ETD Collection

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    Association between HIV/AIDS related adult deaths and migration of household members in rural Rufiji District, Tanzania
    (2011-03-09) Murunga, Frederick Wekesah
    Introduction: The spread and prevalence of the HIV epidemic has resulted in extensive demographic, social and economic impacts among families in the communities affected in Sub Saharan Africa which increase with the severity and duration of the epidemic. The dramatic increase in adult mortality attributable to HIV/AIDS in households in these communities may increase the number of households that do not survive as a functional and cohesive social group in the years to come. The migration of household members and possible dissolution of these households are the challenges stemming from the epidemic. We therefore require rigorous empirical research on the socioeconomic effects of HIV/AIDS in order to develop appropriate strategies to mitigate these impacts and ultimately improve living standards in these communities. This report describes the extent at which these impacts are felt by a rural community using data from the Rufiji HDSS in rural Tanzania. Design: The study will use a longitudinal study design to identify antecedent events and dynamics and trans-temporal aspects in establishing the effects HIV/AIDS, and particularly how adult deaths from the disease determine migration of individual household members, controlling for other individual level and household factors. Objectives: The main objectives of the study include the description of the adult mortality patterns in the area with an emphasis on the HIV/AIDS related adult deaths, the description of the socioeconomic and demographic characteristics of households experiencing these adult deaths; the characterisation of the members migrating from the households as a result of these adult deaths or otherwise. We also estimate the proportion of household members migrating following the deaths of adult members and further compare these rates of migrations from households experiencing adult HIV/AIDS, Non-HIV/AIDS deaths and where there is no experience of death. Methods: Migrating individuals from 4,019 households that experienced at least one adult death were compared with migrating individuals from other households experiencing Non-HIV/AIDS deaths and those from households without deaths. A total of 32, 787 households were included in the study. An adult death was defined as a death of a household member aged 18 years and above. Those aged 60+ years were considered elderly deaths. A total of 4,603 adult deaths were recorded over the period 1st January 2000 to 31st December 2007. The mortality trends were shown by the rates calculated by Kaplan-Meier survival estimates expressed per 1000 PYO. Migration rates were computed while the association between adult mortality and out-migration of household members was assessed using Cox proportional Hazard model controlling for other individual level and household level factors. Results: Adult deaths increase by about 9% the chance of a child, male or female, to migrate within or without the DSA while HIV/AIDS adult deaths increase by a further 19 percentage point the risk of 5 the child to migrate out of the DSA. The results also show that HIV/AIDS adult deaths enhance the risk of adult female internal migration by 6% (adj. HR 1.06; 95% CI 0.91-1.23, p-value 0.01) but is not significantly associated with adult male migration. Non-HIV/AIDS adult deaths also enhance the risk for female internal migration by 5% albeit hardly significantly (adj. HR 1.05; 95% CI 1.0-1.10, pvalue 0.05) but decreases the chance of male internal migration by 13% (adj. HR 0.87; 95% CI 0.81- 0.93, p-value 0.01). Additionally, HIV/AIDS adult death is strongly associated with out-migration of adults, whatever the gender. They predispose female out-migration to 19% (adj. HR 1.19; 95% CI 1.09-1.30, p-value <0.001) and male migration to 30% increased risk (adj. HR 1.30; 95% CI 1.16-1.45, p-value <0.001). This gender difference is however non-significant (the confidence intervals overlap). Non-HIV/AIDS adult death has the inverse effect on out-migration, and the gender difference is significant: 18% increased risk for males (adj. HR 1.18 95% CI 1.14-1.22, p-value <0.001) and 29% for females (adj. HR 1.29; 95% CI 1.26-1.33, p-value <0.001). Conclusion: Adult deaths have a positive impact on out-migration, with some variation by gender. The effect of HIV/AIDS death on out-migration is not very different from other deaths‟ effect.
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    Prevalence and patterns of tobacco use among woman in Benin city, Nigeria
    (2006-11-20T10:04:18Z) Okwuolise, Ogheneruemu Vincent
    Background: Tobacco use is one of the single biggest causes of preventable deaths and is increasingly affecting developing countries and men and women alike. Tobacco use is historically more common in men but is becoming more common among women. In the absence of population-based health information in many dev eloping countries and sub- Saharan Africa in particular, public health planning and priority setting is in disarray. Most of the prevalence studies on tobacco have concentrated on smoked tobacco and men in particular. This cross-sectional study design looked at the prevalence, patterns and determinants of tobacco use among women in Benin City, an urban area in Nigeria. Methods: 491 face-to-face interviews were conducted in 45 enumeration areas randomly sampled in Oredo LGA in Benin City, Nigeria. Twelve households were randomly sampled in each EA and eligible woman over the age of 18 years was identified in each household. Results: The prevalence of tobacco use was 8.8% comprising of smoking (3.3%) and smokeless (5.5%) initiation occur during the teenage years mostly. Smoking cigarettes was more common among the younger, more educated women and Tabba (a mixture of powdered dry tobacco leaf and sodium bicarbonate) used mostly by older less educated women (RR = 3.10, CI = 1.01 - 9.48). The participants perceived friends using tobacco as a reason for their starting to use tobacco. Determinants of tobacco use were education, exposure to tobacco advertising and / or promotions which occurs almost unrestricted despite some tobacco control legislations. Dr. OV Okwuolise; 0209663K/2005 Page 2 of 2 Conclusions: The findings suggest that tobacco use is going on unhindered and unless something is done to curtail the activities of the tobacco industry, a major public health catastrophe is looming.