Mortality and Migration in Rural and Urban Africa: An Analysis of Health and Demographic Surveillance Systems

Philippe Bocquier, University of the Witwatersrand
Mark Collinson, University of the Witwatersrand

In analysing HDSS, migration can rarely be hypothesised to be independent from mortality. Some studies point at a selection effect of the healthy as well as health-motivated return migration. This paper addresses some of the gaps in previous studies by examining the migration-mortality relation in two sites representing a rural origin area (Agincourt HDSS) and an urban destination are (Nairobi slums HDSS), both evolving in a context of increasing AIDS mortality. In origin areas return migration increase mortality level by one third, confirming the ‘returning home to die’ hypothesis. In destination areas, out-migration is associated with lower mortality in the area, but not necessarily elsewhere as migrants ‘return to die’. Had the migrants stayed, they would probably have had the same high mortality experienced by the stayers, as a consequence of poor conditions such as in the slums. Health policies should account for the circular nature of the migration system.