title: Risk of mental health and nutritional problems for left-behind children of international labor migrants.
abstract: BACKGROUND
  One-in-ten Sri Lankans are employed abroad as International Labor Migrants (ILM), mainly as domestic maids or low-skilled laborers. Little is known about the impact their migration has on the health status of the children they 'leave behind'. This national study explored associations between the health status of 'left-behind' children of ILM's with those from comparative non-migrant families.
  
  
  METHODS
  A cross-sectional study design with multi-stage random sampling was used to survey a total of 820 children matched for both age and sex. Socio-demographic and health status data were derived using standardized pre-validated instruments. Univariate and multivariate analyses were used to estimate the differences in mental health outcomes between children of migrant vs. non-migrant families.
  
  
  RESULTS
  Two in every five left-behind children were shown to have mental disorders [95%CI: 37.4-49.2, p < 0.05], suggesting that socio-emotional maladjustment and behavioural problems may occur in absence of a parent in left-behind children. Male left-behind children were more vulnerable to psychopathology. In the adjusted analyses, significant associations between child psychopathological outcomes, child gender and parent's mental health status were observed. Over a quarter (30%) of the left-behind children aged 6-59 months were 'underweight or severely underweight' compared to 17.7% of non-migrant children.
  
  
  CONCLUSIONS
  Findings provide evidence on health consequences for children of migrant worker families in a country experiencing heavy out-migration of labour, where remittances from ILM's remain as the single highest contributor to the economy. These findings may be relevant for other labour 'sending countries' in Asia relying on contractual labor migration for economic gain. Further studies are needed to assess longitudinal health impacts on the children left-behind.
authors.affiliation: Health Unit, International Organization for Migration, No. 62, Green Path, Colombo 3, Sri Lanka. wickramage.kolitha@gmail.com.
authors.forename: Kolitha
authors.initials: K
authors.lastname: Wickramage
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. chesmal@gmail.com.|Faculty of Medical Science, Anglia Ruskin University, Chelmsford, UK. chesmal@gmail.com.|Institute of Psychiatry, King's College London, London, UK. chesmal@gmail.com.
authors.forename: Chesmal
authors.initials: C
authors.lastname: Siriwardhana
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. puwalani@gmail.com.|Department of Cardiothoracic Vascular Surgery, National University Hospital, Singapore, Singapore. puwalani@gmail.com.
authors.forename: Puwalani
authors.initials: P
authors.lastname: Vidanapathirana
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. sweerawarna@gmail.com.
authors.forename: Sulochana
authors.initials: S
authors.lastname: Weerawarna
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. danu_j82@yahoo.com.
authors.forename: Buddhini
authors.initials: B
authors.lastname: Jayasekara
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. gayanipannala@yahoo.com.
authors.forename: Gayani
authors.initials: G
authors.lastname: Pannala
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. anushkaadikari@yahoo.com.
authors.forename: Anushka
authors.initials: A
authors.lastname: Adikari
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. kaushj@gmail.com.
authors.forename: Kaushalya
authors.initials: K
authors.lastname: Jayaweera
authors.affiliation: Health Unit, International Organization for Migration, No. 62, Green Path, Colombo 3, Sri Lanka. sharikapeiris@gmail.com.|Ministry of Health, Colombo, Sri Lanka. sharikapeiris@gmail.com.
authors.forename: Sharika
authors.initials: S
authors.lastname: Peiris
authors.affiliation: Department of Medicine, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka. sisira.siribaddana@gmail.com.
authors.forename: Sisira
authors.initials: S
authors.lastname: Siribaddana
authors.affiliation: Institute for Research & Development, Colombo, Sri Lanka. a.sumathipala@keele.ac.uk.|Research Institute for Primary Care and Health Services, Faculty of Health, Keele University, Keele, UK. a.sumathipala@keele.ac.uk.
authors.forename: Athula
authors.initials: A
authors.lastname: Sumathipala
mesh_terms: D001010:Anxiety, Separation / Q000208:ethnology / Q000523:psychology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration; D004651:Employment / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D008297:Male; D001523:Mental Disorders / Q000208:ethnology / Q000523:psychology*; D008603:Mental Health / Q000208:ethnology; D009748:Nutrition Disorders / Q000208:ethnology / Q000523:psychology*; D010290:Parents; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013188:Sri Lanka / Q000208:ethnology; D014171:Transients and Migrants / Q000523:psychology*