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Kaombe TM. A bivariate Poisson regression to analyse impact of outlier women on correlation between female schooling and fertility in Malawi. BMC Womens Health 2024; 24:55. [PMID: 38245736 PMCID: PMC10799448 DOI: 10.1186/s12905-024-02891-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Women's levels of education and fertility are commonly associated. In Sub-Saharan Africa, the pace of decreasing fertility rates varies greatly, and this is linked to women's levels of education. However, this association may be influenced by unusual females who have uncommon measurements on both variables. Despite this, most studies that researched this association have only analysed the data descriptively, without taking into account the effect of potential outliers. This study aimed to examine the presence and impact of outlier women on the relationship between female education and fertility in Malawi, using regression methods. METHODS To analyse the correlation between women's schooling and fertility and evaluate the effect of outliers on this relationship, a bivariate Poisson model was applied to three recent demographic and health surveys in Malawi. The R software version 4.3.0 was used for model fitting, outlier computations, and correlation analysis. The STATA version 12.0 was used for data cleaning. RESULTS The findings revealed a correlation of -0.68 to -0.61 between schooling and fertility over 15 years in Malawi. A few outlier women were identified, most of whom had either attended 0 or at least 9 years of schooling and had born either 0 or at least 5 children. The majority of the outliers were non-users of modern contraceptive methods and worked as domestic workers or were unemployed. Removing the outliers from the analysis led to marked changes in the fixed effects sizes and slight shifts in correlation, but not in the direction and significance of the estimates. The woman's marital status, occupation, household wealth, age at first sex, and usage of modern contraceptives exhibited significant effects on education and fertility outcomes. CONCLUSION There is a high negative correlation between female schooling and fertility in Malawi. Some outlier women were identified, they had either attended zero or at least nine years of schooling and had either born zero or at least five children. Most of them were non-users of modern contraceptives and domestic workers. Their impact on regression estimates was substantial, but minimal on correlation. Their identification highlights the need for policymakers to reconsider implementation strategies for modern contraceptive methods to make them more effective.
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Affiliation(s)
- Tsirizani Mwalimu Kaombe
- Department of Mathematical Sciences, School of Natural and Applied Sciences, University of Malawi, Zomba, Malawi.
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2
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Saarela J, Wilson B. Forced Migration and the Childbearing of Women and Men: A Disruption of the Tempo and Quantum of Fertility? Demography 2022; 59:707-729. [PMID: 35322268 DOI: 10.1215/00703370-9828869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It is well known that migrant fertility is associated with age at migration, but little is known about this relationship for forced migrants. We study an example of displacement in which the entire population of Finnish Karelia was forced to move elsewhere in Finland in the 1940s. This displacement was unique because of its size and scale, because we have data on almost the whole population of both men and women who moved, and because of the similarity between origin and destination. These aspects enable us to investigate the disruptive impact of forced migration, net of other factors such as adaptation and selection. For all ages at migration from one to 20, female forced migrants had lower levels of completed fertility than similar women born in present-day Finland, which suggests a permanent impact of migration. However, women born in the same year as the initial forced migration showed no difference, which may indicate the presence of a counterbalancing fertility-increasing effect, as observed elsewhere for people born during a humanitarian crisis. There is less evidence of an impact for men, which suggests a gendered impact of forced migration-and its timing-on fertility. Results are similar after controlling for social and spatial mobility, indicating that there may be no major trade-off between reproduction and these forms of mobility.
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Affiliation(s)
- Jan Saarela
- Demography Unit, Åbo Akademi University, Vaasa, Finland
| | - Ben Wilson
- Department of Sociology, University of Stockholm, Stockholm, Sweden.,Department of Methodology, London School of Economics, London, UK
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Sennott C, Kane D. Rights vs. Lived Realities: Women's Views of Gender Equality in Relationships in Rural South Africa. SOCIAL PROBLEMS 2022; 2022:spac015. [PMID: 37426294 PMCID: PMC7614733 DOI: 10.1093/socpro/spac015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
South Africa's Constitution is among the world's most ambitious in promoting gender equality, but the country continues to be marked by inequality and gender-based violence. Given this context, we analyze 43 interviews with Black women aged 18-55 in rural South Africa to explore how the constitutional ideal of gender equality-or "50/50"-has been interpreted and applied in women's intimate relationships. Overall, we found that inequality and gender hierarchy were common in relationships. Women relied on two logics to explain the persistence of inequality in their relationships. First, women offered ideological support for gender norms supporting hierarchy by linking 50/50 to the abandonment of culture, tradition, and respect. Second, women viewed reaffirmation of gender inequality within relationships as a pragmatic way to avoid men's violence and infidelity, thus protecting women from abandonment and HIV. Women's views about equality in relationships were shaped by dominant gender norms, precarity in the local political economy, and the risks of violence and HIV/AIDS. Our findings expand theories of social change by highlighting how not only longstanding social norms, but also local political-economic and health conditions can influence views of equality and ultimately the local adoption or dismissal of international standards of rights and equality.
