Browsing by Author "Alain Vandormael"

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    Health and economic benefits of secondary education in the context of poverty: Evidence from Burkina Faso
    (2022-07-06) Luisa K. Werner; Jan-Ole Ludwig; Ali Sie4; Cheik H. Bagagnan; Pascal Zabre; Alain Vandormael; Guy Harling; Jan-Walter De Neve; Gu¨nther Fink
    Even though formal education is considered a key determinant of individual well-being globally, enrollment in secondary schooling remains low in many low- and middle-income countries, suggesting that the perceived returns to such schooling may be low. We jointly estimate survival and monetary benefits of secondary schooling using detailed demographic and surveillance data from the Boucle du Mouhoun region, Burkina Faso, where national upper secondary schooling completion rates are among the lowest globally (<10%). We first explore surveillance data from the Nouna Health and Demographic Surveillance System from 1992 to 2016 to determine long-term differences in survival outcomes between secondary and higher and primary schooling using Cox proportional hazards models. To estimate average increases in asset holdings associated with secondary schooling, we use regionally representative data from the Burkina Faso Demographic Health Surveys (2003, 2010, 2014, 2017–18; N = 3,924). Survival was tracked for 14,892 individuals. Each year of schooling was associated with a mortality reduction of up to 16% (95% CI 0.75–0.94), implying an additional 1.9 years of life expectancy for men and 5.1 years for women for secondary schooling compared to individuals completing only primary school. Relative to individuals with primary education, individuals with secondary or higher education held 26% more assets (SE 0.02; CI 0.22–0.30). Economic returns for women were 3% points higher than male returns with 10% (SE 0.03; CI 0.04–0.16) vs. 7% (SE 0.02; CI 0.02–0.012) and in rural areas 20% points higher than in urban areas with 30% (SE 0.06; CI 0.19–0.41) vs. 4% (SE 0.01; CI 0.02–0.07). Our results suggest that secondary education is associated with substantial health and economic benefits in the study area and should therefore be considered by researchers, governments, and other major stakeholders to create for example school promotion programs.
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    Large age shifts in HIV-1 incidence patterns in KwaZulu-Natal, South Africa
    (2021-07-13) Adam Akullian; Alain Vandormael; Joel C Miller; Anna Bershteyn; Edward Wenger; Diego Cuadros; Dickman Gareta; Till Bärnighausen; Kobus Herbst; Frank Tanser
    Recent declines in adult HIV-1 incidence have followed the large-scale expansion of antiretroviral therapy and primary HIV prevention across high-burden communities of sub-Saharan Africa. Mathematical modeling suggests that HIV risk will decline disproportionately in younger adult age-groups as interventions scale, concentrating new HIV infections in those >age 25 over time. Yet, no empirical data exist to support these projections. We conducted a population-based cohort study over a 16-y period (2004 to 2019), spanning the early scale-up of antiretroviral therapy and voluntary medical male circumcision, to estimate changes in the age distribution of HIV incidence in a hyperepidemic region of KwaZulu-Natal, South Africa, where adult HIV incidence has recently declined. Median age of HIV seroconversion increased by 5.5 y in men and 3.0 y in women, and the age of peak HIV incidence increased by 5.0 y in men and 2.0 y in women. Incidence declined disproportionately among young men (64% in men 15 to 19, 68% in men 20 to 24, and 46% in men 25 to 29) and young women (44% in women 15 to 19, 24% in women 20 to 24) comparing periods pre- versus post-universal test and treat. Incidence was stable (<20% change) in women aged 30 to 39 and men aged 30 to 34. Age shifts in incidence occurred after 2012 and were observed earlier in men than in women. These results provide direct epidemiological evidence of the changing demographics of HIV risk in sub-Saharan Africa in the era of large-scale treatment and prevention. More attention is needed to address lagging incidence decline among older individuals.
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    Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005–2017)
    (2022) Armstrong Dzomba; Hae‑Young Kim; Andrew Tomita; Alain Vandormael; Kaymarlin Govender; Frank Tanser
    Globally, South Africa hosts the highest number of people living with HIV (PLHIV) and the unique legacy of inter‑ nal labour migration continues to be a major driver of the regional epidemic, interrupting treatment-as-prevention eforts. The study examined levels, trends, and predictors of migration in rural KwaZulu-Natal Province, South Africa, using population-based surveillance data from 2005 through 2017. We followed 69 604 adult participants aged 15–49 years and recorded their migration events (i.e., out-migration from the surveillance area) in 423 038 personyears over 525 397 observations. Multiple failure Cox-regression models were used to measure the risk of migration by socio-demographic factors: age, sex, educational status, marital status, HIV, and community antiretroviral therapy (ART) coverage. Overall, 69% of the population cohort experienced at least one migration event during the follow-up period. The average incidence rate of migration was 9.96 events and 13.23 events per 100 person-years in women and men, respectively. Migration rates declined from 2005 to 2008 then peaked in 2012 for both women and men. Adjusting for other covariates, the risk of migration was 3.4-times higher among young women aged 20–24 years compared to those aged≥40 years (adjusted Hazard Ratio [aHR]=3.37, 95% Confdence Interval [CI]: 3:19–3.57), and 2.9-times higher among young men aged 20–24 years compared to those aged≥40 years (aHR=2.86, 95% CI:2.69– 3.04). There was a 9% and 27% decrease in risk of migration among both women (aHR=0.91, 95% CI: 0.83 – 0.99) and men (aHR=0.73, 95% CI 0.66 – 0.82) respectively per every 1% increase in community ART coverage. Young unmar‑ ried women including those living with HIV, migrated at a magnitude similar to that of their male counterparts, and lowered as ART coverage increased over time, refecting the role of improved HIV services across space in reducing out-migration. A deeper understanding of the characteristics of a migrating population provides critical information towards identifying and addressing gaps in the HIV prevention and care continuum in an era of high mobility