The Female Face of Migration in Sub-Saharan Africa

This paper examines the female face of migration in sub-Saharan Africa.In the last two decades, there has been an increasing amount of research onfeminization of migration, which has begun to fill the gap created by the earlierfocus on male labour migration. Women in earlier migration research were seen ascompanions to men, passive non-decision-makers in the migration process.Currently, Sub-Saharan Africa market demand influences who migrates. The articleseeks to put in perspective the recent developments in female migration and to readdressthe question of stereotypical female migrants. To understand the dynamicsof these female migrations, the paper focuses on causes and changingconfigurations of emerging female migratory flows. More women are nowmigrating independently and as main income-earners instead of following malerelatives. Further, women’s migration experiences often differ significantly frommen’s. Female migrants are disproportionately young and single. There is lessavailability of work for women. Women particularly the younger ones from ruralareas are migrating to work as domestics. Service jobs such as domestic work, childcare, elder care, health care, are female-coded jobs in sub-Saharan Africa. Theirwages are low and not subject to regular laws of supply and demand. Themajorities are clustered in certain types of industry – particularly manufacturingand empirical evidence seems to indicate that some move into this sector from thedomestic service and the informal sector. Women migrants are found to have moresocial and economic ties to places of origin. The paper suggests that Sub-SaharanAfrican governments should pursue policies that empower migrant women, promotepro-poor employment strategies that favour informal and formal labour marketsand those which take into account women’s changing role in migratory flows andreflect the needs and priorities of migrant women

The Influence of Weather on Mortality in Rural Tanzania: A Time-Series Analysis 1999�-2010

Weather and climate changes are associated with a number of immediate and long-term impacts on human health that occur directly or indirectly, through mediating variables. Few studies to date have established the empirical relationship between monthly weather and mortality in sub-Saharan Africa. The objectives of this study were to assess the association between monthly weather (temperature and rainfall) on all-cause mortality by age in Rufiji, Tanzania, and to determine the differential susceptibility by age groups. We used mortality data from Rufiji Health and Demographic Surveillance System (RHDSS) for\ud the period 1999 to 2010. Time-series Poisson regression models were used to estimate the association between monthly weather and mortality adjusted for long-term trends. We used a distributed lag model to estimate the delayed association of monthly weather on mortality. We stratified the analyses per age group to assess susceptibility. In general, rainfall was found to have a stronger association in the age group 0_4 years (RR_1.001, 95% CI_0.961_1.041) in both short and long lag times, with an overall increase of 1.4% in mortality risk for a 10 mm rise in rainfall. On the other hand, monthly average temperature had a stronger association with death in all ages while mortality increased with falling monthly temperature. The association per age group was estimated as: age group 0_4 (RR_0.934, 95% CI_0.894_0.974), age group 5_59 (RR_0.956, 95% CI_ 0.928_0.985) and age group over 60 (RR_0.946, 95% CI_0.912_0.979). The age group 5_59 experienced more delayed lag associations. This suggests that children and older adults are most sensitive to weather related mortality. These results suggest that an early alert system based on monthly weather information may be useful for disease control management, to reduce and prevent fatal effects related to weather and monthly weather.\u

Gendered Migration and the Urban Informal Sector: A Case Study of Mwanza City, Tanzania

This study examined gendered migration patterns in Mwanza City, Tanzania as well as the impacts of differentials of men’s and women’s migration on their absorption in the urban informal sector, their access to assets, adaptation to city life and their livelihood and also their role in development of origin areas. The study employed a combination of Participatory appraisal methods, cross-sectional and causal comparative research design. The study sample comprised of 400 male and female urban migrants. Findings showed that for temporary marginal men migrants, reasons to move were strongly associated with ‘push’ factors rather than ‘pull’ factors. By contrast, their women counterparts’ decision to move was greatly determined by personal/family issues and situations. Social networks played a key role in men’s and women’s migration. However, men migrants relyed more on such close ties as friends and kinsmen, whereas women migrants relyed more on gendered social networks harbouring city-village ties in their migration process and adaptation into city life. The differences in employment absorption in the informal sector as well as upward occupational mobility between men and women migrants resulted from gender roles. Female migrants tended to find employment earlier than males (mainly in the informal sector) due to their willingness to accept lower wages. The disparity between the sexes on access to assets and property was very minimal. Despite female migrants’ low levels of education and working in low profile occupations, they almost universally sent home a higher proportion of their incomes than male migrants

Do Health Workers' Preferences Influence their Practices? Assessment of Providers' Attitude and Personal use of new Treatment Recommendations for Management of Uncomplicated Malaria, Tanzania.

