Migrants: Emergence and re-emergence of public health concerns

THE arrivals of foreign workers in Malaysia have brought along with them, emerging health threats and risks in infectious diseases. There have been calls from several quarters for the relevant authorities in Malaysia to strengthen primary healthcare programs to stop the spread of transmissible pathogens and slow down the emergence and re-emergence of infectious diseases in migrants.

According to the Malaysian Department of Statistics (DOSM), there were approximately three million migrants living in this country by the end of July, last year, and they made up 8.9 per cent of Malaysia’s total population of 33.4 million.

Despite mandatory public health screening for foreign workers, prevalence records of infectious diseases amongst migrant population in Malaysia, are still at negligible proportions. Recent studies by public health experts from Universiti Malaya, Monash University Malaysia and Royal Halloway University of London, reported that migrants in Malaysia were at higher risk for TB, malaria, lymphatic filariasis, giardiasis (diarrheal diseases), cholera, leprosy and leptospirosis.

Experts also stated that lymphatic filariasis was still endemic among this population while thousand cases of TB and cholera had been reported among them due to poor sanitation and camped living conditions in their respective settlements. It also stated that while malaria had gradually decreased and become sporadic, the influx of migrant workers had led to the rising of imported malaria cases in the locals. As for leprosy, they said low cases of leprosy had been recorded but a significant proportion of it was contributed by migrant workers.

Intrinsic and extrinsic factors play a significant role in disease transmission including their vaccination status, country of origin, low educational background and financial constraints that impede them the access to public healthcare facilities. Migrant workers and non-citizens were also found to be lacking in awareness of infectious diseases and disease transmission.

All these warrant the government and the relevant authorities in Malaysia to focus on improving the welfare of migrant workers and non-citizens by ensuring that they are provided with proper and hygienic dwellings by their respective employers.

Migrant-friendly basic health facilities and a comprehensive insurance coverage plan which are already in existence for them, need to be improved further to lessen the financial constraints faced by this vulnerable group of workers. Effective surveillance and control measures must be intensified to curb the spread of the diseases.

The way forward for Malaysia to tackle the emergence and re-emergence of infectious diseases is by adopting fully the scope of the World Health Organisation (WHO) International Health Regulations (IHR) and update any epidemiological databases to enable the authorities to characterize host-pathogen interactions and provide a better understanding of the disease dynamics.

While enhancing healthcare infrastructure and implementing robust surveillance systems are vital in combating infectious diseases among migrant populations, it is equally imperative to prioritise community engagement and cultural sensitivity.

Migrant communities often possess unique cultural beliefs, practices and perceptions related to health and healthcare, which can significantly impact their access to and utilization of healthcare services.

Incorporating community engagement strategies into public health initiatives can help bridge the gap between healthcare providers and migrant communities, fostering trust, understanding and collaboration.

By actively involving migrant communities in the design, implementation, and evaluation of healthcare interventions, we can ensure that these initiatives are culturally appropriate, responsive to community needs, and ultimately more effective in addressing health challenges.

Furthermore, community engagement empowers migrant populations to take ownership of their health, promoting a sense of agency and self-efficacy. Through meaningful dialogue and collaboration, healthcare providers can better understand the barriers faced by migrant communities in accessing healthcare, such as language barriers, legal concerns, and fear of deportation. By addressing these barriers in a culturally sensitive manner, we can create more inclusive and equitable healthcare systems that prioritise the health and well-being of all individuals, regardless of their background or nationality.

As Malaysia grapples with the complexities of infectious disease management amidst its diverse migrant population, a holistic approach that integrates improved healthcare infrastructure, robust surveillance measures and meaningful community engagement is paramount. Moving forward, it is imperative for the government and relevant authorities to heed the call for comprehensive action, guided by principles of equity, compassion, and collaboration in safeguarding the health and well-being of every individual within its borders.

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