a comprehensive examination of internal migration patterns, incorporating variables such as social support, education, occupation, environmental conditions, and perceived health quality. The current study was exempt from IRB review as it involved secondary analysis of publicly available and de-identified data. This approach aligns with ethical research practices and mitigates concerns related to participant privacy and data security. The BEMS study utilized a robust sampling technique, including a community census followed by random household selection, ensuring a representative cross-section of migratory families across different regions in Bangladesh. Additional information regarding the dataset's collection procedures can be found in the BEMS methodology report [ 13 ]. To handle missing data, the survey employed a set of non-response codes, such as "not applicable" (NA), "don’t know" (DK), and "refuses to answer" (REF), to maintain data integrity during analysis. Out of BEMS survey respondents, 40% (n = 1,754) provided data on perceived health status after migration while 60% (n = 2,629) were excluded due to nonresponse of every question as they are healthy or unhealthy. Thus, the final analysis was conducted on the 1,754 respondents. From the sampled respondents, 45.9% have the highest frequency of non-valid answer. This highlights a significant portion of missing data. Having chosen not to answer some of the questions may reflect bias, potentially skewing the results. It is possible that nonresponse resulted from the fact that migrants' experiences, including their fears related to political or family matters, can impact their openness in sharing information. Migrants may withhold information due to concerns over security or familial obligations, particularly when discussing sensitive migration-related topics [ 5 ]. This study investigates factors influencing health perceptions, including social support, educational attainment, occupational engagement, food availability, and environmental risks. While the dataset's design is well-suited for this analysis, it is essential to note that missing data and non-response bias were carefully addressed to ensure analytical rigor. Measure The survey household head was asked about their quality of health after last migration within Bangladesh. The household head was asked, if migration within Bangladesh: what was the quality of health after last migration? Respondents were provided four response choices between healthy and unhealthy. The variable of health status recoded individuals as either "healthy" or "unhealthy," providing a binary measure of overall health positions among migratory populations after migration. This variable enables the analysis of health disparities and outcomes among migratory individuals after migration [ 1 ]. Several variables on perceptions of migration and its measure were chosen to explore the relationship between these variables and migratory household heads health status. The survey asked respondents if they get any monetary and material goods related social support in the last 1 year/12 months. Monetary and material assistance, is a critical factor in improving individual well-being, especially in vulnerable populations. Their responses was provided in four categories (most monthly, occasionally, rarely and never). In this analysis, social support is recoded as either received (1) or not received (0). This binary measurement provides a clear distinction, allows to easily assess within the sampled population. Household heads were asked, in the last 1 year/12 months, did you ask any family or friends for emotional support and advice? This support plays a vital role in individual well-being, particularly in coping with stress and enhancing mental health. Their responses were also recoded in four categories (most monthly, occasionally, rarely and never). This classification offers a straightforward way to assess the presence of emotional support within the population, revealing how widely individuals feel supported. The variable education captures the educational attainment of individuals who migrated. The survey participant’s asked “what is the level of education of the household head?” they were provided seven response choices between no schooling (0) to all other potential options of schooling (1). Although binary categorization may omit the variation in education levels, it is useful for basic descriptive and comparative analysis. The survey asked the respondents that “In the last 12 months did they or other adults (18 + years) in the household cut the size of the meals or skip meals because there was not enough food?” Response choices were yes or no, categorized as no reduction (0) and reduction (1). This binary variable is significant for analyzing food security and nutritional status post-migration. Cutting meals is a key indicator of economic hardship and adverse health outcomes, making it an essential measure of well-being in migratory studies. For example, Gundersen & Ziliak [ 14 ] studied that food insecurity, characterized by behaviors like cutting meals or skipping meals due to lack of resources, is linked to negative outcomes such as malnutrition, chronic illness, and psychological stress. The household head were asked about what their profession was after their migration. All 19 response choices placed into four main groups: "agriculture (e.g., land owner, agricultural worker, fisherman and farmer)," "professional worker," "worker (e.g., Construction worker, Domestic servant, Nonagricultural worker, and driver/ construction supervisor/Seamstresses/tailor)," and "others," which consistence of small traders, unemployed/students, retire, pensioners, homemakers, businessman, etc. This classification provides a clear snapshot of the types of employment individuals engaged in after their migration within country. Survey respondents were asked, ‘did you notice a decrease, increase or no change in these environmental conditions (severity of cyclones) over the past 20 years?’ Response was recoded as decrees, increase and no change. Data were taken for after migration but questioned for last 20 years, if someone lived such long. This classification provides valuable information about the environmental risks faced by people after migration and how these changes impacted on their health status. Analytical Strategy This study followed a comprehensive analytical strategy to examine the factors associated with perceived quality health among migratory individuals with in Bangladesh, using in univariate and bivariate statistical analysis framework. The dependent variable, perceived health quality, was measured as a binary outcome (healthy vs. unhealthy), while the independent variables included social support (monetary/material and emotional), education, occupation, food security, and environmental conditions like severity of cyclone. The analyses were conducted utilizing Stata 15 software with weighted data and the chi-squared test. Univariate analysis provided a descriptive statistic of the data, while bivariate chi-square tests explored relations between the DV and IV’s. Statistical significance was determined with a p-value that is p < .001, p < .01 and p < .05. Missing data were excluded, and non-response bias was acknowledged as a limitation of the study. The results were interpreted by the context of existing literature to shape the perceiving health quality of migratory individuals within Bangladesh. IV. RESULTS AND DISCUSSION Univariate