ETD Collection
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Item The association between socioeconomic status and adult mortality in rural KwaZulu-Natal, South Africa(2010-04-20T09:27:50Z) Nikoi, Christian AshongIntroduction: Although socioeconomic inequality in health and mortality is currently on the top of the epidemiologic debate, studies however on the subject among adult population in Africa has been hampered due to the long absence of data in many countries. With the present reliable records of deaths from emerged demographic surveillance systems on the continent, adult mortality can now be accurately estimated. Objectives: The study‟s main objectives were 1. To calculate and show trend in adult mortality rate in ACDIS between 2001 and 2007. 2. To measure the association between mortality and individual‟s socio-economic status in the ACDIS. Methods: Individuals were selected based on age (15-64 yrs) and residency (Resident in the DSA on 1st January 2001). The total number of adults who met the criteria was 33,677; out of whom 4,058 died during the seven years follow up period. Mortality rates were computed using Kaplan-Meier survival estimates expressed per 1000 PYO. Household wealth index was constructed by use of PCA. The association between SES and adult mortality was assessed using Cox proportional Hazard model controlling for potential confounders such as age, sex and marital status. Results: The High group of the socioeconomic quintile had the highest mortality rate of 22.2 per 1000 PYO, 95% CI (20.7 - 23.7). There was no significant trend in the rates among the SES groups. After adjusting for the potential confounders; the effect of socioeconomic status in the highest SES category was 0.10 times less likelihood for death compared to the lowest SES group [HR=0.90, p=0.042, 95% CI (0.81 - 0.99)]. Conclusion: This study revealed that adult socioeconomic status is not significantly associated with adult mortality. Reducing the gap between the rich and the poor might not be the effective way in reducing adult mortality.Item Socio-economic status and elderly adult mortality in rural Ghana :|bevidence from the Navrongo DSS(2010-02-24T07:44:52Z) Khagayi, SammyIntroduction: In Africa, elderly adult mortality, just like many issues affecting the old has not been adequately addressed by research. This study explored the relationship between socioeconomic status (SES) and elderly adult mortality in an economically deprived region of rural Ghana. Methods: Data from the Navrongo DSS was used for the analysis. SES was determined from the asset data using principal component analysis. A total of 15030 adults aged over 60 years were included in the study, out of which 1315 died. We investigated the above relationship using Cox proportional hazards regression methods while controlling for other variables. Results: Socioeconomic status (SES) was found not to be a determinant of elderly mortality. Compared to the lowest SES quintile, the adjusted hazards ratios were, 0.94 (95%CI: 0.79–1.12) for second quintile, 0.91 (95%CI: 0.76–1.08) for third quintile, 0.89 (95%CI: 0.75–1.07) for fourth quintile and 1.02 (95%CI: 0.86–1.21) for the highest income quintile. However, living without a spouse [HR=1.98, 95%CI: 1.74–2.25], being male [HR=1.80, 95%CI: 1.59–2.04] and age [HR=1.05, 95%CI: 1.04– 1.05] were significant factors for elderly adult mortality. Conclusion: These results indicate that companionship, social and family ties in the health of the elderly adults are of more importance than the socioeconomic status of the household. Efforts should therefore be made to support the elderly, such as stipend for the elderly adults, especially those living alone; lowering the provision of free medical care in public hospitals to cover people over the age of 60 and not just 70 year olds and above as is currently done; encourage family care for the elderly relatives through provision of an elderly caretaker allowance among others.Item The impact of migration on adult mortality in rural South Africa: Do people migrate into rural areas to die?(2007-02-15T10:39:14Z) Welaga, PaulObjective This work investigates the hypothesis that individuals recently migrating into rural areas have a higher mortality than those always resident and that migrant deaths are more likely to be HIV/AIDS related than non migrant deaths. Methods Data from the Africa Centre Demographic Surveillance System (ACDIS), South Africa, was used for the analysis. A total of 41519 adults aged 18 to 60 years since their last visit dates were categorized into three groups; internal migrants, external in migrants and always resident individuals since 2001. Follow up period was from 1st January 2001 to 31st December 2005. Cox proportional hazard regression method was used to quantify the additional risk of dying for migrants who have recently migrated into the DSS area. Logistic regression was used to examine the relationship between migration status and dying from AIDS related complications for the members in the sample whose cause of death have been identified using verbal autopsy procedures. Results External in migrants into the DSS area were 1.52 times more likely to die than those always resident. After adjusting for the effects of sex, age group, socio-economic status and educational level an external in migrant has a relative risk of 1.19, [adjusted HR=1.19, P=0.001, 95% CI (1.08,1.32)] of dying compared to those always resident. Internal migrants were 18% less likely to die compared to always resident individuals, [adjusted HR=0.82, P=0.008, 95% CI (0.71, 0.95)] and males were 1.38 times more likely to die within the follow up period compared to females, [HR=1.38, P<0.001, 95% CI (1.28, 1.49)]. These results were statistically significant at 95% confidence level. Out of a total of 1119 deaths that occurred in 2001 and 2002 whose cause of death have been identified through verbal autopsy procedures, 763 (66%) died of AIDS. The odds of dying from AIDS are 2.09 if you are an external in migrant compared to an always resident member, [unadjusted OR = 2.09, P = 0.009 95% CI (1.38, 3.16)]. After controlling for other factors in the model, the odds of dying from AIDS as an external immigrant was 1.79 times, [adjusted OR = 1.79, P = 0.009, 95% CI (1.15, 2.77)] compared to those always resident. There was no significant difference in AIDS mortality between always resident individuals and internal migrants. The odds of a female dying of AIDS was 2.33 times, [OR = 2.33, P<0.001, 95% CI (1.78, 3.06)] compared to males after controlling for migration status, age, socioeconomic status and educational level. Conclusion External in migrants have an increased risk of death among adults aged 18 to 60 years compared to those always resident. External in migrants are also more at risk of dying from AIDS related illnesses than those always resident. Internal migrants are less likely to die than those always resident. Females are more at risk of dying from AIDS than males. In resource-poor settings, especially in many parts of Africa and other developing countries with very high prevalence of HIV/AIDS and over burdened health services in rural areas, it is important to identify and quantify some of these trends contributing to high disease burdens and mortality in rural areas in order to put in place effective interventions to better the health conditions of the people in these areas.