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Closing the gap: applying health and socio-demographic surveillance to complex health transitions in South and sub-Saharan Africa
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
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 [en]
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: urn:nbn:se:umu:diva-1909ISBN: 978-91-7264-681-0 (print)OAI: oai:DiVA.org:umu-1909DiVA: diva2:142388
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
List of papers
1. Research into health, population, and social transitions in rural South Africa: data and methods of the Agincourt health and demographic surveillance system
Open this publication in new window or tab >>Research into health, population, and social transitions in rural South Africa: data and methods of the Agincourt health and demographic surveillance system
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2007 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, no Suppl. 69, 8-20 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-3602 (URN)10.1080/14034950701505031 (DOI)17676498 (PubMedID)
Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2017-12-14Bibliographically approved
2. Reversal in mortality trends: evidence from the Agincourt field site, South Africa, 1992-1995
Open this publication in new window or tab >>Reversal in mortality trends: evidence from the Agincourt field site, South Africa, 1992-1995
1999 (English)In: AIDS (London), ISSN 0269-9370, E-ISSN 1473-5571, Vol. 13, no 9, 1091-1097 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-3603 (URN)10397540 (PubMedID)
Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2017-12-14Bibliographically approved
3. Fertility trends and net reproduction in Agincourt, rural South Africa: 1992-2004
Open this publication in new window or tab >>Fertility trends and net reproduction in Agincourt, rural South Africa: 1992-2004
2007 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, no Suppl. 69, 68-76 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-3604 (URN)10.1080/14034950701355650 (DOI)17676506 (PubMedID)
Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2017-12-14Bibliographically approved
4. Returning home to die: circular labour migration and mortality in South Africa
Open this publication in new window or tab >>Returning home to die: circular labour migration and mortality in South Africa
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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
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-3605 (URN)10.1080/14034950701355619 (DOI)17676501 (PubMedID)
Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2017-12-14Bibliographically approved
5. Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study
Open this publication in new window or tab >>Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study
Show others...
2008 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 372, no 9642, 893-901 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-3606 (URN)10.1016/S0140-6736(08)61399-9 (DOI)18790312 (PubMedID)
Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2017-12-14Bibliographically approved
6. Health system reform and the role of field sites based upon demographic and health surveillance
Open this publication in new window or tab >>Health system reform and the role of field sites based upon demographic and health surveillance
2000 (English)In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 78, no 1, 125-134 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-3607 (URN)10686747 (PubMedID)
Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2017-12-14Bibliographically approved

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