Statistics : Of the data retained for analysis, 95.3% (n = 1,671) reported being healthy after migration. In terms of social support, 72.4% (n = 1,271) of respondents received social support, while 65.2% (n = 1,143) received emotional social support. Regarding education, 65.5% (n = 1,149) of the respondents were educated. Food security was high, with 92.5% (n = 1,622) of respondents indicating they did not cut meals, suggesting they had adequate food availability. The occupational distribution of the respondents was as follows: 20.1% (n = 3,52) were engaged in agricultural work, 15% (n = 2,63) were professionals, 26.5% (n = 4,65) were workers, and 38.4% (n = 6,74) fell into the "other" category. Perceived changes in cyclone severity after migration were reported as follows: 73.2% (n = 1,284) indicated a decrease in severity, 18.5% (n = 3,26) reported an increase, and 8.2% (n = 1,44) reported no change in cyclone severity. Bivariate Statistics : The data in figure presents the results of a bivariate test to assess the factors. Out of the final sample retained for analysis, 94.7% (n = 1,204) of those who mostly, occasionally, or rarely received monetary and material support in the last year after migration reported being healthy, compared to 96.7% (n = 4,67) of those who did not receive such support. Emotional support in the last year after migration was also positively associated with health outcomes, with 94.9% (n = 1,085) of those who mostly, occasionally, or rarely received emotional support reporting being healthy, compared to 95.9% (n = 5,86) of those who did not receive emotional support. Among households, where the head had schooling (Class I to College), 95.4% (n = 1,437) reported being healthy after migration, while 95% (n = 2,34) of those with no schooling reported being healthy. Food availability had an impact on health as well, with 92.2% (n = 1,22) of respondents who cut meals reporting being healthy compared to 95.5% (n = 1,549) of those who did not cut meals. Each of these four independent variables were not statistically associated with health issues after migration. The occupational breakdown of migratory families shows varying health outcomes: 96% (n = 3,38) of those in agricultural work, 98.9% (n = 2,60) of professionals, 95.7% (n = 4,45) of workers, and 93.2% (n = 6,28) of those in other occupations like small traders, unemployed/students, retire, pensioners, homemakers, etc. Professional category reported being healthy after migration and this relationship was statistically significant (p > 001). Perceptions of cyclone severity after migration also appeared to correlate with health outcomes. Among those who reported a decrease in cyclone severity, 94.9% (n = 1,219) reported being healthy, compared to 96.6% (n = 3,15) of those who experienced an increase and 95.1% (n = 1,37) of those who observed no change. However, this variable was not statistically significant with perceived quality health among migratory families. DISCUSSION Migration within Bangladesh is driven by many factors, where perceiving health after migration is an important issue to find out. By focusing on internal migratory families, this research aims to provide insights into the determinants of health in vulnerable populations. Some of the previous studies often explored individual factors; however, this study integrates social, occupational, and environmental dimensions, offering a comprehensive lens to understand health outcomes in the migratory context [ 1 ][ 3 ]. The current study utilized secondary data from the Bangladesh Environment and Migration Survey (BEMS) [ 13 ], to explore the link between perceived health and various factors such as social support, educational attainment, food security, perceived environmental stability and perceptions of health. Social support is widely recognized as a protective factor for health, especially among vulnerable populations such as migratory families [ 15 ]. However, the current study indicates that the impact of social support, both monetary and emotional on perceived health outcomes among migratory household head may not be as pronounced as previously thought, as this study found similar health outcomes among those who received social support and those who did not. This could be because literature shows that social support cannot explain changes in perceived health by itself, especially when economic stability and access to healthcare are not guaranteed [ 7 ]. Emotional and psychological social support, such as engaging in conversations or providing consolation, plays a pivotal role in perceived health outcomes, especially for households after migration [ 16 ]. But, this study found that while emotional support is often regarded as beneficial, the relationship between having such support and perceiving better health outcomes was not statistically significant. This suggests that structural factors, such as access to employment opportunities or food security, may play a more dominant role in shaping health perceptions among migratory households [ 5 ]. Education has strong connection with health outcomes, as it provides individuals with greater knowledge and resources to navigate health risks and improve socioeconomic status [ 2 ]. Yet this study found no differences in perceived health by education, suggesting that other factors may be more critical in determining health outcomes among migratory populations [ 3 ]. Food security is a crucial determinant of health. It often leads to adverse health outcomes, particularly among migratory families who face economic instability and limited access to social safety nets [ 17 ]. However, this study findings reveal that health outcomes were relatively high those who experienced food insecurity. Employment type has been identified as a significant factor influencing health among migratory populations, with physically demanding jobs often associated with greater health risks. This study find a significant relationship between occupational group and perceiving health after migration within Bangladesh. This study findings indicate that occupational group like professional categories perceived better health then others groups where agricultural occupational group perceived 2nd most health status after migration. Workers and other categories like small traders, unemployed/students, retire, pensioners, homemakers etc. were relatively less healthy. Environmental stressors, especially those related to climate events, add an additional layer of vulnerability for migratory families. Bangladesh susceptive disaster prone country and natural disasters, particularly cyclones, poses ongoing health risks [ 18 ]. However, this study results demonstrate both perceived good health regardless of experienced cyclone severity changes. These findings suggested that migratory families may exhibit resilience in the face of environmental challenges, possibly due to adaptive coping strategies and community support [ 5 ]. V. LIMITATIONS AND RECOMMENDATIONS FOR FUTURE RESEARCH This study provides insights into the factors that influence health quality among migratory household heads in Bangladesh but is not without limitations. First, the cross-sectional nature of the data restricts the ability to infer causal relationships between migration and perceiving quality health. Second, important predictors were left out of the survey, such as political decision making [ 19 ]. Third, some questions had a high prevalence of going unanswered. It is possible that nonresponse resulted