Risk of kidney injury among returnee Nepali migrants: a mixed-method study

International migration for work is essential for survival for tens of thousands of Nepali contributing to one-quarter of the country’s total income. In a country with a population of 29 million, more than four million work permits have been granted in the past decade. Nepali labour migrants are mostly poorly educated males, low-skilled, and the vast majority work in the Gulf countries and Malaysia. In recent years, there is an increasing concern about kidney problems among low-skilled returnee Nepali migrants. Both working conditions and lifestyles in the destination countries could increase the risk of developing kidney disease; such as physically demanding work in a hot environment with recurrent dehydration, long working hours, limited opportunities to use the toilet, chemical exposure, heavy intake of alcohol and sugary drinks, and excessive use of painkillers. The working conditions of low-skilled Nepali migrant workers in the Gulf countries and Malaysia are largely similar to farm workers in Central America and South Asia who also have a markedly higher risk of chronic kidney disease in the absence of established risk factors (e.g. diabetes, high blood pressure). Limited research, some media reports and anecdotal evidence, and our previous work strongly support further investigation in this issue. More than 35 million labour migrants from Asia and Africa work in Gulf countries and Malaysia, most are unskilled/semi-skilled labourers, and a significant proportion could be at the risk of kidney problems.

We wish to generate the first-ever community-based evidence on the kidney health-related risk of returnee Nepali migrant workers and to explore the potential risk factors. We will carry out this study in Dhanusha district which has the highest number of international labour out-migrants in the country. This study has two parts; (a) community-based prevalence survey of kidney health-related diseases and risk factors (using questionnaire, blood and urine samples) among 718 returnee migrant workers and equal number of comparator non-migrants from same area matched with age, sex, ethnicity, and usual occupation; and, (b) 30 interviews of returnee migrant workers who were already diagnosed with kidney problems. Participating returnee migrants should have stayed at least two years (to allow for exposure of migrant worker experience) in the countries of Gulf or Malaysia in any occupation and have returned to Nepal in the past 12 months. We will seek ethical approvals from Bournemouth University (UK) and Nepal Health Research Council, the government’s ethical body.

This study is funded by the Colt Foundation, UK.

For further information please contact Dr Pramod Raj Regmi (pregmi@bournemouth.ac.uk) or Dr Nirmal Aryal (naryal@bournemouth.ac.uk).