So there seems to be a contradiction here, or something that needs resolving, concerning this emotion. I just did it and I had a slower time for the incongruent arrows than for the congruent arrows. I think that that just about does it for me. I thought that this blog was more politics and science and less attack journalism.
The guest poster above as much as said that there is currently no proof behind the science that she is talking about. Its hypothetical right now. There is also only insinuation to suggest that there is a correlation between more open minded people and any specific political leanings. If two cross-sectional variables are significantly correlated i. It could be that A causes B, that B causes A, that they simultaneously cause each other, or that they are indirectly related, through some unobserved variable, but nonetheless causally.
So correlation does indeed imply causation. And so conservatives, it seems, do. There are more catalogued and labeled ideologies than these two, yes. You almost NEVER get the authoritarians joining with the pro-welfare, pro-public-support-of-the-arts people—not en masse at least. Which can only be validly linked to an intrinsically human characteristic if it can be shown to have occurred in post-materialist societies that have evolved separately, with little to no interaction with each other.
This may be true, but there is no evidence to suggest that specific policies are aligned to any individual way of thinking. The most militaristic societies on earth today are leftist governments. Reformers in China support free market reforms while conservatives want to slow any such reform down.
Holland and Scandinavia social liberalism and a big well-fare state is the status quo. The Jost et al. These authors have been criticized in the field for exhibiting bias in their sample selections for their earlier study. Other authors in the field have demonstrated that the majority of the modern U. Additionally, their arguments that authoritarianism is a conservative personality type absolutely misses the mark when you look at basic history.
Countries that support free market economics have fewer incidents of authoritarianism than countries that do not support free market economics. That empirically violates their argument. Considering all of the other totalitarian, resistant to change leftist regimes and the whole narrative of the authors falls apart. Now, this was essentially my point above.
A dynamic thinker will be much more likely to support free-market economics in China than would a static thinker. I true, dyed in the wool free market ideologue is more willing to embrace uncertainty and change than the most hide-bound social democrat. Fundamentally this is junk science because the test subjects numbering less than 50 are mostly college students which exclude vast bastions of lessor educated liberals or conservatives.
Drawing any conclusion about a larger population from a small highly exclusive population is harmful and says far more about the researchers publishing the study and their intentions than any conclusion about the subjects at hand. As someone who is socially liberal this study does little more than confirm liberal policies fail simply because liberals desire to drink their own Kool-Aid.
For example, current educational policy encourages parents to move to the best school districts they can afford resulting in massive poverty in poorly performing school districts. When does the emperor admit they have no clothes? A truly educated person easily admits when they have failed, goes back to the drawing board and looks at ways to fix their error. I am not aware of many psychologists questioning it. Second, the argument about conservatives and change makes perfect sense. This is not at all the same thing as the kind of change that progressives want.
Responding to first: Psychological motives and political orientation—The left, the right, and the rigid: Comment on Jost et al. Psychological Bulletin, Vol 3 , May , Also, even simply looking at the samples, Not one of the Jost et al. Not one was in Central Africa. South Africa is essentially governed by liberalism and western thought today. The only sample in the Middle East was in Israel. In essence, Israel is also a western country, but drifting away from Western thought. This survey was a sampling of ONLY western civilization and can not claim to the universality of conservative thought.
At most, the Jost paper may make an argument for the shape of conservatives in the West, which is essentially governed by liberalism in both its conservative and progressive thought. It does not make an effective argument for the universality of conservative psychology. The earlier Jost et al paper also claims that conservatives are more superstitious on balance, which it uses to support the argument that conservatives are more emotional, but gallup polling has long shown that with the exception of religiosity, conservatives are less superstitious on balance than self-described liberals.
The Jost paper ignores that fact to create its argument. Only the fact that Jost and Kruglanski are prolific writers has created the impression that this data is well backed up. That and the fact that an academy that discriminates against conservatives is unlikely to produce many papers which contradict any argument which puts conservatives in a bad light. Any rational study of political history teaches anyone who cares to look that authoritarianism is universal and egalitarian leftist regimes have been as authoritarian as hierarchical rightist regimes.