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Affiliation(s)
- Christie Sennott
- Corresponding Author: Department of Sociology,
Purdue University, 700 W. State St., West Lafayette, IN 47906, USA.
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Sack DE, Wagner RG, Ohene-Kwofie D, Kabudula CW, Price J, Ginsburg C, Audet CM. Pregnancy-related healthcare utilisation in Agincourt, South Africa, 1993-2018: a longitudinal surveillance study of rural mothers. BMJ Glob Health 2021; 6:e006915. [PMID: 34620615 PMCID: PMC8499259 DOI: 10.1136/bmjgh-2021-006915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/17/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Pregnancy-related health services, an important mediator of global health priorities, require robust health infrastructure. We described pregnancy-related healthcare utilisation among rural South African women from 1993 to 2018, a period of social, political and economic transition. METHODS We included participants enrolled in the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga Province, South Africa, a population-based longitudinal cohort, who reported pregnancy between 1993 and 2018. We assessed age, antenatal visits, years of education, pregnancy intention, nationality, residency status, previous pregnancies, prepregnancy and postpregnancy contraceptive use, and student status over the study period and modelled predictors of antenatal care utilisation (ordinal), skilled birth attendant presence (logistic) and delivery at a health facility (logistic). RESULTS Between 1993 and 2018, 51 355 pregnancies occurred. Median antenatal visits, skilled birth attendant presence and healthcare facility deliveries increased over time. Delivery in 2018 vs 2004 was associated with an increased likelihood of ≥1 additional antenatal visits (adjusted OR (aOR) 10.81, 95% CI 9.99 to 11.71), skilled birth attendant presence (aOR 4.58, 95% CI 3.70 to 5.67) and delivery at a health facility (aOR 3.78, 95% CI 3.15 to 4.54). Women of Mozambican origin were less likely to deliver with a skilled birth attendant (aOR 0.42, 95% CI 0.39 to 0.45) or at a health facility (aOR 0.43, 95% CI 0.41 to 0.46) versus South Africans. Temporary migrants reported fewer antenatal visits (aOR 0.35, 95% CI 0.33 to 0.38) but were more likely to deliver with a skilled birth attendant (aOR 1.91, 95% CI 1.66 to 2.2) or at a health facility (aOR 1.4, 95% CI 1.24 to 1.58) versus permanent residents. CONCLUSION Pregnancy-related healthcare utilisation and skilled birth attendant presence at delivery have increased steadily since 1993 in rural northeastern South Africa, aligning with health policy changes enacted during this time. However, mothers of Mozambican descent are still less likely to use free care, which requires further study and policy interventions.
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Affiliation(s)
- Daniel E Sack
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan G Wagner
- 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
| | - Daniel Ohene-Kwofie
- 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
| | - Chodziwadziwa W Kabudula
- 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
| | - Jessica Price
- 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
| | - Carren Ginsburg
- 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
| | - Carolyn M Audet
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- 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
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Aguilera G, Korinek K. Immigrant Fertility in Comparative Perspective: South Africa and the United States. Demography 2020; 57:297-322. [DOI: 10.1007/s13524-019-00852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Because immigrant fertility is situated within two societies, the resultant childbearing patterns reflect a culmination of selectivity into migration alongside blended experiences of origin-destination contexts around fertility norms. We analyze the ways that national origin shapes patterns of childbearing within fertility covariates. We use data from Statistics South Africa and the United States Census Bureau harmonized in the Integrated Public Use Microdata Series, International for a disaggregated analysis of the odds of a birth in the past year among the three most prominent immigrant groups compared with native-born women in each receiving country. Interacted logistic regression analyses and margins results demonstrate significant nativity-based differences in the odds of childbearing across age, previous childbearing, and marital status, but not across educational attainment. We attribute variation in the covariates of fertility across nativities to demographic composition and the contexts of migration unique to each group.
