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Returning home to die: circular labour migration and mortality in South Africa
Univ of Washington, USA; MRC /Wits, University of Witwatersrand, South Africa.
Witwatersrand University, Johannesburg, South Africa.
Witwatersrand University, Johannesburg, South Africa.
University of Colorado at Boulder, USA.
Show others and affiliations
2007 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, no Suppl. 69, 35-44 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To examine the hypothesis that circular labour migrants who become seriously ill while living away from home return to their rural homes to convalesce and possibly to die. METHODS: Drawing on longitudinal data collected by the Agincourt health and demographic surveillance system in rural northeastern South Africa between 1995 and 2004, discrete time event history analysis is used to estimate the likelihood of dying for residents, short-term returning migrants, and long-term returning migrants controlling for sex, age, and historical period. RESULTS: The annual odds of dying for short-term returning migrants are generally 1.1 to 1.9 times (depending on period, sex, and age) higher than those of residents and long-term returning migrants, and these differences are generally highly statistically significant. Further supporting the hypothesis is the fact that the proportion of HIV/TB deaths among short-term returning migrants increases dramatically as time progresses, and short-term returning migrants account for an increasing proportion of all HIV/TB deaths. CONCLUSIONS: This evidence strongly suggests that increasing numbers of circular labour migrants of prime working age are becoming ill in the urban areas where they work and coming home to be cared for and eventually to die in the rural areas where their families live. This shifts the burden of caring for them in their terminal illness to their families and the rural healthcare system with significant consequences for the distribution and allocation of health care resources.

Place, publisher, year, edition, pages
Taylor and Francis , 2007. Vol. 35, no Suppl. 69, 35-44 p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-3605DOI: 10.1080/14034950701355619PubMedID: 17676501OAI: oai:DiVA.org:umu-3605DiVA: diva2:142385
Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Closing the gap: applying health and socio-demographic surveillance to complex health transitions in South and sub-Saharan Africa
Open this publication in new window or tab >>Closing the gap: applying health and socio-demographic surveillance to complex health transitions in South and sub-Saharan Africa
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The challenge of research in resource-poor settings remains a profound concern and is closely linked to African social development. Work of this thesis spans the end of apartheid and first decade of the democratic era in South Africa, along with emergence of the HIV/AIDS pandemic. It also covers the founding decade of the INDEPTH Network.

Aims: Through appraising health and population research in a rural southern African sub-district over the past decade, to evaluate the utility of health and socio-demographic surveillance in rural African settings for:

• capturing the dynamics of health, population and social transitions

• supporting a mix of research designs, and

• contributing to policy and programme development and evaluation.

To extend this appraisal by examining the multi-site opportunities offered by the INDEPTH Network.

Methods: Work was sited in the Agincourt sub-district, a heavily populated border area of rural north-eastern South Africa. Health and socio-demographic surveillance, introduced in 1992, involved prospective follow-up of the entire sub-district population of 70,000 people (including some 30% Mozambican immigrants) who lived in 11,700 households and 21 villages. Annual census rounds systematically updated household membership and recorded all vital events (births, deaths and migrations) since the previous census. A maternity history was asked of women of reproductive age and a verbal autopsy carried out on all deaths registered. The resulting ‘data and research platform’ – a core feature of all INDEPTH field sites – provided data for computation of trends in vital events and supported an extensive interdisciplinary project portfolio. The population under surveillance can be disaggregated into cohorts selected by age, sex or other criteria. Analyses are possible at multiple levels (individual, family/household or neighborhood) and can include socioeconomic factors.

Findings: The Agincourt community experienced a serious worsening of mortality among most age-sex groups, rapidly declining fertility to near replacement level, and changing patterns of labour migration. This resulted in major changes in population structure and household composition. The rising burden of chronic disease involved both chronic infectious illness (HIV/AIDS and tuberculosis) and non-communicable disorders (such as stroke and related vascular disease). The burden of illness requiring chronic care increased disproportionately to that needing acute care. Potential contributions of field sites based on health and socio-demographic surveillance to local and national health policy are considerable yet remain underexploited.