from the fact that migrants' experiences, including receiving social support, can impact their openness in sharing information. Migratory families may withhold information due to concerns over security or familial obligations, particularly when discussing sensitive migration-related topics [ 5 ]. For the study on migratory family’s longitudinal approach would help establish causal relationships and provide a deeper understanding of how health evolves post-migration [ 1 ]. Future research should expand the scope to include regional and international comparisons of migratory health outcomes that will provide a broader insights into the unique challenges faced by Bangladeshi migratory families. Perceiving health quality may vary between gender and age groups during migration. Another future study should also examine how factors like gender dynamics and household roles influence perceived health quality among migratory families. This study only asked questions to household head only, a future study should take entire household for the study populations. VI. CONCLUSION The study investigates the factors associated with perceived health quality among migratory individuals in Bangladesh, focusing on the role of social support, education, food security, occupational engagement, and environmental conditions. The study found social support and education had limited direct impact on perceived health quality. Similarly food security had marginal impact where many respondents reported good health after migration despite experiencing food shortages. Additionally, environmental changes like cyclone severity, did not show a strong connection with migratory health, suggesting potential external adaptive mechanisms with migration. However, occupational engagement appeared as a significant determinant with perceived health quality among household head. By addressing those factors, this study can connects migration and health issues that can guide a policy interventions aimed at sustainable health quality for migratory individuals in Bangladesh. References K. N. Koly et al. , “Health‐related quality of life among rural‐urban migrants living in dhaka slums: A cross‐sectional survey in Bangladesh,” Int J Environ Res Public Health , vol. 18, no. 19, Oct. 2021, doi: 10.3390/ijerph181910507. R. S. Parrenas, Children of global migration: Transnational families and gendered woes . California: Stanford University Press, 2005. F. Vergunst, H. L. Berry, K. Minor, and N. Chadi, “Climate Change and Substance-Use Behaviors: A Risk-Pathways Framework,” Perspectives on Psychological Science , vol. 18, no. 4, pp. 936–954, Jul. 2023, doi: 10.1177/17456916221132739. H. Castañeda, S. M. Holmes, D. S. Madrigal, M. E. D. T. Young, N. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6440902","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":442350288,"identity":"3a7e5b43-0739-469e-8965-1817216643c9","order_by":0,"name":"Md Sirajul Islam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYDACZsaGAwk8EnIMzHChBEJamA8++CBjYUyCFga2ZMMZNhWJDQgRAlp023nMpHlyJNLXtvMYMPO2HWbgZ88xwKvF7DBIyxmJ3G2H2RLAWiR73hChhbcHpIX5AHPOmcMMBjeIsYX3n0S62WHGBrAWe8JaQN7nkUgwA9tSAbRFgqAWUCDzSBiC/HL4T0U6j8SZZwX4tZw/CIrKOnmz82cMH84wsJbjb0/egFcLCjgAxDzEKx8Fo2AUjIJRgBMAACQtQqS3dLJVAAAAAElFTkSuQmCC","orcid":"","institution":"West Virginia University, Morgantown, WV, USA","correspondingAuthor":true,"prefix":"","firstName":"Md","middleName":"Sirajul","lastName":"Islam","suffix":""},{"id":442350289,"identity":"d975c146-7901-4d84-8c29-a00cf72b56d5","order_by":1,"name":"Sabiha Afrin","email":"","orcid":"","institution":"Begum Badrunnessa Govt. Girls’ College, Dhaka, Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"Sabiha","middleName":"","lastName":"Afrin","suffix":""},{"id":442350290,"identity":"1aa0eb69-8cc8-48f9-bbbd-5ec17d594815","order_by":2,"name":"A.S.M. Taj Uddin","email":"","orcid":"","institution":"West Virginia University, Morgantown, WV, USA","correspondingAuthor":false,"prefix":"","firstName":"A.S.M.","middleName":"Taj","lastName":"Uddin","suffix":""}],"badges":[],"createdAt":"2025-04-13 19:52:07","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6440902/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6440902/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80602138,"identity":"48199d17-c142-4593-8cfe-7ee0b6972756","added_by":"auto","created_at":"2025-04-15 05:39:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":107243,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered Image in the Results and Discussion Section.\u003c/p\u003e","description":"","filename":"Unnumberfig.png","url":"https://assets-eu.researchsquare.com/files/rs-6440902/v1/b45fdb4dc3ef28bd9c3f4ef2.png"},{"id":80602141,"identity":"9b3ad70d-af50-428d-9fa6-0521ae7833a4","added_by":"auto","created_at":"2025-04-15 05:39:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":432305,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6440902/v1/176e1746-a7a8-412c-a5cf-3ceeecb3dda6.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eFactors are associated with perceived higher quality health among people that have migrated within Bangladesh\u003c/p\u003e","fulltext":[{"header":"I. INTRODUCTION","content":"\u003cp\u003eMigration has become a pressing issue in South Asian countries like Bangladesh where internal migration driven by a range of social, economic, and environmental factors, has become increasingly significant in recent years. Migration is a common phenomenon worldwide and it often seen as a pathway to better opportunities and improved living conditions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Whether the benefits of migration are realized can depend on numerous factors such as social support, educational background, and environmental shifts, including climate events like cyclones, which are common in Bangladesh[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. One potential measure of success post-migration could be perceived quality of health. In exploration, this study investigates the determinants of perceived health quality among people who have migrated within Bangladesh, examining how support systems and environmental conditions collectively impact perceiving quality health where migration is increasingly recognized as a determinant of health [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBangladesh is a developing nation; it has seen substantial rural-to-urban and interregional migration, especially, the density of the capital city, Dhaka, is increasing rapidly because of internal migration. Migratory families experience significant changes in their social environment, which affects both physical and mental well-being. Factors before, during, and after migration in the social environment can positively or negatively impact well-being. For example, Carling [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] highlighted that support from family and community networks can mitigate the stress associated with relocation and improve mental health outcomes for migratory individuals. This research explores whether social support received or not, correlate with perceived health quality among migratory individuals in Bangladesh.