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Affiliation(s)
- Guadalupe Aguilera
- Department of Sociology, University of Utah, 380 S 1530 E RM 301, Salt Lake City, UT 84112, USA
| | - Kim Korinek
- Department of Sociology, University of Utah, 380 S 1530 E RM 301, Salt Lake City, UT 84112, USA
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Margherio C. Centering female agency while investigating contraceptive use: a case study in Agincourt, South Africa. Int J Equity Health 2019; 18:60. [PMID: 31046765 PMCID: PMC6498472 DOI: 10.1186/s12939-019-0965-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rural areas of South Africa face persistently high teenage and premarital childbearing rates, reflecting a lack of or inconsistent use of modern contraception. In attempting to understand this behavior, much of the literature has denied agency to young women, portraying them solely as victims of their environments. This study moved beyond these approaches to understanding adolescent contraceptive use, to reframe the investigation to focus on the tension around exercising agency within specific structural constraints. METHODS Findings are based on a qualitative study in Agincourt, South Africa. Data were collected through six focus group discussions with 63 women aged 18-44. A grounded theory approach utilizing emergent coding was performed focusing on the decision-making processes around family planning. The focus group participants discussed attitudes and norms around: early first births, contraceptive use, unplanned pregnancy, abortion, and HIV testing. When possible, differences that emerged around these topics according to the age groups (18-24, 25-34, and 35-44) and/or nationality of village (South African or Mozambican) are highlighted. RESULTS Participants of all focus groups agreed that early first birth were common and undesirable. Younger participants described pregnancy prevention as a key rationale for contraceptive usage, while older participants were more inclined to cite HIV prevention. Women of all focus groups discussed the importance of women taking the initiative with family planning. Participants expressed a range of opinions about the acceptability of abortion, and all focus groups discussed concerns about the safety of abortion. Finally, all of the focus group participants stressed the importance of HIV testing, both to protect themselves and to protect their families. CONCLUSION This study found many locations of agency for young women in rural South Africa. The decision-making surrounding contraceptive use consists of a series of decision junctures at which women must assign values to certain factors and then select their behavior on the basis of those values. Young women weigh the costs and benefits of contraception and of pregnancy, while also taking into account the chances of actually becoming pregnant along with the costs and benefits of abortion. Furthermore, the women explicitly viewed contraception as within their own realm of decision-making and action (as opposed to within the realm of their male partners).
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Affiliation(s)
- Cara Margherio
- Center for Evaluation & Research for STEM Equity (CERSE), University of Washington, Box 353340, Seattle, WA, 98195, USA.
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7
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Eyre RW, House T, Gómez-Olivé FX, Griffiths FE. Modelling fertility in rural South Africa with combined nonlinear parametric and semi-parametric methods. Emerg Themes Epidemiol 2018; 15:5. [PMID: 29507596 PMCID: PMC5833110 DOI: 10.1186/s12982-018-0073-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Central to the study of populations, and therefore to the analysis of the development of countries undergoing major transitions, is the calculation of fertility patterns and their dependence on different variables such as age, education, and socio-economic status. Most epidemiological research on these matters rely on the often unjustified assumption of (generalised) linearity, or alternatively makes a parametric assumption (e.g. for age-patterns). Methods We consider nonlinearity of fertility in the covariates by combining an established nonlinear parametric model for fertility over age with nonlinear modelling of fertility over other covariates. For the latter, we use the semi-parametric method of Gaussian process regression which is a popular methodology in many fields including machine learning, computer science, and systems biology. We applied the method to data from the Agincourt Health and Socio-Demographic Surveillance System, annual census rounds performed on a poor rural region of South Africa since 1992, to analyse fertility patterns over age and socio-economic status. Results We capture a previously established age-pattern of fertility, whilst being able to more robustly model the relationship between fertility and socio-economic status without unjustified a priori assumptions of linearity. Peak fertility over age is shown to be increasing over time, as well as for adolescents but not for those later in life for whom fertility is generally decreasing over time. Conclusions Combining Gaussian process regression with nonlinear parametric modelling of fertility over age allowed for the incorporation of further covariates into the analysis without needing to assume a linear relationship. This enabled us to provide further insights into the fertility patterns of the Agincourt study area, in particular the interaction between age and socio-economic status.
