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Soc Sci Med. 2016 Sep;164:59-73. doi: 10.1016/j.socscimed.2016.06.035. Epub 2016 Jun 23.

Healthy or unhealthy migrants? Identifying internal migration effects on mortality in Africa using health and demographic surveillance systems of the INDEPTH network.

Author information

1
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.
2
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.
3
African Population and Health Research Centre, Nairobi, Kenya.
4
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.
5
Manhiςa HDSS, Manhiςa, Mozambique.
6
Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
7
The Africa Centre for Population Health, UKZN, South Africa.
8
Institut Supérieur des Sciences de la Population (ISSP), Université de Ouagadougou, Burkina Faso.
9
KEMRI & CDC - Centre for Global Health Research, Kisumu, Kenya; INDEPTH Network, Accra, Ghana.
10
Kenya Medical Research Institute, Wellcome Trust Research Programme, Kilifi, Kenya.
11
Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
12
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.
13
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.

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.

KEYWORDS:

Health and demographic surveillance system; INDEPTH network; Internal migration; Mortality; Sub-Saharan Africa

PMID:
27471131
PMCID:
PMC6469963
DOI:
10.1016/j.socscimed.2016.06.035
[Indexed for MEDLINE]
Free PMC Article

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