Interpretation: Rural South and southern Africa is in the midst of multiple, interrelated transitions with implications for health, social and development sectors. Health and socio-demographic surveillance systems are effective research instruments that can capture the rapidly-changing dynamics of health and social transitions in developing settings. Similarly, they can support a range of observational and intervention study designs including policy evaluations. The INDEPTH Network should boost much-needed comparative research; yet singly, and as a group, many of these sites have yet to fulfil their undoubted potential.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin, 2008. 68 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1226
Keyword
demographic surveillance system, health transition, mortality transition, fertility transition, health policy, primary health care, South Africa
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-1909 (URN)978-91-7264-681-0 (ISBN)
Public defence
2008-11-26, Sal 135, 9A, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2010-01-18Bibliographically approved
2. Striving against adversity.: the dynamics of migration, health and poverty in rural South Africa
Open this publication in new window or tab >>Striving against adversity.: the dynamics of migration, health and poverty in rural South Africa
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

 Background: The study is based in post-apartheid South Africa and looks at the health and well being of households in the rural northeast. Temporary migration remains important in South Africa because it functions as a mainstay for income and even survival of rural communities. The economic base of rural South Africans is surprisingly low because there is high inequity at a national level, within and between racial groups. There has now been a democratic system in place for 15 years and there is no longer restriction of mobility, but there remain high levels of poverty in rural areas and rising mortality rates. Migration patterns did not change after apartheid in the manner expected. We need to examine consequences of migration and learn how to offset negative impacts with targeted policies.

Aims: To determine a relevant typology of migration in a typical rural sending community, namely the Agincourt sub-district of Mpumalanga, South Africa, and relate it to the urban transition at a national level – Paper (I) . To evaluate the dynamics of socio-economic status in this rural community and examine the relationship with migration – Paper (II). To explore, using longitudinal methods, the impact of migration on key dimensions of health, including adult and child mortality, and sexual partnerships, over a period of an emerging HIV/AIDS epidemic – Papers (III), (IV) and (V).

Methods: The health and socio-demographic surveillance system (HDSS) is a large open cohort where the migration dynamics are monitored as they unfold. They are recorded as temporary or permanent migration. Settled refugees are captured using nationality on entry into the HDSS. Longitudinal methods, namely a household panel and two discrete time event history analyses, are used to examine consequences of migration.

Results: Migration features prominently and different types have different age and sex profiles. Temporary migration impacts the most on socio-economic status (SES) and health, but permanent migration and the settlement of former refugees are also important. Remittances from migrants make a significant difference to SES. For the poorest households the key factors improving SES are government grants and female temporary migration, while for less poor it is male temporary migration and local employment. Migration has been associated with HIV. Migrants that return more frequently may be less exposed to outside partners and therefore less implicated in the HIV epidemic. There are links between migration and mortality including a higher risk of dying for returnee migrants compared to permanent residents. A mother’s migration can impact on child survival after accounting for other factors. There remains a higher mortality risk for children of Mozambican former refugee parents.

Interpretation: Migration changes the risks and resources for health with positive and negative implications. Measures such as improved transportation and roads should be seen as a positive, not a negative intervention, even though it will create more migration. Health services need to adapt to a reality of high levels of circular migration ranging from budget allocation to referral systems. Data should be enhanced at a national level by accounting for temporary migration in national censuses and surveys. At individual level we can offset negative consequences by treating migrants as persons striving against adversity, instead of unwelcome visitors in our better-off communities. 

Place, publisher, year, edition, pages
Umeå: Epidemiologi och folkhälsovetenskap, 2009. 65 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1251
Keyword
migration, temporary migration, permanent migration, refugee settlement, socioeconomic status, HIV transmission, adult mortality, child mortaality, returning to die
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-22056 (URN)ISBN 978-91-7264-746-6 (ISBN)
Distributor:
Epidemiologi och folkhälsovetenskap, 901 87, Umeå
Public defence
2009-05-15, Betula, byggnad 6M, Norrlands Univ sjukhus, Norrlands universitetsjukhus, 901 85 Umeå, 09:00 (English)
Supervisors
Available from: 2009-04-29 Created: 2009-04-22 Last updated: 2010-01-18Bibliographically approved

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