Migration and the epidemiological transition: insights from the Agincourt sub-district of northeast South Africa.
BACKGROUND
Migration and urbanization are central to sustainable development and health, but data on temporal trends in defined populations are scarce. Healthy men and women migrate because opportunities for employment and betterment are not equally distributed geographically. The disruption can result in unhealthy exposures and environments and income returns for the origin household.


OBJECTIVE
The objectives of the paper are to describe the patterns, levels, and trends of temporary migration in rural northeast South Africa; the mortality trends by cause category over the period 2000-2011; and the associations between temporary migration and mortality by broad cause of death categories.


METHODS
Longitudinal, Agincourt Health and Demographic Surveillance System data are used in a continuous, survival time, competing-risk model.


RESULTS
In rural, northeast South Africa, temporary migration, which involves migrants relocating mainly for work purposes and remaining linked to the rural household, is more important than age and sex in explaining variations in mortality, whatever the cause. In this setting, the changing relationship between temporary migration and communicable disease mortality is primarily affected by reduced exposure of the migrant to unhealthy conditions. The study suggests that the changing relationship between temporary migration and non-communicable disease mortality is mainly affected by increased livelihood benefits of longer duration migration.


CONCLUSIONS
Since temporary migration is not associated with communicable diseases only, public health policies should account for population mobility whatever the targeted health risk. There is a need to strengthen the rural health care system, because migrants tend to return to the rural households when they need health care.
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana; mark.collinson@wits.ac.za.
Mark A
MA
Collinson
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Sociology, Population Studies and Training Center, Brown University, Providence, RI, USA.
Michael J
MJ
White
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre de recherche en démographie et sociétés, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.
Philippe
P
Bocquier
Brown University School of Public Health, International Health Institute, Brown University, Providence, RI, USA.
Stephen T
ST
McGarvey
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Sulaimon A
SA
Afolabi
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Department of Sociology, University of Washington, Seattle, USA; Institute of Behavioral Science (IBS), University of Colorado at Boulder, Boulder, CO, USA.
Samuel J
SJ
Clark
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana.
Kathleen
K
Kahn
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana.
Stephen M
SM
Tollman
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003710:Demography; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D019456:Health Transition; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009026:Mortality; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D013019:South Africa / Q000453:epidemiology; D014507:Urbanization; D055815:Young Adult
Agincourt; South Africa; epidemiological transition; health and demographic surveillance; migration; mortality; temporary migration