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Affiliation(s)
- Robert W Eyre
- 1Centre for Complexity Science, University of Warwick, Coventry, CV4 7AL UK
| | - Thomas House
- 2School of Mathematics, University of Manchester, Manchester, M13 9PL UK
| | - F Xavier Gómez-Olivé
- 3Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances E Griffiths
- 4Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK.,5Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
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Houle B, Angotti N, Gómez-Olivé FX, Clark SJ. Fieldworker effects on substance use reporting in a rural South African setting. INTERNATIONAL JOURNAL OF ALCOHOL AND DRUG RESEARCH 2018; 7:29-39. [PMID: 31191791 PMCID: PMC6561499 DOI: 10.7895/ijadr.246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIMS Fieldworkers capturing reports of sensitive behaviors, such as substance use, may influence survey responses and represent an important factor in response validity. We explored the effects and interaction of fieldworker and respondent characteristics (age and gender) in substance (tobacco and alcohol) use reporting. We aim to further the literature on conditional social attribution effects on substance use reporting in the context of South Africa, where accurate estimates of modifiable risk factors are critical for medical and public health practitioners and policy-makers in efforts to reduce chronic disease burden and mortality. DESIGN We modeled substance use reporting using binary logistic regression. We also tested if fieldworker effects remained, allowing for correlation in reporting for respondents with the same fieldworker using multi-level logistic regression. SETTING Agincourt Health and Socio-Demographic Surveillance System site, rural South Africa. PARTICIPANTS We used data from a 2010-2011 study on HIV and cardiometabolic risk, ages 15+ (N = 4,684). MEASURES Lifetime and current alcohol and tobacco use. FINDINGS Respondents reported higher lifetime smoking use to older fieldworkers. Male respondents reported higher lifetime alcohol use to older fieldworkers. No fieldworker effects were significant on reports of current smoking. An older, male fieldworker increased the probability of reports of current alcohol use. Adjusting for intra-fieldworker correlation explained many of the observed fieldworker effects. CONCLUSIONS Our results highlight the importance of adjusting for interviewer characteristics to improve the accuracy of chronic disease risk factor estimates and validity of inferred associations. We recommend that surveys collecting information that may be subject to response bias routinely include anonymized fieldworker identifiers and demographic information. Analysts can then use these additional fieldworker data as a tool in evaluating probable bias in respondent reporting.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, ACT, Australia
- CU Population Center, Population Program, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States
- 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
| | - Nicole Angotti
- CU Population Center, Population Program, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States
- 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 and Center on Health, Risk and Society, American University, Washington, D.C., United States
| | - F. Xavier Gómez-Olivé
- 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
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
- INDEPTH Network, Accra, Ghana
| | - Samuel J. Clark
- CU Population Center, Population Program, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States
- 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, The Ohio State University, Columbus, Ohio, United States
- INDEPTH Network, Accra, Ghana
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Babalola S. Changes in Ideational Profiles of Women of Reproductive Age in Urban Nigeria: The Role of Health Communication. HEALTH EDUCATION & BEHAVIOR 2017; 44:907-917. [DOI: 10.1177/1090198117699510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Gaziano TA, Abrahams-Gessel S, Gomez-Olive FX, Wade A, Crowther NJ, Alam S, Manne-Goehler J, Kabudula CW, Wagner R, Rohr J, Montana L, Kahn K, Bärnighausen TW, Berkman LF, Tollman S. Cardiometabolic risk in a population of older adults with multiple co-morbidities in rural south africa: the HAALSI (Health and Aging in Africa: longitudinal studies of INDEPTH communities) study. BMC Public Health 2017; 17:206. [PMID: 28212629 PMCID: PMC5314614 DOI: 10.1186/s12889-017-4117-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/07/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A consequence of the widespread uptake of anti-retroviral therapy (ART) is that the older South African population will experience an increase in life expectancy, increasing their risk for cardiometabolic diseases (CMD), and its risk factors. The long-term interactions between HIV infection, treatment, and CMD remain to be elucidated in the African population. The HAALSI cohort was established to investigate the impact of these interactions on CMD morbidity and mortality among middle-aged and older adults. METHODS We recruited randomly selected adults aged 40 or older residing in the rural Agincourt sub-district in Mpumalanga Province. In-person interviews were conducted to collect baseline household and socioeconomic data, self-reported health, anthropometric measures, blood pressure, high-sensitivity C-reactive protein (hsCRP), HbA1c, HIV-status, and point-of-care glucose and lipid levels. RESULTS Five thousand fifty nine persons (46.4% male) were enrolled with a mean age of 61.7 ± 13.06 years. Waist-to-hip ratio was high for men and women (0.92 ± 0.08 vs. 0.89 ± 0.08), with 70% of women and 44% of men being overweight or obese. Blood pressure was similar for men and women with a combined hypertension prevalence of 58.4% and statistically significant increases were observed with increasing age. High total cholesterol prevalence in women was twice that observed for men (8.5 vs. 4.1%). The prevalence of self-reported CMD conditions was higher among women, except for myocardial infarction, and women had a statistically significantly higher prevalence of angina (10.82 vs. 6.97%) using Rose Criteria. The HIV- persons were significantly more likely to have hypertension, diabetes, or be overweight or obese than HIV+ persons. Approximately 56% of the cohort had at least 2 measured or self-reported clinical co-morbidities, with HIV+ persons having a consistently lower prevalence of co-morbidities compared to those without HIV. Absolute 10-year risk cardiovascular risk scores ranged from 7.7-9.7% for women and from 12.5-15.3% for men, depending on the risk score equations used. CONCLUSIONS This cohort has high CMD risk based on both traditional risk factors and novel markers like hsCRP. Longitudinal follow-up of the cohort will allow us to determine the long-term impact of increased lifespan in a population with both high HIV infection and CMD risk.
