Ubiquitous burden: contribution of migration to AIDS/TB mortality in rural South Africa. A population-based surveillance study

In South Africa, many circular migrants return to their places of origin when ill. To estimate the contribution the internal migrants have made to excess mortality in a rural sub-district population, we computed AIDS and TB cause-deleted life expectancy and crude death rates by gender and migration status between 1994 and 2006. The annualised crude death rate almost tripled from 5∙39 to 15∙10 per 1000 over the years 1994-2006. This reduced life expectancy from 67∙7 to 47∙0 years. AIDS and TB in returning migrants contributed to 44∙4% of the overall loss in life expectancy with a notable disparity by gender: 62∙3% for males and 34∙2% for females. The contribution of AIDS and TB in returned migrants to the increase in crude death rate was 78∙7% for males and 44∙4% for females. In a typical South African setting dependent on labour migration for rural livelihoods, the contribution of returned migrants, many infected with AIDS and TB, to the burden of disease is high. Returned male migrants are more affected by AIDS and TB than female migrants and non-migrant males and females. Care and referral systems must bridge long distances and span different settlement types to maintain continuity of health care.