\u003c/p\u003e \u003cp\u003eEnvironmental vulnerability is a big issue for migration in the context of Bangladesh. Particularly, cyclones impose significant health risks, with implications for both immediate physical well-being and longer-term mental health stability. This study captures effects of cyclone severity among migrated people and assesses its association with health outcomes after migration. Understanding the impact of environmental stressors on health can inform targeted interventions aimed at enhancing resilience and well-being in vulnerable communities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOccupational and educational factors also play a vital role in shaping health outcomes. Employment opportunities vary significantly for migratory individuals, with occupations ranging from agriculture to professional work, each carrying different health risks. Studies have shown that physical demands of certain occupations can lead to adverse health effects, while professional jobs may offer relatively better health outcomes due to less physically demanding work environments [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Education, often linked to health and economic stability, provides migratory people with the resources to navigate post-migration challenges. This study explores how occupation and educational attainment interact with health outcomes, emphasizing the role of human capital in promoting well-being among migratory populations.\u003c/p\u003e \u003cp\u003eThis study aims to investigate these diverse factors to better understand health quality among migratory individuals within Bangladesh. Specifically, it examines the impact of social support, education, occupation, and environmental perceptions on post-migration health status. By assessing these variables, this research will seek to inform policies that can address health disparities among migratory individuals. Insights gained from this study could support the development of targeted interventions, such as enhanced social support networks, educational opportunities, and occupational health initiatives that promote the well-being of migratory populations across Bangladesh.\u003c/p\u003e"},{"header":"II. LITERATURE REVIEW","content":"\u003cp\u003eMigration within Bangladesh, primarily driven by socioeconomic and environmental factors, has gained attention for its impact on the well-being of migratory populations, especially in terms of health. Researchers have highlighted several factors influencing quality health among migratory populations, including social support, education, occupation, and environmental stressors. This literature review examines these factors, drawing from existing research to provide a foundation for understanding determinants of health quality among migratory individuals within Bangladesh.\u003c/p\u003e \u003cp\u003eSocial support is one of the well documented protective factors for health, particularly in the context of migration [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Social networks provide emotional, material, and monetary support, which can mitigate the negative impacts of relocation and socioeconomic instability. Household head who migrated with other households or a bigger community described the maintenance or re-establishment of social ties that seemed to be linked with a more positive migration experience with possible implications for mental health and wellbeing [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAneshensel [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] suggested that social support acts as a buffer against stress, fostering resilience among vulnerable populations in Bangladesh. In particular social support plays an essential role for migratory people who are often cut off from their traditional support systems [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Similarly, emotional support has been shown to alleviate stress and promote mental well-being, essential for navigating the complexities of post-migration life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] ). Additionally, Parrenas [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] explored that out-migration could have some beneficial effects on emotional health, by reconstructing local gender relations and increasing left-behind women\u0026rsquo;s autonomy and decision-making power.\u003c/p\u003e \u003cp\u003eEducation is another critical factor that impacts migratory population\u0026rsquo;s health outcomes. Higher levels of education are often associated with improved health, as they provide individuals with better access to resources and opportunities. Maron et al.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] indicated that education can enhance resilience by equipping migratory individuals with knowledge and skills that facilitate adaptation to new environments. In Bangladesh, educational disparities are significant and the level of education sometimes determine a person\u0026rsquo;s ability to access health services like finding a stable employment, and navigate post-migration challenges [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Education mitigates the effects of migration on health by promoting economic stability and enabling families to make informed health-related decisions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOccupation status of a migratory individual indicate a certain view of health outcomes. Occupations involving manual labor, such as agriculture, expose individuals to greater physical risks and strain, which can lead to adverse health effects. In Bangladesh, many migratory household head engage in labor-intensive jobs, which may exacerbate health disparities due to poor working conditions and limited access to healthcare [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. On the other hand, professional employment often provides safer working conditions and access to health benefits, contributing to better health outcomes. Study shown that individuals in physically demanding jobs face higher risks of chronic illnesses and injuries, highlighting the importance of employment opportunities that support health and well-being for migratory families [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEnvironmental factors, particularly climate-related risks, are another dimension perceived health among migratory individuals in Bangladesh. Bangladesh's geographical susceptibility to natural disasters, such as cyclones, adds an environmental layer of vulnerability for migratory populations [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Research has shown that exposure to severe weather events can lead to physical injuries, mental health issues, and long-term stress, which collectively impact overall well-being [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. For instance, people who migrate to cyclone-prone regions face increased risks to both their mental and physical health. The experience of natural disasters induces trauma and stress, further exacerbating health issues among populations already facing economic hardships [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFood security is another crucial determinant of health outcomes of migratory families. Previous research has shown that access to sufficient and nutritious food is essential for maintaining physical and mental well-being for migrants [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile each factor has an individual effect on perceived health among migratory facilities, they also intersect. For example, one study found that social support systems may offset some of the adverse effects of low educational attainment and physically demanding occupations, while education equips individuals to adapt to environmental changes and occupational challenges [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Moreover, environmental stressors, like cyclones, interact with socioeconomic vulnerabilities, demonstrating that a multifaceted approach is required to address health disparities among migratory individuals [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe relationship between migration and health status of migratory persons are very important issue to study. Especially in Bangladesh, thousands of families are migrated within country every year and this moving impacts their health status positively or negatively at multiple levels [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Thus, this study focused on perceiving health status as its dependent variable, and some of the environmental, social, educational, and occupational determinants are its independent variables. Because all of those independent factors are much more influential in perceiving health after migration within Bangladesh.