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Affiliation(s)
- Thomas A. Gaziano
- Department of Cardiovascular Medicine, Brigham & Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA 02115 USA
| | - Shafika Abrahams-Gessel
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA 02115 USA
| | - F. Xavier Gomez-Olive
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA 02138 USA
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew’s Road, Johannesburg, Parktown 2193 South Africa
- INDEPTH Network, Accra, Ghana
- Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa
| | - Alisha Wade
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew’s Road, Johannesburg, Parktown 2193 South Africa
- INDEPTH Network, Accra, Ghana
- Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J. Crowther
- National Health Laboratory Service and Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd., Johannesburg, Parktown 2193 South Africa
| | - Sartaj Alam
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115 USA
| | - Jennifer Manne-Goehler
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 USA
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Chodziwadziwa W Kabudula
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew’s Road, Johannesburg, Parktown 2193 South Africa
- INDEPTH Network, Accra, Ghana
- Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ryan Wagner
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew’s Road, Johannesburg, Parktown 2193 South Africa
- INDEPTH Network, Accra, Ghana
- Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Julia Rohr
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA 02138 USA
| | - Livia Montana
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA 02138 USA
| | - Kathleen Kahn
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew’s Road, Johannesburg, Parktown 2193 South Africa
- INDEPTH Network, Accra, Ghana
- Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Till W. Bärnighausen
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Africa Health Research Institute (AHRI), Mtubatuba, South Africa
- Institute of Public Health, Faculty of Medicine, University of Heidelberg, INF 130.3, Heidelberg, Baden-Württemberg 69120 Germany
| | - Lisa F. Berkman
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA 02138 USA
| | - Stephen Tollman
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew’s Road, Johannesburg, Parktown 2193 South Africa
- INDEPTH Network, Accra, Ghana
- Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
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Garenne M, Collinson MA, Kabudula CW, Gómez-Olivé FX, Kahn K, Tollman S. Completeness of birth and death registration in a rural area of South Africa: the Agincourt health and demographic surveillance, 1992-2014. Glob Health Action 2016; 9:32795. [PMID: 27782873 PMCID: PMC5081031 DOI: 10.3402/gha.v9.32795] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/09/2016] [Accepted: 09/23/2016] [Indexed: 11/24/2022] Open
Abstract
Background Completeness of vital registration remains very low in sub-Saharan Africa, especially in rural areas. Objectives To investigate trends and factors in completeness of birth and death registration in Agincourt, a rural area of South Africa covering a population of about 110,000 persons, under demographic surveillance since 1992. The population belongs to the Shangaan ethnic group and hosts a sizeable community of Mozambican refugees. Design Statistical analysis of birth and death registration over time in a 22-year perspective (1992–2014). Over this period, major efforts were made by the government of South Africa to improve vital registration. Factors associated with completeness of registration were investigated using univariate and multivariate analysis. Results Birth registration was very incomplete at onset (7.8% in 1992) and reached high values at end point (90.5% in 2014). Likewise, death registration was low at onset (51.4% in 1992), also reaching high values at end point (97.1% in 2014). For births, the main factors were mother's age (much lower completeness among births to adolescent mothers), refugee status, and household wealth. For deaths, the major factors were age at death (lower completeness among under-five children), refugee status, and household wealth. Completeness increased for all demographic and socioeconomic categories studied and is likely to approach 100% in the future if trends continue at this speed. Conclusion Reaching high values in the completeness of birth and death registration was achieved by excellent organization of the civil registration and vital statistics, a variety of financial incentives, strong involvement of health personnel, and wide-scale information and advocacy campaigns by the South African government.
