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Striving against adversity.: the dynamics of migration, health and poverty in rural South Africa
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
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 [en]
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: urn:nbn:se:umu:diva-22056ISBN: ISBN 978-91-7264-746-6 OAI: oai:DiVA.org:umu-22056DiVA: diva2:212616
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
List of papers
1. Migration, settlement change and health in post-apartheid South Africa: triangulating health and demographic surveillance with national census data.
Open this publication in new window or tab >>Migration, settlement change and health in post-apartheid South Africa: triangulating health and demographic surveillance with national census data.
2007 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Scandinavian journal of public health. Supplement, ISSN 1403-4956, Vol. Suppl. 69, 77-84 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: World population growth will be increasingly concentrated in the urban areas of the developing world; however, some scholars caution against the oversimplification of African urbanization noting that there may be "counter-urbanization" and a prevailing pattern of circular rural-urban migration. The aim of the paper is to examine the ongoing urban transition in South Africa in the post-apartheid period, and to consider the health and social policy implications of prevailing migration patterns. METHODS: Two data sets were analysed, namely the South African national census of 2001 and the Agincourt health and demographic surveillance system. A settlement-type transition matrix was constructed on the national data to show how patterns of settlement have changed in a five-year period. Using the sub-district data, permanent and temporary migration was characterized, providing migration rates by age and sex, and showing the distribution of origins and destinations. FINDINGS: The comparison of national and sub-district data highlight the following features: urban population growth, particularly in metropolitan areas, resulting from permanent and temporary migration; prevailing patterns of temporary, circular migration, and a changing gender balance in this form of migration; stepwise urbanization; and return migration from urban to rural areas. CONCLUSIONS: Policy concerns include: rural poverty exacerbated by labour migration; explosive conditions for the transmission of HIV; labour migrants returning to die in rural areas; and the challenges for health information created by chronically ill migrants returning to rural areas to convalesce. Lastly, suggestions are made on how to address the dearth of relevant population information for policy-making in the fields of migration, settlement change and health.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-21754 (URN)10.1080/14034950701356401 (DOI)17676507 (PubMedID)
Available from: 2009-04-22 Created: 2009-04-20 Last updated: 2017-12-13
2. The dynamics of poverty and migration in a rural South African community, 2001-2005
Open this publication in new window or tab >>The dynamics of poverty and migration in a rural South African community, 2001-2005
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(English)In: Article in journal (Other academic) Submitted
Identifiers
urn:nbn:se:umu:diva-22067 (URN)
Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2015-04-29
3. Trends in internal labour migration from rural Limpopo Province, male risk behaviour and implications for the spread of HIV/AIDS in rural South Africa
Open this publication in new window or tab >>Trends in internal labour migration from rural Limpopo Province, male risk behaviour and implications for the spread of HIV/AIDS in rural South Africa
2006 (English)In: Journal of ethnic and migration studies, ISSN 1369-183X, E-ISSN 1469-9451, Vol. 32, no 4, 633-648 p.Article in journal (Refereed) Published
Abstract [en]

Given improvements in the transport infrastructure and the end of travel restrictions characteristic of the apartheid period, there could be a reasonable expectation that male risk behaviour in sexual relations would be reduced as rural-/urban connections were enhanced. Using the example of Limpopo Province, South Africa, this research draws on an existing demographic surveillance system and a specialised survey to test the hypothesis. We find that male risk behaviour and lack of awareness of risks have not altered significantly and that there are potentially explosive possibilities for the spread of HIV/AIDS to and from Limpopo Province. There have to be enhanced measures to bring the labour market closer to rural settings to arrest this phenomenon.

Place, publisher, year, edition, pages
Routledge, 2006
Keyword
Internal migration, HIV/AIDS, Rrual-urban migration, Limpopo Province
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-22068 (URN)10.1080/13691830600610023 (DOI)
Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2017-12-13
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. Child mortality, migration and parental presence in rural South Africa near the border with Mozambique
Open this publication in new window or tab >>Child mortality, migration and parental presence in rural South Africa near the border with Mozambique
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(English)Manuscript (preprint) (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-22077 (URN)
Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2017-02-01Bibliographically approved

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