Do migrant children face greater health hazards in slum settlements? Evidence from Nairobi, Kenya

Between 60% and 70% of Nairobi City’s population live in congested informal settlements, commonly referred to as slums, without proper access to sanitation, clean water, health care and other social services. Children in such areas are exposed to disproportionately high health hazards. This paper examines the impact of mother and child migration on the survival of more than 10,000 children in two of Nairobi’s informal settlements—Korogocho and Viwandani—between July 2003 and June 2007, using a two-stage semi-parametric proportional hazards (Cox) model that controls for attrition and various factors that affect child survival. Results show that the slum-born have higher mortality than non-slum-born, an indication that delivery in the slums has long-term health consequences for children. Children born in the slums to women who were pregnant at the time of migration have the highest risk of dying. Given the high degree of circular migration, factors predisposing children born in the slums to recent migrant mothers to higher mortality should be better understood and addressed

Association between internal migration and epidemic dynamics: An analysis of cause-specific mortality in Kenya and South Africa using health and demographic surveillance data

Background Many low- and middle-income countries are facing a double burden of disease with persisting high levels of infectious disease, and an increasing prevalence of non-communicable disease (NCD). Within these settings, complex processes and transitions concerning health and population are underway, altering population dynamics and patterns of disease. Understanding the mechanisms through which changing socioeconomic and environmental contexts may influence health is central to developing appropriate public health policy. Migration, which involves a change in environment and health exposure, is one such mechanism. Methods This study uses Competing Risk Models to examine the relationship between internal migration and premature mortality from AIDS/TB and NCDs. The analysis employs 9 to 14 years of longitudinal data from four Health and Demographic Surveillance Systems (HDSS) of the INDEPTH Network located in Kenya and South Africa (populations ranging from 71 to 223 thousand). The study tests whether the mortality of migrants converges to that of non-migrants over the period of observation, controlling for age, sex and education level. Results In all four HDSS, AIDS/TB has a strong influence on overall deaths. However, in all sites the probability of premature death (45q15) due to AIDS/TB is declining in recent periods, having exceeded 0.39 in the South African sites and 0.18 in the Kenyan sites in earlier years. In general, the migration effect presents similar patterns in relation to both AIDS/TB and NCD mortality, and shows a migrant mortality disadvantage with no convergence between migrants and non-migrants over the period of observation. Return migrants to the Agincourt HDSS (South Africa) are on average four times more likely to die of AIDS/TB or NCDs than are non-migrants. In the Africa Health Research Institute (South Africa) female return migrants have approximately twice the risk of dying from AIDS/TB from the year 2004 onwards, while there is a divergence to higher AIDS/TB mortality risk amongst female migrants to the Nairobi HDSS from 2010. Conclusion Results suggest that structural socioeconomic issues, rather than epidemic dynamics are likely to be associated with differences in mortality risk by migrant status. Interventions aimed at improving recent migrant’s access to treatment may mitigate risk

Migration Analysis using Demographic Surveys and Surveillance Systems

Although migration analysis is not a core objective of Demographic and Health Surveys (DHS) and Health and Demographic Surveillance Systems (HDSS), these demographic sources can be quite helpful for the study of migration, either as the event of interest or as a determinant. This chapter presents useful criteria on the basis of sampling and data collections procedures to evaluate such data sources as regard to migration analysis. This chapter justifies a number of advices illustrated with examples from DHS and HDSS data: Limiting the analysis to three years before the survey and to large geographical areas is important to analyze migration matrices without biases; Analyses of interactions between migration and another event should check for the order of these events; Migration as a determinant should be a time-varying covariate that includes information on origin and destination and reasons for migration; Migration is a major source of bias through informative censoring for the analysis of other events of interest; Information prior to migration and follow-up after migration are important improvements that should be encouraged in existing data collection programs