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Affiliation(s)
- Michel Garenne
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France.,Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France.,FERDI, Université d'Auvergne, Clermont-Ferrand, France; /
| | - Mark A Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit, 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, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit, 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, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, 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, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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12
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Houle B, Pantazis A, Kabudula C, Tollman S, Clark SJ. Social patterns and differentials in the fertility transition in the context of HIV/AIDS: evidence from population surveillance, rural South Africa, 1993 - 2013. Popul Health Metr 2016; 14:10. [PMID: 27019642 PMCID: PMC4807549 DOI: 10.1186/s12963-016-0079-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Literature is limited on the effects of high prevalence HIV on fertility in the absence of treatment, and the effects of the introduction of sustained access to antiretroviral therapy (ART) on fertility. We summarize fertility patterns in rural northeast South Africa over 21 years during dynamic social and epidemiological change. METHODS We use data for females aged 15-49 from the Agincourt health and socio-demographic surveillance system (1993-2013). We use discrete time event history analysis to summarize patterns in the probability of any birth. RESULTS Overall fertility declined in 2001-2003, increased in 2004-2011, and then declined in 2012-2013. South Africans showed a similar pattern. Mozambicans showed a different pattern, with strong declines prior to 2003 before stalling during 2004-2007, and then continued fertility decline afterwards. There was an inverse gradient between fertility levels and household socioeconomic status. The gradient did not vary by time or nationality. CONCLUSIONS The fertility transition in rural South Africa shows a pattern of decline until the height of the HIV/AIDS pandemic, with a resulting stall until further decline in the context of ART rollout. Fertility patterns are not homogenous among groups.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, #9 Fellows Road, Acton, ACT Australia, Canberra, Australia ; Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO USA ; 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
| | - Athena Pantazis
- Department of Sociology, University of Washington, Seattle, WA USA
| | - Chodziwadziwa Kabudula
- 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 Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Tollman
- 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 ; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana ; Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Samuel J Clark
- Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO USA ; 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, University of Washington, Seattle, WA USA ; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana
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13
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Mee P, Kahn K, Kabudula C, Wagner R, Gómez-Olivé FX, Madhavan S, Collinson MA, Tollman S, Byass P. The development of a localised HIV epidemic and the associated excess mortality burden in a rural area of South Africa. Glob Health Epidemiol Genom 2016; 1:e7. [PMID: 29302331 PMCID: PMC5738674 DOI: 10.1017/gheg.2016.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 01/25/2023] Open
Abstract
The human immunodeficiency virus (HIV) epidemic in South Africa rapidly developed into a major pandemic. Here we analyse the development of the epidemic in a rural area of the country. The data used were collected between 1992 and 2013 in a longitudinal population survey, the Agincourt Health and Demographic Surveillance Study, in the northeast of the country. Throughout the period of study mortality rates were similar in all villages, suggesting that there were multiple index cases evenly spread geographically. These were likely to have been returning migrant workers. For those aged below 39 years the HIV mortality rate was higher for women, above this age it was higher for men. This indicates the protective effect of greater access to HIV testing and treatment among older women. The recent convergence of mortality rates for Mozambicans and South Africans indicates that the former refugee population are being assimilated into the host community. More than 60% of the deaths occurring in this community between 1992 and 2013 could be attributed directly or indirectly to HIV. Recently there has been an increasing level of non-HIV mortality which has important implications for local healthcare provision. This study demonstrates how evidence from longitudinal analyses can support healthcare planning.
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Affiliation(s)
- P. Mee
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- Department of Population Health, Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London,UK
| | - K. Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - C.W. Kabudula
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - R.G. Wagner
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - F. X. Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - S. Madhavan
- Medical Research Council/Wits University 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 African-American Studies, University of Maryland-College Park, College Park, MD, USA
| | - Mark A. Collinson
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - S.M. Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
- International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - P. Byass
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
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14
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Relationship between Receipt of a Social Protection Grant for a Child and Second Pregnancy Rates among South African Women: A Cohort Study. PLoS One 2015; 10:e0137352. [PMID: 26398678 PMCID: PMC4580643 DOI: 10.1371/journal.pone.0137352] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/14/2015] [Indexed: 11/19/2022] Open
Abstract
Background Social protection programs issuing cash grants to caregivers of young children may influence fertility. Grant-related income could foster economic independence and/or increase access to job prospects, education, and health services, resulting in lower pregnancy rates. In the other direction, these programs may motivate family expansion in order to receive larger grants. Here, we estimate the net effect of these countervailing mechanisms among rural South African women. Methods We constructed a retrospective cohort of 4845 women who first became eligible for the Child Support Grant with the birth of their first child between 1998 and 2008, with data originally collected by the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga province, South Africa. We fit Cox regression models to estimate the hazard of second pregnancy in women who reported grant receipt after birth of first child, relative to non-recipients. As a secondary analysis to explore the potential for grant loss to incentivize second pregnancy, we exploited a natural experiment created by a 2003 expansion of the program’s age eligibility criterion from age seven to nine. We compared second pregnancy rates between (i) women with children age seven or eight in 2002 (recently aged out of grant eligibility) to (ii) women with children age seven or eight in 2003 (remained grant-eligible). Results The adjusted hazard ratio for the association between grant exposure and second pregnancy was 0.66 (95% CI: 0.58, 0.75). Women with first children who aged out of grant eligibility in 2002 had similar second pregnancy rates to women with first children who remained grant-eligible in 2003 [IRR (95% CI): 0.9 (0.5, 1.4)]. Conclusions Across both primary and secondary analyses, we found no evidence that the Child Support Grant incentivizes pregnancy. In harmony with South African population policy, receipt of the Child Support Grant may result in longer spacing between pregnancies.