\ud \ud Due to growing antimalarial drug resistance, Tanzania changed malaria treatment policies twice within a decade. First in 2001 chloroquine (CQ) was replaced by sulfadoxine-pyrimethamine (SP) for management of uncomplicated malaria and by late 2006, SP was replaced by artemether-lumefantrine (AL). We assessed health workers' attitudes and personal practices following the first treatment policy change, at six months post-change and two years later. Two cross-sectional surveys were conducted in 2002 and 2004 among healthcare workers in three districts in South-East Tanzania using semi-structured questionnaires. Attitudes were assessed by enquiring which antimalarial was considered most suitable for the management of uncomplicated malaria for the three patient categories: i) children below 5; ii) older children and adults; and iii) pregnant women. Practice was ascertained by asking which antimalarial was used in the last malaria episode by the health worker him/herself and/or dependants. Univariate and multivariate logistic regression was used to identify factors associated with reported attitudes and practices towards the new treatment recommendations. A total of 400 health workers were interviewed; 254 and 146 in the first and second surveys, respectively. SP was less preferred antimalarial in hospitals and private health facilities (p<0.01) in the first round, and the preference worsened in the second round. In the first round, clinicians did not prefer SP for children below age of 5 and pregnant women (p<0.01), but two years later, they did not prefer it for all patient scenarios. SP was the most commonly used antimalarial for management of the last malaria episode for health workers and their dependants in both rounds, in the public sector (p<0.01). Health workers in the dispensaries had the highest odds of using SP for their own treatment [adjusted OR- first round: 6.7 (95%CI: 1.9-23.4); crude OR- second round: 4.5 (1.5-13.3)]. Following changes in malaria treatment recommendations, most health workers did not prefer the new antimalarial drug, and their preferences worsened over time. However, many of them still used the newly recommended drug for management of their own or family members' malaria episode. This indicates that, other factors than providers' attitude may have more influence in their personal treatment practices

Evaluation of the Implementation of Health Interventions and their Impact on Child Survival in Tanzania

