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Available from: Abraham Jacobus Herbst, Oct 04, 2015
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    • "Although this is a predominantly rural area, the principal source of income for most households is waged employment and state pensions rather than agriculture. In 2006 approximately 77% of households in the surveillance area had access to piped water and toilet facilities [34]. Due to the availability of antiretroviral therapy in South Africa's public-sector health system (government clinics and hospitals) starting in 2004, adult life expectancy (i.e., life expectancy at 15 years of age) in this community increased from about 49 years in 2003 to 61 years in 2011 [35]. "
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    ABSTRACT: Because measles vaccination prevents acute measles disease and morbidities secondary to measles, such as undernutrition, blindness, and brain damage, the vaccination may also lead to higher educational attainment. However, there has been little evidence to support this hypothesis at the population level. In this study, we estimate the effect of childhood measles vaccination and educational attainment among children born between 1995 and 2000 in South Africa. We use data on measles vaccination status and school grade attainment among 4783 children. The data were collected by the Wellcome Trust Africa Center Demographic Information System, which is one of Africa's largest health and demographic surveillance systems. It is located in a poor, predominantly rural, Zulu-speaking community in KwaZulu-Natal, South Africa. Using mother-fixed-effects regression, we compare the school grade attainment of siblings who are discordant in their measles vaccination status but share the same mother and household. This fixed-effects approach controls for confounding due to both observed and unobserved factors that do not vary between siblings, including sibling-invariant mother and household characteristics such as attitudes toward risk, conscientiousness, and aspirations for children. We further control for a range of potential confounders that vary between siblings, such as sex of the child, year of birth, mother's age at child's birth, and birth order. We find that measles vaccination is associated with 0.188 higher school grades per child (95% confidence interval, 0.0424-0.334; p=0.011). Measles vaccination increased educational attainment in this poor, largely rural community in South Africa. For every five to seven children vaccinated against measles, one additional school grade was gained. The presence of a measles vaccination effect in this community is plausible because (i) measles vaccination prevents complications including blindness, brain damage, and undernutrition; (ii) a large number of number of children were at risk of contracting measles because of the comparatively low measles vaccination coverage; and (iii) significant measles transmission occurred in South Africa during the study observation period. Our results demonstrate for the first time that measles vaccination affects human development not only through its previously established and significant effect on health but also through its effect on education. Copyright © 2015. Published by Elsevier Ltd.
    Vaccine 04/2015; 21(38). DOI:10.1016/j.vaccine.2015.04.072 · 3.62 Impact Factor
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    • "In ACDIS, individuals are included in the surveillance population on the basis of being a member of a household in the study area irrespective of whether the person is a resident or not (Hosegood and Timaeus, 2005a; Tanser et al., 2008). The residency status (whether resident or non-resident) and place of residence are routinely recorded for all household members. "
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    ABSTRACT: Gender is increasingly recognised as fundamental to understanding migration processes, causes, and consequences. In South Africa, it is intrinsic to the social transformations fueling high levels of internal migration and complex forms of mobility. Although female migration in Africa has often been characterised as less prevalent than male migration and primarily related to marriage, in South Africa, a feminisation of internal migration is underway, fueled by women's increasing labour market participation. In this paper, we report sex differences in patterns, trends, and determinants of internal migration based on data collected in a demographic surveillance system between 2001 and 2006 in rural KwaZulu-Natal. We show that women were somewhat more likely than men to undertake any migration, but sex differences in migration trends differed by migration flow, with women more likely to migrate into the area than men and men more likely to out-migrate. Out-migration was suppressed by marriage, particularly for women, but most women were not married; both men's and women's out-migrations were undertaken mainly for purposes of employment. Over half of female out-migrations (vs 35% of male out-migrations) were to nearby rural areas. The findings highlight the high mobility of this population and the extent to which gender is intimately related to the processes determining migration. We consider the implications of these findings for the measurement of migration and mobility, in particular for health and social policy and research among highly mobile populations in southern Africa. © 2013 The Authors. Population, Space and Place published by John Wiley & Sons Ltd.
    Population Space and Place 08/2014; [In Press](6). DOI:10.1002/psp.1794 · 1.82 Impact Factor
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    • "The 1,527 households with a woman over 18 years of age who had delivered in the preceding year were defined as the households needing maternal health services. The Africa Centre Demographic Information System (ACDIS) collects similar data on approximately 85,000 people in an area of Hlabisa [[11]]. Data from this database were extracted for 2009 on 8,448 households with complete socio-economic data and the subset of 1,491 households with a woman over 18 years of age who had delivered in the preceding year. "
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    ABSTRACT: Background There is global concern with geographical and socio-economic inequalities in access to and use of maternal delivery services. Little is known, however, on how local-level socio-economic inequalities are related to the uptake of needed maternal health care. We conducted a study of relative socio-economic inequalities in use of hospital-based maternal delivery services within two rural sub-districts of South Africa. Methods We used both population-based surveillance and facility-based clinical record data to examine differences in the relative distribution of socio-economic status (SES), using a household assets index to measure wealth, among those needing maternal delivery services and those using them in the Bushbuckridge sub-district, Mpumalanga, and Hlabisa sub-district, Kwa-Zulu Natal. We compared the SES distributions in households with a birth in the previous year with the household SES distributions of representative samples of women who had delivered in hospitals in these two sub-districts. Results In both sub-districts, women in the lowest SES quintile were significantly under-represented in the hospital user population, relative to need for delivery services (8% in user population vs 21% in population in need; p < 0.001 in each sub-district). Exit interviews provided additional evidence on potential barriers to access, in particular the affordability constraints associated with hospital delivery. Conclusions The findings highlight the need for alternative strategies to make maternal delivery services accessible to the poorest women within overall poor communities and, in doing so, decrease socioeconomic inequalities in utilisation of maternal delivery services.
    Globalization and Health 07/2014; 10(60). DOI:10.1186/s12992-014-0060-1 · 2.25 Impact Factor
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