The Links between Legal Status and Environmental Health: A Case Study of Mozambican Refugees and Their Hosts in the Mpumalanga (Eastern Transvaal) Lowveld, South Africa

Dolan, Christopher G.; Tollman, Stephen; Nkuna, Vusimuzi Goodman; Gear, J. H. S.

doi:10.2307/4065272

Cited by 12 publications

(9 citation statements)

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“…Though the situation is changing, people in these villages have lived with limited legal recognition without fully being integrated into South African society. The villages have poor dwellings and infrastructure and are worse off than mainly South African villages with respect to basic services including water, sanitation, electricity and health facilities [44,45]. Other researchers in the study area have also found poorer health outcomes in children living in former Mozambican households [46].…”

Section: Discussionmentioning

confidence: 99%

Nutritional status and HIV in rural South African children

et al. 2011

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BackgroundAchieving the Millennium Development Goals that aim to reduce malnutrition and child mortality depends in part on the ability of governments/policymakers to address nutritional status of children in general and those infected or affected by HIV/AIDS in particular. This study describes HIV prevalence in children, patterns of malnutrition by HIV status and determinants of nutritional status.MethodsThe study involved 671 children aged 12-59 months living in the Agincourt sub-district, rural South Africa in 2007. Anthropometric measurements were taken and HIV testing with disclosure was done using two rapid tests. Z-scores were generated using WHO 2006 standards as indicators of nutritional status. Linear and logistic regression analyses were conducted to establish the determinants of child nutritonal status.ResultsPrevalence of malnutrition, particularly stunting (18%), was high in the overall sample of children. HIV prevalence in this age group was 4.4% (95% CI: 2.79 to 5.97). HIV positive children had significantly poorer nutritional outcomes than their HIV negative counterparts. Besides HIV status, other significant determinants of nutritional outcomes included age of the child, birth weight, maternal age, age of household head, and area of residence.ConclusionsThis study documents poor nutritional status among children aged 12-59 months in rural South Africa. HIV is an independent modifiable risk factor for poor nutritional outcomes and makes a significant contribution to nutritional outcomes at the individual level. Early paediatric HIV testing of exposed or at risk children, followed by appropriate health care for infected children, may improve their nutritional status and survival.

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Section: Discussionmentioning

confidence: 99%

Nutritional status and HIV in rural South African children

et al. 2011

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“…Despite voluntary repatriation programmes following a formal peace agreement in 1992, it was estimated that by 2000 that more than 200,000 former Mozambican refugees were still living in the province (Johnston, 2000). They have remained a poorer and more vulnerable group, living in isolated villages with less or weaker infrastructure, poor access to water and sanitation, generally further away from health facilities and labour markets, with limited legal rights and experience barriers to accessing social grants, education and health services (Dolan et al, 1997, Hargreaves et al, 2004; Kahn, 2008). Hargreaves and colleagues (2004) have demonstrated higher mortality rates among children from Mozambican-headed households when compared to South African-headed households; lack of legal status and poorer SES of many former Mozambican refugees partly explains this disparity.…”

Section: Discussionmentioning

confidence: 99%

Survived infancy but still vulnerable: spatial-temporal trends and risk factors for child mortality in the Agincourt rural sub-district, South Africa, 1992-2007

et al. 2011

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Abstract.Targeting of health interventions to poor children at highest risk of mortality are promising approaches for enhancing equity. Methods have emerged to accurately quantify excess risk and identify space-time disparities. This provides useful and detailed information for guiding policy. A spatio-temporal analysis was performed to identify risk factors associated with child (1-4 years) mortality in the Agincourt sub-district, South Africa, to assess temporal changes in child mortality patterns within the study site between 1992 and 2007, and to produce all-cause and cause-specific mortality maps to identify high risk areas. Demographic, maternal, paternal and fertility-related factors, household mortality experience, distance to health care facility and socio-economic status were among the examined risk factors. The analysis was carried out by fitting a Bayesian discrete time Bernoulli survival geostatistical model using Markov chain Monte Carlo simulation. Bayesian kriging was used to produce mortality risk maps. Significant temporal increase in child mortality was observed due to the HIV epidemic. A distinct spatial risk pattern was observed with higher risk areas being concentrated in poorer settlements on the eastern part of the study area, largely inhabited by former Mozambican refugees. The major risk factors for childhood mortality, following multivariate adjustment, were mother's death (especially when due to HIV and tuberculosis), greater number of children under 5 years living in the same household and winter season. This study demonstrates the use of Bayesian geostatistical models for accurately quantifying risk factors and producing maps of child mortality risk in a health and demographic surveillance system. According to the space-time analysis, the southeast and upper central regions of the site appear to have the highest mortality risk. The results inform policies to address health inequalities in the Agincourt sub-district and to improve access to health services. Targeted efforts to prevent vertical transmission of HIV in specific settings need to be undertaken as well as ensuring the survival of the mother and father in childhood.

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“…Our results show that there was a persistent (constant) wealth (SEP) gap between former refugee and South African households despite the fact that former refugee households had slightly higher asset accumulation rates in terms of the number of assets (Table ). In this respect, the refugees arrived with very few assets (Dolan et al ., ; Rodgers, ) and were unable to close the wealth gap because their asset accumulation rate was influenced by lower return strategies levied off a lower initial asset base. The long‐term effect of a low initial asset status (Barrett, ), therefore, continues to affect their asset accumulation rate despite having arrived over 20 years ago (Schatz, ; Collinson, ).…”

Section: Discussionmentioning

confidence: 99%

Rural Poverty Dynamics and Refugee Communities in South Africa: A Spatial–Temporal Model

Sartorius

Tollman

et al. 2011

Population Space and Place

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The assimilation of refugees into their host community economic structures is often problematic. The paper investigates the ability of refugees in rural South Africa to accumulate assets over time relative to their host community. Bayesian spatial–temporal modelling was employed to analyse a longitudinal database that indicated that the asset accumulation rate of former Mozambican refugee households was similar to their host community; however, they were unable to close the wealth gap. A series of geo-statistical wealth maps illustrate that there is a spatial element to the higher levels of absolute poverty in the former refugee villages. The primary reason for this is their physical location in drier conditions that are established further away from facilities and infrastructure. Neighbouring South African villages in close proximity, however, display lower levels of absolute poverty, suggesting that the spatial location of the refugees only partially explains their disadvantaged situation. In this regard, the results indicate that the wealth of former refugee households continues to be more compromised by higher mortality levels, poorer education, and less access to high-return employment opportunities. The long-term impact of low initial asset status appears to be perpetuated in this instance by difficulties in obtaining legal status in order to access state pensions, facilities, and opportunities. The usefulness of the results is that they can be used to sharpen the targeting of differentiated policy in a given geographical area for refugee communities in rural Africa. Copyright © 2011 John Wiley & Sons, Ltd.

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The Links between Legal Status and Environmental Health: A Case Study of Mozambican Refugees and Their Hosts in the Mpumalanga (Eastern Transvaal) Lowveld, South Africa

Cited by 12 publications

References 4 publications

Nutritional status and HIV in rural South African children

Nutritional status and HIV in rural South African children

Survived infancy but still vulnerable: spatial-temporal trends and risk factors for child mortality in the Agincourt rural sub-district, South Africa, 1992-2007

Rural Poverty Dynamics and Refugee Communities in South Africa: A Spatial–Temporal Model

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