\u003c/p\u003e \u003cp\u003eIn summary, perceiving health after migration of a migratory individual are interdependent on many factors like social support, education, occupation, and environmental conditions after migration [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This study findings suggests that those factors are pivotal determinants of health among migratory populations. The relationship with these factors shapes health outcomes, whether they perceived good or bad health after their migration within Bangladesh.\u003c/p\u003e"},{"header":"III. METHODS","content":"\u003cp\u003eThis study utilized secondary data from the Bangladesh Environment and Migration Survey (BEMS) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], which focuses on migratory households within Bangladesh. The study used a sample size of 1,754, which is substantial and provides a robust representation of the population, allowing for more reliable and meaningful correlations. The dataset provides a comprehensive examination of internal migration patterns, incorporating variables such as social support, education, occupation, environmental conditions, and perceived health quality. The current study was exempt from IRB review as it involved secondary analysis of publicly available and de-identified data. This approach aligns with ethical research practices and mitigates concerns related to participant privacy and data security. The BEMS study utilized a robust sampling technique, including a community census followed by random household selection, ensuring a representative cross-section of migratory families across different regions in Bangladesh. Additional information regarding the dataset's collection procedures can be found in the BEMS methodology report [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. To handle missing data, the survey employed a set of non-response codes, such as \"not applicable\" (NA), \"don\u0026rsquo;t know\" (DK), and \"refuses to answer\" (REF), to maintain data integrity during analysis.\u003c/p\u003e \u003cp\u003eOut of BEMS survey respondents, 40% (n\u0026thinsp;=\u0026thinsp;1,754) provided data on perceived health status after migration while 60% (n\u0026thinsp;=\u0026thinsp;2,629) were excluded due to nonresponse of every question as they are healthy or unhealthy. Thus, the final analysis was conducted on the 1,754 respondents. From the sampled respondents, 45.9% have the highest frequency of non-valid answer. This highlights a significant portion of missing data. Having chosen not to answer some of the questions may reflect bias, potentially skewing the results. It is possible that nonresponse resulted from the fact that migrants' experiences, including their fears related to political or family matters, can impact their openness in sharing information. Migrants may withhold information due to concerns over security or familial obligations, particularly when discussing sensitive migration-related topics [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This study investigates factors influencing health perceptions, including social support, educational attainment, occupational engagement, food availability, and environmental risks. While the dataset's design is well-suited for this analysis, it is essential to note that missing data and non-response bias were carefully addressed to ensure analytical rigor.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMeasure\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe survey household head was asked about their quality of health after last migration within Bangladesh. The household head was asked, if migration within Bangladesh: what was the quality of health after last migration? Respondents were provided four response choices between healthy and unhealthy. The variable of health status recoded individuals as either \"healthy\" or \"unhealthy,\" providing a binary measure of overall health positions among migratory populations after migration. This variable enables the analysis of health disparities and outcomes among migratory individuals after migration [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Several variables on perceptions of migration and its measure were chosen to explore the relationship between these variables and migratory household heads health status. The survey asked respondents if they get any monetary and material goods related social support in the last 1 year/12 months. Monetary and material assistance, is a critical factor in improving individual well-being, especially in vulnerable populations. Their responses was provided in four categories (most monthly, occasionally, rarely and never). In this analysis, social support is recoded as either received (1) or not received (0). This binary measurement provides a clear distinction, allows to easily assess within the sampled population.\u003c/p\u003e \u003cp\u003eHousehold heads were asked, in the last 1 year/12 months, did you ask any family or friends for emotional support and advice? This support plays a vital role in individual well-being, particularly in coping with stress and enhancing mental health. Their responses were also recoded in four categories (most monthly, occasionally, rarely and never). This classification offers a straightforward way to assess the presence of emotional support within the population, revealing how widely individuals feel supported. The variable education captures the educational attainment of individuals who migrated. The survey participant\u0026rsquo;s asked \u0026ldquo;what is the level of education of the household head?\u0026rdquo; they were provided seven response choices between no schooling (0) to all other potential options of schooling (1). Although binary categorization may omit the variation in education levels, it is useful for basic descriptive and comparative analysis.\u003c/p\u003e \u003cp\u003eThe survey asked the respondents that \u0026ldquo;In the last 12 months did they or other adults (18\u0026thinsp;+\u0026thinsp;years) in the household cut the size of the meals or skip meals because there was not enough food?