It is widely accepted that achieving the highest and most equitable levels of health of populations through the most rational use of resources is the ultimate goal of national and international policymakers, public health officials and health professionals at large. However, doing this depends upon understanding the burden of disease, its distribution and causes in a given population and the effectiveness of different preventive, curative and palliative interventions that can reduce these burdens. Demand for comparable cause-specific mortality data of high quality has grown due to increased pressure to meet ambitious short-term goals and targets set by the international donor community. Robust data are urgently needed to assist policy makers and health planners in setting intervention priorities, the allocation of resources, and the analysis of the equity and effectiveness of health interventions and systems. The counting of births, deaths by age and sex, and documentation of causes of death is the norm for all routine vital registration systems implemented throughout the developed world. But in most developing countries, routine empirical data on population burden of disease are usually missing, or at best, grossly incomplete due to the lack of systems and resources to support their collection and documentation. Mortality surveillance systems or surveys using verbal autopsy have the potential to provide invaluable data for informing the health system on the burden of disease, and for monitoring and evaluating of the impact of different health and health system interventions as they are being implemented. The sentinel surveillance platform that includes the Ifakara, Rufiji and AMMP Demographic Surveillance System sites in Tanzania offers a great opportunity to examine this potential. The goal of this thesis was to explore a variety of innovative approaches to evaluating the implementation of health interventions and their impact on child survival in Tanzania. Ths was pursued by analyzing the burden of disease for the period from 2000-2002 in the rural areas of Kilombero and Ulanga district in which a population of approximately 65,000 people is under continuous surveillance. I also examined health systems access for pregnant women and children younger than five in a rural area in Rufiji district by combining demographic surveillance systems with geographic information systems in a population of approximately 70,000 people in 12,000 households. Using a sentinel surveillance platform in a non-randomised "plausibility" design across the four districts of Kilombero, Ulanga, Morogoro Rural and Rufiji, the thesis also examines the child survival effectiveness, cost and impact of the integrated management of childhood illness (IMCI). The main findings were: - 42% of mortality in children younger than five years of age occurred due to conditions that are well known and for which Districts have the technology to prevent or treat. - Spatial access to health care by children and pregnant women in Rufiji District was similar with an average travel time to a health facility of less than 1 hour. - Facility based IMCI improved quality of care and was associated with a 13% reduction in mortality in children younger than five in intervention districts. - The costs of child health care in districts implementing IMCI was similar to or lower than those in comparison districts. - Introduction of IMCI led to improvements in child health that did not occur at the expense of equity. - Changes in the programmatic delivery strategy of vitamin A supplementation improved coverage in Tanzania and has been sustained for more than three years. - Delivery of high dose of vitamin A supplementation in mothers and children less than six months of age was well tolerated, but did not confer any important absolute effect on morbidity. Experience gained from the studies documented in this work can contribute to the body of knowledge on the estimation of causes of death, inform future evaluations, and help to shape child health policy in Tanzania and other similar settings. The need for robust, representative routine demographic and health statistics is critical for the monitoring and evaluation of health interventions and systems. The model recently proposed by the Health Metrics Network provides this opportunity for more countries. Investing in the strengthening of health systems, including health information sub-systems such as sentinel surveillance, is necessary if strategies like IMCI are to be prioritized and implemented effectively. IMCI implementation was successful in Tanzania because of the strong health system support that existed. Although results from the DHS 2004 and from sentinel surveillance indicate dramatic improvements, overall, infant and under five mortality rates are still unacceptably high. Achieving the Millennium Development Goal of reducing the 1990 level of child mortality by two-thirds by 2015 will require infensified efforts and new interventions to prevent deaths from major killers of children in Tanzania which include malaria, pneumonia, diarrhoea, under nutrition and perinatal causes. Wider and more equitable coverage is required, especially for the districts that are still lagging behind in the implementation. This thesis shows that important progress can be made with a practical mix of population based evidence used in a health systems approach

Causes and Risk Factors for Maternal Mortality in Rural Tanzania - Case of Rufiji Health and Demographic Surveillance Site (HDSS)

Complications of childbirth and pregnancy are leading causes of death among women of reproductive age. Developing countries account for 99% of maternal deaths. The aim of this study was to explore levels, causes and risk factors associated with maternal mortality in rural Tanzania. Longitudinal data (2002-2006) from Rufiji HDSS was used where a total of 26 427 women aged 15-49 years were included in the study; 64 died and there were 15 548 live births. Cox proportional hazards regression was used to assess the risk factors associated with maternal deaths. MMR was 412 per 100 000 live births. The main causes of death were haemorrhage (28%), eclampsia (19%) and puerperal sepsis (8%). An increased risk of 154% for maternal death was found for women aged 30-39 versus 15-19 years (HR=2.54, 95% CI=1.001-6.445). Married women had a protective effect of 62% over unmarried ones (HR=0.38, 95% CI=0.176-0.839). (Afr J Reprod Health 2013; 17[3]: 119-130).\u

Rural-urban residence, modernism and fertility: a study of Mwanza region, Tanzania

The aim of this study is to assess the effect of rural-urban residence and modernization on fertility preference among urban female migrants versus rural female non-migrants. The specific objective is to assess the impact of the amount and timing of urban residential experience on six dimensions of modernism in attitudes and behaviour. A sample of 397 women of the reproductive age living in Mwanza region was interviewed in 2012. Data were collected using structured questionnaires and focus group discussions. Data analysis technique employed was multivariate using SPSS version 16.0 and ethnograph softwares for quantitative and qualitative data respectively.  Results show that scores on modernism indices were consistently higher for women with urban residential experience. Women who migrated from villages to the city reported attitudes and behaviours more modern than women with no urban residential experience. The study concludes that the change from traditional to modern values, norms and behaviours among female migrants came from gaining an urban experience. Thus recommending that women’s migration empowerment is crucial to fertility regulation in Tanzania