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Purpose: The MAKASI intervention aimed to empower Sub-Saharan African immigrants living in precarious situations in the Paris metropolitan area. Because there are factors specifically related to immigration that may increase the risk for common mental disorders, the present study aimed to examine participants' levels of depression and loneliness and analyze the effect of the intervention on depression and loneliness. Methods: The MAKASI study was designed as a stepped wedge cluster randomized trial. Study participants were recruited through an outreach program led by a nongovernmental organization and randomly assigned to two clusters, with an intervention delay of 3 months between them. Participants were assessed for 6 months after inclusion and the effect of the intervention on depression and loneliness was assessed using generalized linear mixed models. The study was conducted from 2018 to 2021 and took in consideration whether being interviewed during one of the Covid-19 confinement had an effect on the results. Results: Between 2018 and 2021 a total of 821 subjects participated in the Makasi study. High levels of depression and loneliness were found in the study population. We found no effect of the intervention on depression [95% CI 0.77 to 2.40]. Similarly, no effect of the intervention was found on loneliness [95% CI 0.87 to 2.54]. Conclusions: The intervention tested did not appear to improve the level of depression and loneliness among participants. However, the high prevalence of mental and emotional problems in the study population suggests a public health crisis among immigrants in the greater Paris area. Clinical Trial Registration Number: Trial registration Clinicaltrials.gov, NCT04468724 (July 13, 2020). [ABSTRACT FROM AUTHOR]

This paper combines population and climate data to estimate the volume of migration induced by the drought events that have hit Mali since the late 1980s. The results show that droughts have had the effect of decreasing net migration rates in the affected localities. This is true for both men and women, regardless of their age. The effect of drought episodes, however, is found to differ according to localities and households' capacity to adapt to climatic constraints: it fades in localities characterized by more diversified crops and in areas that receive more rainfall on average. Climate shocks also had an impact on international mobility: over the 2004–2009 period, around 2300 additional departures per year can be attributed to the droughts that hit Mali during the 2000s. We forecast that, under different climate scenarios and population growth projections, mobility induced by drought events will substantially grow in the next decades. [ABSTRACT FROM AUTHOR]

Throughout Europe, migration-related health inequalities are mirrored by large inequalities in health coverage. There is a need to develop novel strategies to secure access to health insurance for immigrants in Europe, in order to meet the shared Sustainable Development Goal of universal health coverage. We evaluated the impact of an original health-related empowerment intervention on access to health coverage among vulnerable, mostly undocumented immigrants in France. As part of the MAKASI study, we adopted an outreach approach and developed a community-based intervention with and for immigrants from sub-Saharan Africa living in precarious conditions in the Greater Paris area. This participatory intervention was grounded in the theory of individual empowerment. Using a stepped wedge randomised design, we first conducted a robust evaluation of the effect of the intervention on access to health coverage at three and six months post-intervention. We then investigated whether the intervention effect was mediated by a health empowerment process. Between 2018 and 2021, a total of 821 participants – 77% of whom were men – were recruited in public spaces and followed up for six months. Participants had been living in France for four years on average, 75% of them had no residence permit, and 44% had no health coverage at the time of inclusion. The probability of accessing health coverage increased by 29 percentage points at six months post-intervention (p < 0.01). This improvement was partially mediated by a health empowerment process, namely a reinforcement of participants' knowledge of and capacity to access available social and health resources. A health empowerment intervention largely improved access to health insurance among vulnerable immigrants in France. Our findings may be transferred to other settings where immigrants are entitled to health insurance. This study offers promising perspectives – beyond information provision and direct referral – to reduce migration-related inequalities in health coverage. • We developed an intervention for vulnerable sub-Saharan African immigrants in France. • Our community-based outreach intervention was grounded in the theory of empowerment. • Participants' access to health coverage increased by 29 percentage points in 6 months. • This improvement was partially mediated by a health empowerment process. • Such intervention can reduce migration-related inequalities in health coverage. [ABSTRACT FROM AUTHOR]