Search

In Malaysia, marginalised non-citizen children are excluded from formal education at public schools. Recognising education as a fundamental human right, the barriers and facilitators to educational access among refugee and asylum-seeker, migrant, stateless and undocumented children in Malaysia were explored. Qualitative data were collected via 32 in-depth interviews with multiple stakeholders. Data were thematically analysed and organised at three socio-ecological levels. At the 'legislative and policy' level, the requirement of citizenship documents only allows some stateless children to access public schools. Yet, many informal learning centres are not state-endorsed, as they are unable to fulfil licensing criteria. Importantly, denying the right to work for adult refugees and other undocumented people demotivates the pursuit of education among children. At the 'individual and family' level, financial constraints constitute a major reason for school dropouts, especially through expectations on boys to work. Cultural norms partly contribute to the lower enrolment of Rohingya refugee girls in secondary education, but gender parity is maintained for most in primary education. Another factor is proximity to learning centres, which links to safety concerns and transportation costs. Those who accessed public schools reported bullying by local children, which parallels institutional discrimination against marginalised non-citizens. At the 'community and educational institutions' level, inadequate funding for learning centres limits their ability to invest in physical facilities, teachers' salaries and others. Despite difficult operating conditions, learning centres address diverse school readiness, educational backgrounds, and language competencies among students by having sensitised teachers, placement tests and preparatory classes at school entry, and options for vocational training. We propose the gradual inclusion of all children in public schools and the immediate state recognition and support of learning centres. Correspondingly, realising the 'Right to Work' for refugees and stateless peoples will be synergistic in advancing universal education access for all children., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Loganathan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Education is a fundamental human right. Yet there remain gaps in our understanding of undocumented children in Malaysia and their vulnerabilities in education access. This study aims to describe and contextualise undocumented children in Malaysia and their access to education. We conducted a desk review and in-depth interviews with 33 key stakeholders from June 2020 to March 2021. Framework analysis was conducted. Salient themes were geographical location and legal identity in terms of citizenship and migration status. We found that the lack of legal identity and non-recognition by the State was the root cause of vulnerability, experienced uniformly by undocumented populations in Malaysia. Only undocumented children with Malaysian parents or guardians can enter public schools under the Malaysian government's 'Zero Reject Policy'. Most undocumented and non-citizen children must rely on informal education provided by alternative or community learning centres that typically lack standardised curricula, resources, and accreditation for education progression beyond primary levels. Nevertheless, as non-citizen groups are diverse, certain groups experience more privilege, while others are more disadvantaged in terms of the quality of informal education and the highest level of education accessible. In Peninsular Malaysia, a very small proportion of refugees and asylum-seekers may additionally access tertiary education on scholarships. In Sabah, children of Indonesian migrant workers have access to learning centres with academic accreditation supported by employers in plantations and the Indonesian Consulate, whereas Filipino migrants who were initially recognised as refugees are now receiving little government or embassy support. Stateless Rohingya refugees in Peninsular Malaysia and Bajau Laut children at Sabah are arguably the most marginalised and have the poorest educational opportunities at basic literacy and numeracy levels, despite the latter receiving minimal governmental education support. Implementing a rights-based approach towards education would mean allowing all children equal opportunity to access and thrive in high-quality schools., Competing Interests: The authors have declared that no competing interests exist.

The COVID-19 pandemic disrupted schooling for children worldwide. Most vulnerable are non-citizen children without access to public education. This study aims to explore challenges faced in achieving education access for children of refugee and asylum-seekers, migrant workers, stateless and undocumented persons in Malaysia during the pandemic. In-depth interviews of 33 stakeholders were conducted from June 2020 to March 2021. Data were thematically analysed. Our findings suggest that lockdowns disproportionately impacted non-citizen households as employment, food and housing insecurity were compounded by xenophobia, exacerbating pre-existing inequities. School closures disrupted school meals and deprived children of social interaction needed for mental wellbeing. Many non-citizen children were unable to participate in online learning due to the scarcity of digital devices, and poor internet connectivity, parental support, and home learning environments. Teachers were forced to adapt to online learning and adopt alternative arrangements to ensure continuity of learning and prevent school dropouts. The lack of government oversight over learning centres meant that measures taken were not uniform. The COVID-19 pandemic presents an opportunity for the design of more inclusive national educational policies, by recognising and supporting informal learning centres, to ensure that no child is left behind., Competing Interests: The authors have declared that no competing interests exist.

