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- Byass, Peter, et al.
(författare)
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Malaria mortality in a hypoendemic area of North-Eastern South Africa : population-based surveillance from 1992 to 2013 reveals an increasing malaria burden
- 2015
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Ingår i: Tropical medicine & international health. - : Wiley-Blackwell. - 1360-2276 .- 1365-3156. ; 20:Suppl. 1, s. 128-128
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Most of South Africa is malaria-free, but hypoendemic levels of transmission persist in lowveld areas in the north-east of the country, adjacent to Mozambique. Many families have links to relatives in Mozambique, where malaria transmission remains much higher, and cross-border travel is commonplace, although the Kruger National Park provides something of a depopulated buffer zone along the border. Malaria diagnosis and treatment is relatively easily available at public and private facilities in the endemic area.Methods: The Agincourt Health and Socio-Demographic Surveillance Site has monitored population health in a defined area within Mpumulanga Province, around 24.7°S, 31.2°E, since 1992. A circumscribed semi-rural area with a population ranging from approximately 60 000 in 1992 to 90 000 in 2013 was covered. All households were visited regularly to consistently record demographic and health data, including the documentation of deaths and their causes using verbal autopsy.Results: From 1992 to 2013 a total of 13 251 deaths were documented over 1.58 million person-years observed. Of that total mortality burden, 1.2% of deaths were ascribed to malaria. Half of the malaria deaths were among children aged under 15 years, with most of the remainder among working-age adults. Malaria deaths were strongly correlated with temperature and rainfall. The malaria mortality rate was over 50% higher during the last 5 years of the surveillance period, compared with earlier years. A huge HIV/AIDS epidemic that developed and receded in this population during the period of observation had no apparent effect on malaria mortality.Conclusions: This detailed longitudinal examination of malaria mortality showed that although malaria is a relatively minor cause of death in this population, it has become more common in recent years, and shows no sign of retreating despite rapid socioeconomic development. In addition to local relevance, these findings are important for understanding potential population burdens of hypoendemic malaria in other areas of sub-Saharan Africa as progress towards malaria control and elimination targets is realised.
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- Byass, Peter
(författare)
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Towards a global agenda on ageing
- 2008
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Ingår i: Global Health Action. - : CoAction Publishing. - 1654-9716 .- 1654-9880. ; 1
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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- Collinson, Mark A, 1964-
(författare)
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Striving against adversity. : the dynamics of migration, health and poverty in rural South Africa
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- 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.
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- Emmelin, Anders, 1950-
(författare)
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Counted - and then? : trends in child mortality within an Ethiopian demographic surveillance site
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Knowledge of the state of health of a population is necessary for planning for health services for that population. It is a paradox that the health of populations is most commonly measured by mortality and cause of death patterns, but the absence of medical services available to a majority of the world population has made it unavoidable to equate “state of health” with “cause of death pattern”. In the absence of population registration, mortality and causes of death must be studied in samples from the population. The research presented in this thesis mainly has been done within such a sample in a collaborative project between Umeå university and the Addis Ababa university in Ethiopia. This research started 1986 and has run continuously since then. The thesis attempts to measure the effect that social and geographical inequalities has had on the mortality of the children in the study population. Population and Methods The population that is included in the demographic surveillance is the children under five years of age in nine rural and one urban community in central Ethiopia. Mortality and causes of death among the children have been followed since 1987. Results The mortality of the children in the study is high by international comparisons. The most important reason for mortality differences within the population is the difference in living conditions and societal services between the rural and urban areas. Approximately 45% of the child deaths could have been prevented if living conditions and services had been equal to rural and urban children. Conclusions Information concerning mortality and cause of death patterns are essential to planning. In order to empower the population, knowledge of the mortality and most common causes of death must be known to them.
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