title: Healthy or unhealthy migrants? Identifying internal migration effects on mortality in Africa using health and demographic surveillance systems of the INDEPTH network.
abstract: Migration has been hypothesised to be selective on health but this healthy migrant hypothesis has generally been tested at destinations, and for only one type of flow, from deprived to better-off areas. The circulatory nature of migration is rarely accounted for. This study examines the relationship between different types of internal migration and adult mortality in Health and Demographic Surveillance System (HDSS) populations in West, East, and Southern Africa, and asks how the processes of selection, adaptation and propagation explain the migration-mortality relationship experienced in these contexts. The paper uses longitudinal data representing approximately 900 000 adults living in nine sub-Saharan African HDSS sites of the INDEPTH Network. Event History Analysis techniques are employed to examine the relationship between all-cause mortality and migration status, over periods ranging from 3 to 14 years for a total of nearly 4.5 million person-years. The study confirms the importance of migration in explaining variation in mortality, and the diversity of the migration-mortality relationship over a range of rural and urban local areas in the three African regions. The results confirm that the pattern of migration-mortality relationship is not exclusively explained by selection but also by propagation and adaptation. Consequences for public health policy are drawn.
authors.affiliation: Medical Research Council/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.
authors.forename: Carren
authors.initials: C
authors.lastname: Ginsburg
authors.affiliation: Centre de Recherches en Démographie, Université Catholique de Louvain, Louvain-la-Neuve, Belgium; Medical Research Council/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. Electronic address: philippe.bocquier@uclouvain.be.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bocquier
authors.affiliation: African Population and Health Research Centre, Nairobi, Kenya.
authors.forename: Donatien
authors.initials: D
authors.lastname: Béguy
authors.affiliation: Medical Research Council/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.
authors.forename: Sulaimon
authors.initials: S
authors.lastname: Afolabi
authors.affiliation: Manhiςa HDSS, Manhiςa, Mozambique.
authors.forename: Orvalho
authors.initials: O
authors.lastname: Augusto
authors.affiliation: Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
authors.forename: Karim
authors.initials: K
authors.lastname: Derra
authors.affiliation: The Africa Centre for Population Health, UKZN, South Africa.
authors.forename: Kobus
authors.initials: K
authors.lastname: Herbst
authors.affiliation: Institut Supérieur des Sciences de la Population (ISSP), Université de Ouagadougou, Burkina Faso.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lankoande
authors.affiliation: KEMRI & CDC - Centre for Global Health Research, Kisumu, Kenya; INDEPTH Network, Accra, Ghana.
authors.forename: Frank
authors.initials: F
authors.lastname: Odhiambo
authors.affiliation: Kenya Medical Research Institute, Wellcome Trust Research Programme, Kilifi, Kenya.
authors.forename: Mark
authors.initials: M
authors.lastname: Otiende
authors.affiliation: Institut Supérieur des Sciences de la Population (ISSP), Université de Ouagadougou, Burkina Faso.
authors.forename: Abdramane
authors.initials: A
authors.lastname: Soura
authors.affiliation: African Population and Health Research Centre, Nairobi, Kenya.
authors.forename: Marylene
authors.initials: M
authors.lastname: Wamukoya
authors.affiliation: Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
authors.forename: Pascal
authors.initials: P
authors.lastname: Zabré
authors.affiliation: Medical Research Council/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; Population Studies and Training Centre, Brown University, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: White
authors.affiliation: Medical Research Council/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; Umeå Centre for Global Health Research, Umeå University, Sweden.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Collinson
mesh_terms: D000328:Adult; D000349:Africa; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality; D011159:Population Surveillance / Q000379:methods*
keywords: Health and demographic surveillance system; INDEPTH network; Internal migration; Mortality; Sub-Saharan Africa