Ubiquitous burden: the contribution of migration to AIDS and Tuberculosis mortality in rural South Africa

Abstract

The paper aims to estimate the extent to which migrants are contributing to AIDS or tuberculosis (TB) mortality among rural sub-district populations. The Agincourt (South Africa) health and socio-demographic surveillance system provided comprehensive data on vital and migration events between 1994 and 2006. AIDS and TB cause-deleted life expectancy, and crude death rates by gender, migration status and period were computed. The annualised crude death rate almost tripled from 5·39 [95% CI 5·13-5·65] to 15·10 [95% CI 14·62-15·59] per 1000 over the years 1994-2006. The contribution of AIDS and TB in returned migrants to the increase in crude death rate was 78·7% [95% CI 77·4-80·1] for males and 44·4% [95% CI 43·2-46·1] for females. So, in a typical South African setting dependent on labour migration for rural livelihoods, the contribution of returned migrants, many infected with AIDS and TB, to the burden of disease is high.

Keywords: AIDS; HDSS; Migration; Mortality; Tuberculosis.

Figure 1. Death rates of adult males (18+) by duration of residence, Agincourt sub-district, South Africa (1994–2006)

Straight lines starting at year 0 refer to non-migrant males who never lived outside of the sub-district for more than 6 months a year for a period of 6 years or more. Broken lines denote in-migrant mortality with thicker lines showing more recent periods; and with dots showing where the death rate of migrants differed significantly (p>0.05) from non-migrant for the same period.

Figure 2. Death rates of adult females (18+) by duration of residence, Agincourt sub-district, South Africa (1994–2006)

Straight lines starting at year 0 refer to non-migrant females who never lived outside of the sub-district for more than 6 months a year for a period of 6 years or more. Broken lines denote in-migrant mortality with thicker lines showing more recent periods; and with dots showing where the death rate of migrants differed significantly (p>0.05) from non-migrant for the same period.