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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.
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    Immigration Internal Migration and Crime in South Africa A multilevel model analysis
    (Wiley Online Library, 2019-09) Kollamparambil, U
    A review of South African literature on crime confirms the lack of a study that considers the impact of migration on the crime rate in the country. The high levels of crime in South Africa aside, additional motivation behind the study has been the increasing rhetoric in media and by politicians insinuating the prominent role of foreign immigrants in the high crime levels of the country. While this is the first attempt to study this relationship in the South African context, it also stands apart from existing studies undertaken in the developed countries by accounting for both internal migrants as well as foreign immigrants. Further, the study claims the use of multi-level regression estimations as an improvement from the existing studies on the issue by accounting for variance clustering across different spatial levels. In all the estimated models, internal migrant ratio came out as being positively and significantly related to crime rates across five different crime categories, with the sole exception of sexual crime rate. There was no evidence of foreign immigrant ratio impacting on crime rate in any of the crimes analysed except crime relating to property. Further, income inequality and sex ratio figure as determining factors across most types of crime in South Africa. © The Authors 2018. Development Policy Review © 2018 Overseas Development Institute