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15
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Houle B, Angotti N, Clark SJ, Williams J, Gómez-Olivé FX, Menken J, Kabudula C, Klipstein-Grobusch K, Tollman SM. Let's Talk about Sex, Maybe: Interviewers, Respondents, and Sexual Behavior Reporting in Rural South Africa. FIELD METHODS 2015; 28:112-132. [PMID: 28190977 PMCID: PMC5300069 DOI: 10.1177/1525822x15595343] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Researchers are often skeptical of sexual behavior surveys: respondents may lie or forget details of their intimate lives, and interviewers may exercise authority in how they capture responses. We use data from a 2010-2011 cross-sectional sexual behavior survey in rural South Africa to explore who says what to whom about their sexual lives. Results show an effect of fieldworker age across outcomes -- respondents report "safer", more "responsible" sexual behavior to older fieldworkers; and an effect of fieldworker sex -- men report more sexual partners to female fieldworkers. Understanding fieldworker effects on the production of sexual behavior survey data serves methodological and analytical goals.
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Affiliation(s)
- Brian Houle
- Australian Demographic and Social Research Institute, Australian National University, Canberra, Australia; Population Program, Institute of Behavioral Science, University of Colorado, Boulder, USA
| | - Nicole Angotti
- Population Program, Institute of Behavioral Science, University of Colorado, Boulder, USA; Department of Sociology and Center on Health, Risk and Society, American University, Washington DC, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Samuel J Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; University of Washington, USA; INDEPTH Network, Accra, Ghana
| | - Jill Williams
- Population Program, Institute of Behavioral Science, University of Colorado, Boulder, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Menken
- Population Program, Institute of Behavioral Science, University of Colorado, Boulder, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Global Health Unit, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Netherlands
| | - Stephen M Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Health Research, Umea University, Sweden; INDEPTH Network, Accra, Ghana
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16
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Myers B, Jones HE, Doherty IA, Kline TL, Key ME, Johnson K, Wechsberg WM. Correlates of lifetime trauma exposure among pregnant women from Cape Town, South Africa. Int J Ment Health Addict 2015; 13:307-321. [PMID: 27087804 DOI: 10.1007/s11469-015-9544-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A cross-sectional survey of 298 pregnant women from Cape Town, South Africa was conducted to examine socio-demographic, reproductive health, mental health, and relationship correlates of lifetime trauma exposure and whether these correlates vary as a function of age. Overall, 19.8% of participants reported trauma exposure. We found similarities and differences in correlates of trauma exposure among women in emerging adulthood and older women. Prior termination of pregnancy was associated with trauma exposure in both age groups. Difficulties in resolving arguments, lifetime substance use, and a prior sexually transmitted infection were associated with trauma exposure among women in emerging adulthood. In contrast, depression and awareness of substance abuse treatment programmes were associated with trauma exposure among older women. These findings highlight the need for interventions that prevent and treat trauma exposure among vulnerable women. Such interventions should be tailored to address the correlates of trauma exposure in each age group.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Hendrée E Jones
- UNC Horizons Program, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, USA; Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Irene A Doherty
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA
| | - Tracy L Kline
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA
| | - Mary E Key
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Wendee M Wechsberg
- RTI International, Research Triangle Park, Raleigh, North Carolina, USA; Gillings Global School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Psychology in the Public Interest, North Carolina State University, North Carolina, USA; Psychiatry and Behavioral Sciences, Duke University School of Medicine, North Carolina, USA
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17
