A test of the epidemiological paradox in a context of forced migration: Low birthweight among Syrian newborns in Lebanon

Abstract

Background Studies on immigrants revealed an epidemiological paradox whereby low-socioeconomic status (SES) immigrant mothers exhibit favourable birth outcomes compared with native-born mothers. We tested the epidemiological paradox in a context of forced migration, comparing associations of low birthweight (LBW) and maternal SES between Syrian and Lebanese newborns in Lebanon. Methods We used data from the National Collaborative Perinatal Neonatal Network (NCPNN) of 31 Lebanese hospitals, including 45 442 Lebanese and 4910 Syrian neonates born 2011-13. We assessed associations between LBW and maternal SES for both groups. Logistic regression models examined interactions between maternal origin and SES. Results Syrian births increased exponentially between 2011 and 2013, along with the group's forced migration into Lebanon. Although Syrian mothers are more socioeconomically disadvantaged compared with Lebanese mothers, Syrian LBW (6.2%) was only marginally higher than Lebanese LBW (5.6%; P = 0.059). Only 20-24-years-old Syrian women [odds ratio (OR) = 2.02 (0.98-4.16)] and those with ≥ university education [OR = 1.70 (1.22-2.36)] exhibited higher odds of delivering an LBW baby compared with Lebanese women of the same age and education. Conclusions The findings do not provide strong evidence for the epidemiological paradox in a forced migration context. However, the relatively advantageous LBW profile among Syrian neonates, despite their mothers' low SES and exposure to acute and chronic psychological stress, points to protective mechanisms. One of these mechanisms may be a collective response by the displaced population to improve neonatal outcomes as a way of recovering from loss and death. © The Author(s) 2018; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.