Browsing by Author "Ginsburg, Carren"

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Association between internal migration and epidemic dynamics: an analysis of cause-specific mortality in Kenya and South Africa using health and demographic surveillance data
(BioMed Central, 2018-07) Ginsburg, Carren; Bocquier, Philippe; Kahn, Kathleen; Collinson, Mark A.; Béguy, Donatien; Afolabi, Sulaimon; Obor, David; Tanser, Frank; Tomita, Andrew; Wamukoya, Marylene
Background: Many low- and middle-income countries are facing a double burden of disease with persisting high levels of infectious disease, and an increasing prevalence of non-communicable disease (NCD). Within these settings, complex processes and transitions concerning health and population are underway, altering population dynamics and patterns of disease. Understanding the mechanisms through which changing socioeconomic and environmental contexts may influence health is central to developing appropriate public health policy. Migration, which involves a change in environment and health exposure, is one such mechanism. Methods: This study uses Competing Risk Models to examine the relationship between internal migration and premature mortality from AIDS/TB and NCDs. The analysis employs 9 to 14 years of longitudinal data from four Health and Demographic Surveillance Systems (HDSS) of the INDEPTH Network located in Kenya and South Africa (populations ranging from 71 to 223 thousand). The study tests whether the mortality of migrants converges to that of non-migrants over the period of observation, controlling for age, sex and education level. Results: In all four HDSS, AIDS/TB has a strong influence on overall deaths. However, in all sites the probability of premature death (45q15) due to AIDS/TB is declining in recent periods, having exceeded 0.39 in the South African sites and 0.18 in the Kenyan sites in earlier years. In general, the migration effect presents similar patterns in relation to both AIDS/TB and NCD mortality, and shows a migrant mortality disadvantage with no convergence between migrants and non-migrants over the period of observation. Return migrants to the Agincourt HDSS (South Africa) are on average four times more likely to die of AIDS/TB or NCDs than are non-migrants. In the Africa Health Research Institute (South Africa) female return migrants have approximately twice the risk of dying from AIDS/TB from the year 2004 onwards, while there is a divergence to higher AIDS/TB mortality risk amongst female migrants to the Nairobi HDSS from 2010. Conclusion: Results suggest that structural socioeconomic issues, rather than epidemic dynamics are likely to be associated with differences in mortality risk by migrant status. Interventions aimed at improving recent migrant’s access to treatment may mitigate risk.
Exploring the relationship between orphanhood status, living arrangements and sexual and reproductive health outcomes among female adolescents in Southern Africa
(University of the Witwatersrand, Johannesburg, 2024) Shoko, Mercy; Kahn, Kathleen; Ginsburg, Carren
Adolescent Sexual and Reproductive Health (ASRH) is high on the global development agenda. Among the respective research conducted is the various social contexts that may contribute to adverse SRH outcomes, including the overlapping issues of orphanhood and living arrangements. These are crucial given that the presence or absence of parents emerges as critical for the sexual and reproductive well-being of adolescents. While orphanhood, particularly in the context of the HIV epidemic in Southern Africa, receives considerable attention, this study highlights a noteworthy gap in the literature – the limited focus on living arrangements and its influence on ASRH, often overshadowed by orphanhood. This research is important given the evidence suggesting that the African traditional kinship care systems offer support for orphans. However, recent research also highlights the crucial role of biological parents in providing effective care and support for adolescents. The study aims to contribute by exploring the relationship between orphanhood status, living arrangements, and ASRH in Southern Africa. Utilising cross-sectional Demographic and Health Survey (DHS) data, the analysis delves into key dimensions of SRH, including sexual debut, HIV knowledge, and adolescent fertility, which are all critical links to HIV risk. The findings underscore a significant association between non-coresidency with parents, whether due to orphanhood or separate living arrangements, and a heightened risk of adverse SRH outcomes. This suggests that interventions aimed at addressing adolescent SRH in Southern Africa should encompass a holistic understanding of parental presence or absence. The study emphasises the complex interplay between orphanhood, parental absence, and various individual, household, and geographic factors that collectively contribute to the vulnerability of female adolescents in the context of ASRH. Despite that the results suggest that the data on orphanhood and living arrangements may be of acceptable quality, the study recognises the potential for detailed insights through future research employing longitudinal data. Such an approach could offer a more nuanced and comprehensive understanding of ASRH over time, subsequently informing targeted policies and interventions in the unique socio-cultural context of Southern Africa
Residential mobility in greater Johannesburg: patterns, associations and educational outcomes amongst children in the birth to twenty cohort
(2011-11-23) Ginsburg, Carren
The United Nations has projected that Africa’s urban population will expand from fourth largest to becoming the second largest of the world’s regions by the year 2050. Patterns of migration and urbanisation have therefore been highlighted as significant focus areas for research and policy. Movement has the potential to result in improved living conditions and well-being, but may also reinforce inequalities and conditions of vulnerability. These consequences may pose particular risks in the case of children, and understanding the patterns, drivers and outcomes associated with child mobility is therefore critical. South Africa provides an important setting in which to explore child movements. The shift within the country from politically controlled migration to movement based on choice has resulted in high levels of mobility both to and within urban areas. Children have been shown to participate in such movements either independently or in conjunction with connected adults. However, there is currently little knowledge of the patterns and consequences of child residential mobility in South Africa, particularly within the urban environment. This PhD thesis attempts to address this research gap. Data from Birth to Twenty, a cohort of South African urban children living in Greater Johannesburg, was used to investigate three central research questions concerning residential mobility of cohort children over a 14 year period. Specifically, the thesis aimed to determine the frequencies and patterns of residential mobility observed over the first 14 years of the children’s lives, to examine the associations with mobility of children over a set of domains relating to the child, the child’s primary caregiver, and the child’s household and to assess the relationships between residential and school mobility and a set of educational outcomes. Routine data collected over the course of the Birth to Twenty study was supplemented with data from a Residential Move Questionnaire, administered to children’s primary caregivers in order to validate and provide additional information concerning the children’s residential movements over the time frame. The research objectives were achieved through the use of cross-sectional and longitudinal analysis techniques applied to these data. In particular, multilevel event-history analysis was used to model the children’s residential movements over time. Of the 3273 children enrolled into the cohort in 1990, two thirds of the children (64%) had moved home at least once by the time they reached 15 years of age. Nonetheless, a third of the children had never moved, indicating stability or a lack of opportunity for movement amongst this urban child population. Mobility was found to be more likely amongst children whose primary caregivers had no formal education and who lived in households with fewer assets and less access to services, suggesting that residential movement within this group of children was more common in the context of disadvantage. Extending these findings to an exploration of children’s educational outcomes revealed some unexpected results. The analyses provided evidence of a positive association between changes in residence and numeracy and literacy scores, and school mobility was found to be associated with grade repetition, however, a negligible relationship was found between residential mobility and school progression. In conclusion, mobility is associated with opportunities for some children in the cohort and challenges or hardships for others. However, even in the instance of movement connected to disadvantage, changes of residence did not prejudice children in terms of the educational outcomes investigated. This is suggestive of children’s possible resilience and adaptability in the face of change and highlights the potential for mobility to influence children’s lives positively. The findings concerning the relationship between mobility and child well-being run counter to trends observed in high-income countries and on that basis, the need for further research into dynamics associated with child mobility in other low- and middle-income country settings is highlighted. There is justification for monitoring child mobility in South Africa; mobility trends provide a valuable indicator of children’s living situations as well as the spatial and social changes occurring in the country more broadly. Keywords: residential mobility; internal migration; urban children; South Africa; eventhistory models; school progression; numeracy and literacy; school mobility