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Rosenberg M, Pettifor A, Miller WC, Thirumurthy H, Emch M, Afolabi SA, Kahn K, Collinson M, Tollman S. Relationship between school dropout and teen pregnancy among rural South African young women. Int J Epidemiol 2015; 44:928-36. [PMID: 25716986 DOI: 10.1093/ije/dyv007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sexual activity may be less likely to occur during periods of school enrolment because of the structured and supervised environment provided, the education obtained and the safer peer networks encountered while enrolled. We examined whether school enrolment was associated with teen pregnancy in South Africa. METHODS Using longitudinal demographic surveillance data from the rural Agincourt sub-district, we reconstructed the school enrolment status from 2000 through 2011 for 15 457 young women aged 12-18 years and linked them to the estimated conception date for each pregnancy during this time. We examined the effect of time-varying school enrolment on teen pregnancy using a Cox proportional hazard model, adjusting for: age; calendar year; household socioeconomic status; household size; and gender, educational attainment and employment of household head. A secondary analysis compared the incidence of pregnancy among school enrolees by calendar time: school term vs school holiday. RESULTS School enrolment was associated with lower teen pregnancy rates [adjusted hazard ratio (95% confidence interval): 0.57 (0.50, 0.65)].This association was robust to potential misclassification of school enrolment. For those enrolled in school, pregnancy occurred less commonly during school term than during school holidays [incidence rate ratio (95% confidence interval): 0.90 (0.78, 1.04)]. CONCLUSIONS Young women who drop out of school may be at higher risk for teen pregnancy and could likely benefit from receipt of accessible and high quality sexual health services. Preventive interventions designed to keep young women in school or addressing the underlying causes of dropout may also help reduce the incidence of teen pregnancy.
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Affiliation(s)
- Molly Rosenberg
- Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Center for Population and Development Studies, Harvard University, Cambridge, MA USA,
| | - Audrey Pettifor
- Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - William C Miller
- Department of Epidemiology, Division of Infectious Diseases in the Department of Medicine, University of North Carolina-Chapel Hill, NC, USA
| | - Harsha Thirumurthy
- Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Department of Health Policy and Management
| | - Michael Emch
- Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Department of Geography, and
| | - Sulaimon A Afolabi
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Demography and Population Studies, School of Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umeå University, Umeå, Sweden and INDEPTH Network, Accra, Ghana
| | - Mark Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umeå University, Umeå, Sweden and INDEPTH Network, Accra, Ghana
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umeå University, Umeå, Sweden and INDEPTH Network, Accra, Ghana
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18
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Williams J, Ibisomi L, Sartorius B, Kahn K, Collinson M, Tollman S, Garenne M. Convergence in fertility of South Africans and Mozambicans in rural South Africa, 1993-2009. Glob Health Action 2013; 6:19236. [PMID: 23364078 PMCID: PMC3556705 DOI: 10.3402/gha.v6i0.19236] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/26/2012] [Accepted: 10/10/2012] [Indexed: 11/23/2022] Open
Abstract
Background Although there are significant numbers of people displaced by war in Africa, very little is known about long-term changes in the fertility of refugees. Refugees of the Mozambican civil war (1977–1992) settled in many neighbouring countries, including South Africa. A large number of Mozambican refugees settled within the Agincourt sub-district, underpinned by a Health and Socio-demographic Surveillance Site (AHDSS), established in 1992, and have remained there. The AHDSS data provide a unique opportunity to study changes in fertility over time and the role that the fertility of self-settled refugee populations plays in the overall fertility level of the host community, a highly relevant factor in many areas of sub-Saharan Africa. Objectives To examine the change in fertility of former Mozambican self-settled refugees over a period of 16 years and to compare the overall fertility and fertility patterns of Mozambicans to host South Africans. Methods Prospective data from the AHDSS on births from 1993 to 2009 were used to compare fertility trends and patterns and to examine socio-economic factors that may be associated with fertility change. Results There has been a sharp decline in fertility in the Mozambican population and convergence in fertility patterns of Mozambican and local South African women. The convergence of fertility patterns coincides with a convergence in other socio-economic factors. Conclusion The fertility of Mozambicans has decreased significantly and Mozambicans are adopting the childbearing patterns of South African women. The decline in Mozambican fertility has occurred alongside socio-economic gains. There remains, however, high unemployment and endemic poverty in the area and fertility is not likely to decrease further without increased delivery of family planning to adolescents and increased education and job opportunities for women.
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Affiliation(s)
- Jill Williams
- Institute of Behavioral Science, Population Program, University of Colorado Boulder, Boulder, CO 80309, USA.
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