Background: A large number of international migrants in Malaysia face challenges in obtaining good health, the extent of which is still relatively unknown. This study aims to map the existing academic literature on migrant health in Malaysia and to provide an overview of the topical coverage, quality and level of evidence of these scientific studies., Methods: A scoping review was conducted using six databases, including Econlit, Embase, Global Health, Medline, PsycINFO and Social Policy and Practice. Studies were eligible for inclusion if they were conducted in Malaysia, peer-reviewed, focused on a health dimension according to the Bay Area Regional Health Inequities Initiative (BARHII) framework, and targeted the vulnerable international migrant population. Data were extracted by using the BARHII framework and a newly developed decision tree to identify the type of study design and corresponding level of evidence. Modified Joanna Briggs Institute checklists were used to assess study quality, and a multiple-correspondence analysis (MCA) was conducted to identify associations between different variables., Results: 67 publications met the selection criteria and were included in the study. The majority (n=41) of studies included foreign workers. Over two-thirds (n=46) focused on disease and injury, and a similar number (n=46) had descriptive designs. The average quality of the papers was low, yet quality differed significantly among them. The MCA showed that high-quality studies were mostly qualitative designs that included refugees and focused on living conditions, while prevalence and analytical cross-sectional studies were mostly of low quality., Conclusion: This study provides an overview of the scientific literature on migrant health in Malaysia published between 1965 and 2019. In general, the quality of these studies is low, and various health dimensions have not been thoroughly researched. Therefore, researchers should address these issues to improve the evidence base to support policy-makers with high-quality evidence for decision-making., Competing Interests: Competing interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: For Malaysia, a nation highly dependent on migrant labour, the large non-citizen workforce presents a unique health system challenge. Although documented migrant workers are covered by mandatory healthcare insurance (SPIKPA), financial constraints remain a major barrier for non-citizen healthcare access. Malaysia recently extended protection for migrant workers under the national social security scheme (SOCSO), previously exclusive to citizens. This study aims to evaluate healthcare financing and social security policies for migrant workers to identify policy gaps and opportunities for intervention., Methods: A total of 37 in-depth interviews were conducted of 44 stakeholders from July 2018 to July 2019. A mixed-methods analysis combining major themes from qualitative interviews with policy document reviews was conducted. Descriptive analysis of publicly available secondary data, namely revenues collected at government healthcare facilities, was conducted to contextualise the policy review and qualitative findings., Results: We found that migrant workers and employers were unaware of SPIKPA enrolment and entitlements. Higher fees for non-citizens result in delayed care-seeking. While the Malaysian government nearly doubled non-citizen healthcare fees revenues from RM 104 to 182 million (USD 26 to 45 million) between 2014 to 2018, outstanding revenues tripled from RM 16 to 50 million (USD 4 to 12 million) in the same period. SPIKPA coverage is likely inadequate in providing financial risk protection to migrant workers, especially with increased non-citizens fees at public hospitals. Undocumented workers and other migrant populations excluded from SPIKPA contribution to unpaid fees revenues are unknown. Problems described with the previous Foreign Workers Compensation Scheme (FWCS), could be partially addressed by SOCSO, in theory. Nevertheless, questions remain on the feasibility of implementing elements of SOCSO, such as recurring payments to workers and next-of-kin overseas., Conclusion: Malaysia is moving towards migrant inclusion with the provision of SOCSO for documented migrant workers, but more needs to be done. Here we suggest the expansion of the SPIKPA insurance scheme to include all migrant populations, while broadening its scope towards more comprehensive coverage, including essential primary care., Competing Interests: The authors have declared that no competing interests exist.