\u0026rdquo; Response choices were yes or no, categorized as no reduction (0) and reduction (1). This binary variable is significant for analyzing food security and nutritional status post-migration. Cutting meals is a key indicator of economic hardship and adverse health outcomes, making it an essential measure of well-being in migratory studies. For example, Gundersen \u0026amp; Ziliak [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] studied that food insecurity, characterized by behaviors like cutting meals or skipping meals due to lack of resources, is linked to negative outcomes such as malnutrition, chronic illness, and psychological stress. The household head were asked about what their profession was after their migration. All 19 response choices placed into four main groups: \"agriculture (e.g., land owner, agricultural worker, fisherman and farmer),\" \"professional worker,\" \"worker (e.g., Construction worker, Domestic servant, Nonagricultural worker, and driver/ construction supervisor/Seamstresses/tailor),\" and \"others,\" which consistence of small traders, unemployed/students, retire, pensioners, homemakers, businessman, etc. This classification provides a clear snapshot of the types of employment individuals engaged in after their migration within country.\u003c/p\u003e \u003cp\u003eSurvey respondents were asked, \u0026lsquo;did you notice a decrease, increase or no change in these environmental conditions (severity of cyclones) over the past 20 years?\u0026rsquo; Response was recoded as decrees, increase and no change. Data were taken for after migration but questioned for last 20 years, if someone lived such long. This classification provides valuable information about the environmental risks faced by people after migration and how these changes impacted on their health status.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAnalytical Strategy\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study followed a comprehensive analytical strategy to examine the factors associated with perceived quality health among migratory individuals with in Bangladesh, using in univariate and bivariate statistical analysis framework. The dependent variable, perceived health quality, was measured as a binary outcome (healthy vs. unhealthy), while the independent variables included social support (monetary/material and emotional), education, occupation, food security, and environmental conditions like severity of cyclone. The analyses were conducted utilizing Stata 15 software with weighted data and the chi-squared test. Univariate analysis provided a descriptive statistic of the data, while bivariate chi-square tests explored relations between the DV and IV\u0026rsquo;s. Statistical significance was determined with a p-value that is p\u0026thinsp;\u0026lt;\u0026thinsp;.001, p\u0026thinsp;\u0026lt;\u0026thinsp;.01 and p\u0026thinsp;\u0026lt;\u0026thinsp;.05. Missing data were excluded, and non-response bias was acknowledged as a limitation of the study. The results were interpreted by the context of existing literature to shape the perceiving health quality of migratory individuals within Bangladesh.\u003c/p\u003e"},{"header":"IV. RESULTS AND DISCUSSION","content":"\u003cp\u003e\u003cstrong\u003eUnivariate Statistics\u003c/strong\u003e: Of the data retained for analysis, 95.3% (n\u0026thinsp;=\u0026thinsp;1,671) reported being healthy after migration. In terms of social support, 72.4% (n\u0026thinsp;=\u0026thinsp;1,271) of respondents received social support, while 65.2% (n\u0026thinsp;=\u0026thinsp;1,143) received emotional social support. Regarding education, 65.5% (n\u0026thinsp;=\u0026thinsp;1,149) of the respondents were educated. Food security was high, with 92.5% (n\u0026thinsp;=\u0026thinsp;1,622) of respondents indicating they did not cut meals, suggesting they had adequate food availability. The occupational distribution of the respondents was as follows: 20.1% (n\u0026thinsp;=\u0026thinsp;3,52) were engaged in agricultural work, 15% (n\u0026thinsp;=\u0026thinsp;2,63) were professionals, 26.5% (n\u0026thinsp;=\u0026thinsp;4,65) were workers, and 38.4% (n\u0026thinsp;=\u0026thinsp;6,74) fell into the \u0026quot;other\u0026quot; category. Perceived changes in cyclone severity after migration were reported as follows: 73.2% (n\u0026thinsp;=\u0026thinsp;1,284) indicated a decrease in severity, 18.5% (n\u0026thinsp;=\u0026thinsp;3,26) reported an increase, and 8.2% (n\u0026thinsp;=\u0026thinsp;1,44) reported no change in cyclone severity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBivariate Statistics\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe data in figure presents the results of a bivariate test to assess the factors. Out of the final sample retained for analysis, 94.7% (n\u0026thinsp;=\u0026thinsp;1,204) of those who mostly, occasionally, or rarely received monetary and material support in the last year after migration reported being healthy, compared to 96.7% (n\u0026thinsp;=\u0026thinsp;4,67) of those who did not receive such support. Emotional support in the last year after migration was also positively associated with health outcomes, with 94.9% (n\u0026thinsp;=\u0026thinsp;1,085) of those who mostly, occasionally, or rarely received emotional support reporting being healthy, compared to 95.9% (n\u0026thinsp;=\u0026thinsp;5,86) of those who did not receive emotional support. Among households, where the head had schooling (Class I to College), 95.4% (n\u0026thinsp;=\u0026thinsp;1,437) reported being healthy after migration, while 95% (n\u0026thinsp;=\u0026thinsp;2,34) of those with no schooling reported being healthy. Food availability had an impact on health as well, with 92.2% (n\u0026thinsp;=\u0026thinsp;1,22) of respondents who cut meals reporting being healthy compared to 95.5% (n\u0026thinsp;=\u0026thinsp;1,549) of those who did not cut meals. Each of these four independent variables were not statistically associated with health issues after migration.\u003c/p\u003e\n\u003cp\u003eThe occupational breakdown of migratory families shows varying health outcomes: 96% (n\u0026thinsp;=\u0026thinsp;3,38) of those in agricultural work, 98.9% (n\u0026thinsp;=\u0026thinsp;2,60) of professionals, 95.7% (n\u0026thinsp;=\u0026thinsp;4,45) of workers, and 93.2% (n\u0026thinsp;=\u0026thinsp;6,28) of those in other occupations like small traders, unemployed/students, retire, pensioners, homemakers, etc. Professional category reported being healthy after migration and this relationship was statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;001). Perceptions of cyclone severity after migration also appeared to correlate with health outcomes. Among those who reported a decrease in cyclone severity, 94.9% (n\u0026thinsp;=\u0026thinsp;1,219) reported being healthy, compared to 96.6% (n\u0026thinsp;=\u0026thinsp;3,15) of those who experienced an increase and 95.1% (n\u0026thinsp;=\u0026thinsp;1,37) of those who observed no change. However, this variable was not statistically significant with perceived quality health among migratory families.