The Agincourt demographic and health study--site description, baseline findings and implications

Abstract

Objectives: To present baseline results from first-phase demographic and health surveillance in the Agincourt field site, Bushbuckridge. To contrast findings with international data, and comment on their relevance to health development.

Design: Multi-round, prospective community-based study. Baseline census, 1992.

Setting: A subdistrict in South Africa's rural north-east, adjacent to the border with Mozambique.

Subjects: Entire population of the Agincourt subdistrict.

Outcome measures: Baseline variables for each resident included age, sex, months spent at home during 1991, mother alive/dead, highest educational standard achieved, and refugee status. A full demographic profile was constructed.

Results: In 1992 the subdistrict contained 57,609 persons, 26.4% of whom were Mozambican, with a population density of 148 persons per km2. Forty-four per cent were under 15 years of age, and the dependency ratio was 93%. Fertility was declining, along with a moderate decline in adult female mortality. The approximate total fertility rate was 4.0; teenage parenting was common and almost 40% of 19-year-olds had at least one child. Over 60% of men and 14% of women in the 30-49-year age group were migrants, resulting in a high proportion of single-parent households. Despite improvements, most children experienced delays in reaching primary school, and less than half made the transition to secondary school. Educational levels among Mozambican children were lower than those of local children.

Conclusions: Agincourt contains a complex mix of communities comprising migrant workers, Mozambicans and a more stable permanent population. The area shares features with sub-Saharan Africa, although the mortality and fertility transitions have progressed further. Reliable, local information is essential for managing decentralised health systems.