Background: In addition to healthcare entitlements, 'migrant-friendly health services' in Thailand include interpretation and cultural mediation services which aim to reduce language and cultural barriers between health personnel and migrants. Although the Thai Government started implementing these services in 2003, challenges in providing them still remain. This study aims to analyse the health system functions which support the interpretation and cultural mediation services of migrant health worker (MHW) and migrant health volunteer (MHV) programmes in Thailand., Methods: In-depth interviews were conducted in two migrant-populated provinces using purposive and snowball sampling. A total of fifty key informants were recruited, including MHWs, MHWs, health professionals, non-governmental organisation (NGO) staff and policy stakeholders. Data were triangulated using information from policy documents. The deductive thematic analysis was classified into three main themes of evolving structure of MHW and MHV programmes, roles and responsibilities of MHWs and MHVs, and supporting systems., Results: The introduction of the MHW and MHV programmes was one of the most prominent steps taken to improve the migrant-friendliness of Thai health services. MHWs mainly served as interpreters in public facilities, while MHVs served as cultural mediators in migrant communities. Operational challenges in providing services included insufficient budgets for employment and training, diverse training curricula, and lack of legal provisions to sustain the MHW and MHV programmes., Conclusion: Interpretation and cultural mediation services are hugely beneficial in addressing the health needs of migrants. To ensure the sustainability of current service provision, clear policy regulation and standardised training courses should be in place, alongside adequate and sustainable financial support from central government, NGOs, employers and migrant workers themselves. Moreover, regular monitoring and evaluation of the quality of services are recommended. Finally, a lead agency should be mandated to collaborate with stakeholders in planning the overall structure and resource allocation for the programmes.

Providing sexual and reproductive health (SRH) services to migrant workers is key to fulfilling sustainable developmental goals. This study aims to explore key informants' views on the provision of SRH services for migrant women in Malaysia, exploring the provision of SRH education, contraception, abortion, antenatal and delivery, as well as the management of gender-based violence. In-depth interviews of 44 stakeholders were conducted from July 2018 to July 2019. Data were thematically analysed. Migrant workers that fall pregnant are unable to work legally and are subject to deportation. Despite this, we found that insufficient SRH information and contraceptive access are provided, as these are seen to encourage promiscuity. Pregnancy, rather than sexually transmitted infection prevention, is a core concern among migrant women, the latter of which is not adequately addressed by private providers. Abortions are often seen as the only option for pregnant migrants. Unsafe abortions occur which are linked to financial constraints and cultural disapproval, despite surgical abortions being legal in Malaysia. Pregnant migrants often delay care-seeking, and this may explain poor obstetric outcomes. Although health facilities for gender-based violence are available, non-citizen women face additional barriers in terms of discrimination and scrutiny by authorities. Migrant women face extremely limited options for SRH services in Malaysia and these should be expanded.

By using OECD Guideline 106 batch equilibrium method, this paper studied the characteristics of As (V) adsorption and desorption in brown soil as affected by the biochars produced from dairy manure, pine needle, and corn straw. When the addition amount of the biochars was 0.5%, the maximum adsorption amount of As (V) was decreased in the order of dairy manure biochar > pine needle biochar > corn straw biochar, which was related to the basic characteristics of the biochars. The adsorption isotherm of As (V) could be well fitted by Langmuir model (R2 = 0.997). In comparing with CK, both the adsorption capacity (lgKf = 1.99-2.10) and the adsorption intensity (1/N = 0.413-0.449) of As (V) were low, and the main adsorption mechanism was physical adsorption. The desorption rate of As (V) (14.5%-18.7%) was decreased in the order of dairy manure biochar > pine needle biochar > corn straw biochar. The addition of the biochars decreased the adsorption of As (V) by brown soil, which could induce the increase of the bioavailability of As, and strengthen the toxicity of As in soil.

To explore whether human umbilical cord blood CD34+ cells transduced with human aldehyde dehydrogenase class-1 (ALDH1) and multidrug resistance gene (MDR1) increase resistance to 4-Hyaroxycyclophosphophamide (4-HC) and P-Glycoprotein Effluxed Drugs, a bicistronic Retroviral vector G1Na-ALDH1-IRES-MDR1 was constructed. The vector was transduced into the packaging cell lines GP + E86 and PA317 by LipofectAMINE. Using the medium containing VCR and 4-HC for cloning selection and pingponging supernatant infection between ecotropic producer clone and amphotropic producer clone, we obtained high titer amphotropic PA317 producer clone with the highest titer up to 5.6 x 10(5) CFU/ml. Cord blood CD34+ cells were transfectced repeatedly with supernatant of retrovirus containing human ALDH1 and MDR1cDNA under stimulation of hemopoietie growth factors. PCR, RT-PCR, Southern blot, Northern blot, FACS and MTT method analyses show that dual drug resistance genes have been integrated into the genomic DNA of cord blood CD34+ cells and expressed efficiently. The transgenes recipient cells confered 4- to 7.2-folds stronger resistance to cyclophospsphamede and P-Glycoprotein Effluxes drug in comparison with the nontransduced cells. This study provided a foundation for the application of combination chemotherapy in tumor clinical trial.