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDISCUSSION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMigration within Bangladesh is driven by many factors, where perceiving health after migration is an important issue to find out. By focusing on internal migratory families, this research aims to provide insights into the determinants of health in vulnerable populations. Some of the previous studies often explored individual factors; however, this study integrates social, occupational, and environmental dimensions, offering a comprehensive lens to understand health outcomes in the migratory context [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e][\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe current study utilized secondary data from the Bangladesh Environment and Migration Survey (BEMS) [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e], to explore the link between perceived health and various factors such as social support, educational attainment, food security, perceived environmental stability and perceptions of health. Social support is widely recognized as a protective factor for health, especially among vulnerable populations such as migratory families [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, the current study indicates that the impact of social support, both monetary and emotional on perceived health outcomes among migratory household head may not be as pronounced as previously thought, as this study found similar health outcomes among those who received social support and those who did not. This could be because literature shows that social support cannot explain changes in perceived health by itself, especially when economic stability and access to healthcare are not guaranteed [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eEmotional and psychological social support, such as engaging in conversations or providing consolation, plays a pivotal role in perceived health outcomes, especially for households after migration [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. But, this study found that while emotional support is often regarded as beneficial, the relationship between having such support and perceiving better health outcomes was not statistically significant. This suggests that structural factors, such as access to employment opportunities or food security, may play a more dominant role in shaping health perceptions among migratory households [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eEducation has strong connection with health outcomes, as it provides individuals with greater knowledge and resources to navigate health risks and improve socioeconomic status [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e]. Yet this study found no differences in perceived health by education, suggesting that other factors may be more critical in determining health outcomes among migratory populations [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eFood security is a crucial determinant of health. It often leads to adverse health outcomes, particularly among migratory families who face economic instability and limited access to social safety nets [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, this study findings reveal that health outcomes were relatively high those who experienced food insecurity.\u003c/p\u003e\n\u003cp\u003eEmployment type has been identified as a significant factor influencing health among migratory populations, with physically demanding jobs often associated with greater health risks. This study find a significant relationship between occupational group and perceiving health after migration within Bangladesh. This study findings indicate that occupational group like professional categories perceived better health then others groups where agricultural occupational group perceived 2nd most health status after migration. Workers and other categories like small traders, unemployed/students, retire, pensioners, homemakers etc. were relatively less healthy.\u003c/p\u003e\n\u003cp\u003eEnvironmental stressors, especially those related to climate events, add an additional layer of vulnerability for migratory families. Bangladesh susceptive disaster prone country and natural disasters, particularly cyclones, poses ongoing health risks [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, this study results demonstrate both perceived good health regardless of experienced cyclone severity changes. These findings suggested that migratory families may exhibit resilience in the face of environmental challenges, possibly due to adaptive coping strategies and community support [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e"},{"header":"V. LIMITATIONS AND RECOMMENDATIONS FOR FUTURE RESEARCH","content":"\u003cp\u003eThis study provides insights into the factors that influence health quality among migratory household heads in Bangladesh but is not without limitations. First, the cross-sectional nature of the data restricts the ability to infer causal relationships between migration and perceiving quality health. Second, important predictors were left out of the survey, such as political decision making [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Third, some questions had a high prevalence of going unanswered.\u003c/p\u003e \u003cp\u003eIt is possible that nonresponse resulted from the fact that migrants' experiences, including receiving social support, can impact their openness in sharing information. Migratory families may withhold information due to concerns over security or familial obligations, particularly when discussing sensitive migration-related topics [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor the study on migratory family\u0026rsquo;s longitudinal approach would help establish causal relationships and provide a deeper understanding of how health evolves post-migration [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Future research should expand the scope to include regional and international comparisons of migratory health outcomes that will provide a broader insights into the unique challenges faced by Bangladeshi migratory families. Perceiving health quality may vary between gender and age groups during migration. Another future study should also examine how factors like gender dynamics and household roles influence perceived health quality among migratory families. This study only asked questions to household head only, a future study should take entire household for the study populations.\u003c/p\u003e"},{"header":"VI. CONCLUSION","content":"\u003cp\u003eThe study investigates the factors associated with perceived health quality among migratory individuals in Bangladesh, focusing on the role of social support, education, food security, occupational engagement, and environmental conditions. The study found social support and education had limited direct impact on perceived health quality. Similarly food security had marginal impact where many respondents reported good health after migration despite experiencing food shortages. Additionally, environmental changes like cyclone severity, did not show a strong connection with migratory health, suggesting potential external adaptive mechanisms with migration. However, occupational engagement appeared as a significant determinant with perceived health quality among household head. By addressing those factors, this study can connects migration and health issues that can guide a policy interventions aimed at sustainable health quality for migratory individuals in Bangladesh.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eK. N. Koly \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Health‐related quality of life among rural‐urban migrants living in dhaka slums: A cross‐sectional survey in Bangladesh,\u0026rdquo; \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e, vol. 18, no. 19, Oct. 2021, doi: 10.3390/ijerph181910507.\u003c/li\u003e\n \u003cli\u003eR. S. Parrenas, \u003cem\u003eChildren of global migration: Transnational families and gendered woes\u003c/em\u003e. California: Stanford University Press, 2005.\u003c/li\u003e\n \u003cli\u003eF. Vergunst, H. L. Berry, K. Minor, and N. Chadi, \u0026ldquo;Climate Change and Substance-Use Behaviors: A Risk-Pathways Framework,\u0026rdquo; \u003cem\u003ePerspectives on Psychological Science\u003c/em\u003e, vol. 18, no. 4, pp. 936\u0026ndash;954, Jul. 2023, doi: 10.1177/17456916221132739.\u003c/li\u003e\n \u003cli\u003eH. Casta\u0026ntilde;eda, S. M. Holmes, D. S. Madrigal, M. E. D. T. Young, N. Beyeler, and J. Quesada, \u0026ldquo;Immigration as a social determinant of health,\u0026rdquo; Mar. 18, 2015, \u003cem\u003eAnnual Reviews Inc.\u003c/em\u003e doi: 10.1146/annurev-publhealth-032013-182419.\u003c/li\u003e\n \u003cli\u003eJ. Carling, \u0026ldquo;Migration in the age of involuntary immobility,\u0026rdquo; \u003cem\u003eJ Ethn Migr Stud\u003c/em\u003e, vol. 28, pp. 5\u0026ndash;42, 2002.\u003c/li\u003e\n \u003cli\u003eF. Vergunst \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Association of youth climate change worry with present and past mental health symptoms: a longitudinal population-based study,\u0026rdquo; \u003cem\u003eClim Change\u003c/em\u003e, vol. 177, no. 10, Oct. 2024, doi: 10.1007/s10584-024-03807-1.\u003c/li\u003e\n \u003cli\u003eJ. , K. L. , P. O. , G. de M. E. , \u0026amp; P. D. Maron, \u0026ldquo;Occupational inequalities in psychoactive substance use: A question of conceptualization?,\u0026rdquo; \u003cem\u003eAddiction Research \u0026amp; Theory\u003c/em\u003e, vol. 24, no. 3, pp. 186\u0026ndash;198, 2016.\u003c/li\u003e\n \u003cli\u003eH. Doma, T. Tran, P. Rioseco, and J. Fisher, \u0026ldquo;Understanding the relationship between social support and mental health of humanitarian migrants resettled in Australia,\u0026rdquo; \u003cem\u003eBMC Public Health\u003c/em\u003e, vol. 22, no. 1, Dec. 2022, doi: 10.1186/s12889-022-14082-z.\u003c/li\u003e\n \u003cli\u003eP. N. Schwerdtle \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;A risk exchange: Health and mobility in the context of climate and environmental change in bangladesh\u0026mdash;a qualitative study,\u0026rdquo; \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e, vol. 18, no. 5, pp. 1\u0026ndash;17, Mar. 2021, doi: 10.3390/ijerph18052629.\u003c/li\u003e\n \u003cli\u003eC. S. Aneshensel, \u0026ldquo;SOCIAL STRESS: THEORY AND RESEARCH,\u0026rdquo; 1992. [Online]. Available: https://about.jstor.org/terms\u003c/li\u003e\n \u003cli\u003eM. R. , \u0026amp; M. D. Chowdhury, \u0026ldquo;Cyclone resilience among rural communities in Bangladesh,\u0026rdquo; \u003cem\u003eCyclone resilience among rural communities in Bangladesh. Asian Journal of Environmental Research\u003c/em\u003e, vol. 12, no. 3, pp. 125\u0026ndash;136, 2019.\u003c/li\u003e\n \u003cli\u003eF. Thomas, E. Chase, and P. Aggleton, \u0026ldquo;Health education and migration,\u0026rdquo; Feb. 01, 2019, \u003cem\u003eSAGE Publications Ltd\u003c/em\u003e. doi: 10.1177/0017896918813592.\u003c/li\u003e\n \u003cli\u003eA. , \u0026amp; D. K. M. Carrico, \u0026ldquo;Bangladesh Environment and Migration Survey (BEMS),\u0026rdquo; 2019. Accessed: Jan. 06, 2025. [Online]. Available: https://doi.org/10.3886/ICPSR38846.v1\u003c/li\u003e\n \u003cli\u003eC. Gundersen and J. P. Ziliak, \u0026ldquo;Food insecurity and health outcomes,\u0026rdquo; \u003cem\u003eHealth Aff\u003c/em\u003e, vol. 34, no. 11, pp. 1830\u0026ndash;1839, 2015, doi: 10.1377/hlthaff.2015.0645.\u003c/li\u003e\n \u003cli\u003eL. F. , \u0026amp; G. T. Berkman, \u0026ldquo;Social integration, social networks, social support, and health,\u0026rdquo; \u003cem\u003eSocial Epidemiology\u003c/em\u003e, pp. 137\u0026ndash;173, 2000, Accessed: Jan. 06, 2025. [Online]. Available: https://doi.org/10.1093/acprof:oso/9780195138382.001.0001\u003c/li\u003e\n \u003cli\u003eP. A. Thoits, \u0026ldquo;Mechanisms linking social ties and support to physical and mental health,\u0026rdquo; \u003cem\u003eJ Health Soc Behav\u003c/em\u003e, vol. 52, no. 2, pp. 145\u0026ndash;161, Jun. 2011, doi: 10.1177/0022146510395592.\u003c/li\u003e\n \u003cli\u003eJ. T. Cook \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Community and International Nutrition Food Insecurity Is Associated with Adverse Health Outcomes among Human Infants and Toddlers 1,2,\u0026rdquo; 2004. [Online]. Available: http://www.ers.usda.gov/briefing/foodsecurity/,\u003c/li\u003e\n \u003cli\u003eU. Haque, M. Hashizume, K. N. Kolivras, H. J. Overgaard, B. Das, and T. Yamamoto, \u0026ldquo;Reduced death rates from cyclones in Bangladesh: What more needs to be done?,\u0026rdquo; \u003cem\u003eBull World Health Organ\u003c/em\u003e, vol. 90, no. 2, pp. 150\u0026ndash;156, Feb. 2012, doi: 10.2471/BLT.11.088302.\u003c/li\u003e\n \u003cli\u003eC. Telsa\u0026ccedil;, \u0026ldquo;Deep economic factors causing migration,\u0026rdquo; \u003cem\u003eInternational Journal of Global\u0026nbsp;\u003c/em\u003e\u003cem\u003ePolitics and Public Administration-GLOPA Journal\u003c/em\u003e, vol. 1, no. 1, pp. 39\u0026ndash;53, 2024, Accessed: Jan. 06, 2025. [Online]. Available: http://www.glopajournal.com\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"West Virginia University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"migration, health, social support, occupation, environment","lastPublishedDoi":"10.21203/rs.3.rs-6440902/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6440902/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe purpose of this study is to examine the factors associated with perceiving quality of health among individuals who have migrated within Bangladesh, focusing on social support, education, food availability, occupation, and environmental conditions. Data were taken from the Bangladesh Environment and Migration Survey (BEMS) involving 1,754 migratory families. Perceived quality of health was assessed with social and emotional support, education, food availability, occupation, and perceived changes in cyclone severity. The analyses were conducted utilizing Stata software with weighted data and the chi-squared test. The study found, majority of the respondents perceived quality health after migration. Most of the migrants reported quality health after receiving emotional and social support from the community. Those who had better educational status or not, improved their health status after migration. Bivariate chi square analyses revealed that professional occupation reported the highest quality health perceived versus other occupation (p\u0026lt;.001). On the environmental aspects, both perceived quality health regardless of experienced cyclone severity changes. Contrary to common belief, this study finds a weaker relationship between education, food shortages or social support and quality health after migration. These findings have important implications for understanding perceived quality of health, suggesting that other factors associated with the control variables, may play a more significant role. A major limitation of this study is to use a cross-sectional data that restricts the ability to infer causal relationships between migration and perceiving quality health.\u003c/p\u003e","manuscriptTitle":"Factors are associated with perceived higher quality health among people that have migrated within Bangladesh","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-15 05:31:10","doi":"10.21203/rs.3.rs-6440902/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a59dc606-4da2-4389-ab2e-9f9341a8b568","owner":[],"postedDate":"April 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47092811,"name":"Sociology"}],"tags":[],"updatedAt":"2025-04-15T05:31:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-15 05:31:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6440902","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6440902","identity":"rs-6440902","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}