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As to the second: It still serves to undermine the argument conservatives are not change seeking. Over respondents, among whom were conservatives and liberals who were asked to rank the top criteria they seek in jobs. The top criteria for both leftist and rightists was interesting work, but the second criteria was potential for advancement for the right-wing respondents while it was higher pay for the left-wing respondents.
In this case, the right-wing were looking for greater opportunity for change advancement while the liberals were looking for greater stability. There is more complexity here that needs to be ferreted out. It may be a good argument, but right now it is shaded to make conservatives look bad. I am a liberal, not a conservative and not a progressive. I happen to agree with Republicans more today because they are more liberal than the Democrats in trying to protect economic freedoms and prevent government theft of property, but I also side more with the Democrats when the Republicans try to enforce some ridiculous morality on civil society.
No democracy can exist without a robust civil society, yet much leftist thought is based on homogenizing society to get rid of dissent. I can not abide that. Hence while interesting and perhaps merits further study this single result is of no value in itself. One interesting conclusion we can draw is that just as humans need to be both logical and emotional to peform best in life, we equally need both liberals and conservatives for different but important reasons in order for society to be at its best.
In short, too much stability and we stagnate; too much innovation and we disintegrate. This fits squarely with the conservative stereotype that liberals are arrogant. One could equally interpret the results to mean that conservatives are more compassionate and ethical since empathy is the central element in these valued-traits. In addition, conservatives would generally make better leaders since emotional self-awareness and empathy are central components in emotional intelligence.
Since the enlargement is on the right amygdala, conservatives are better able to control their emotions making them less prone to sophistry or demagoguery. This also enhances their ability to lead since they are better able to respond to changing circumstances without a purely visceral reaction. In other words, greater emotional self-management makes them more objective and principle-driven. As demonstrated in the paper I linked to regarding emotion regulation strategies as well as numerous other references I can provide you with at request , suppression is NOT an effective emotion regulation strategy; those individuals that engage in suppression rather than reappraisal, or intellectualizing strategies, are LESS effective at regulating emotions.
So your entire premise is false. This actually makes them LESS likely to use effective strategies of regulation in times of crisis. Many studies have shown an increase in regulation using reappraisal, and increased stress and less regulation help using suppression. The literature on this concept alone is very fascinating. I can make some recommendations if you want further reading on this. Conservatives are MORE likely to respond with a visceral reaction, not less that is mentioned in the direct quote from the research.
Regarding greater emotional self-management and being objective and principle-driven, you are right—those qualities would be valued in leaders. But those are traits of the liberal thinking style, not conservative. I think you might be projecting an expectation bias into your reading of the article. Let me know if there is anything else you have possibly misinterpreted, and I will try and clear that up as well.
First, there are too many cultural laden definitions at play. You cannot study the brains of conservatives if the label is fluid to begin with. Secondly, it is the liberal brain that gets to frame the study, and therefore the debate. This is an interesting intellectual exercise but drawing hard conclusions is really premature. The ability of the above readers to draw diametrically opposed conclusions is evidence of that. Unfortunately, you are fallaciously slanting the the idea of suppression of emotion. Suppression in this sense is not value-laden.
Suppression is simply keeping them in check, a purely adaptive function. You also assume that greater suppression means less appraisal. This does not follow. These functions work holistically in the brain. I hope, as a side note, you understand the ethical implications of your conclusions? It was rightly criticized just as yours is here. I can take the exact same data and draw a rational conclusion opposite of yours even if you disagree. If the research only muddies the water, conclusions based on the data are likely premature.
In the end this is just another way to dismiss a whole people-group as less intelligent or capable. I assume as a liberal you are repulsed by that too?
It is obvious you are trying to provoke me and are teetering on the edge of insulting my scientific integrity, and.. Sorry to spoil the fun. However, I did find a short, easy to read comprehensive look at the different types of emotion regulation strategies and their effectiveness, and providing the link for you. This review focuses on two commonly used strategies for down-regulating emotion. The first, reappraisal, comes early in the emotion-generative process. It consists of changing the way a situation is construed so as to decrease its emotional impact.
The second, suppression, comes later in the emotiongenerative process. It consists of inhibiting the outward signs of inner feelings. Experimental and individual-difference studies find reappraisal is often more effective than suppression. Reappraisal decreases emotion experience and behavioral expression, and has no impact on memory.
By contrast, suppression decreases behavioral expression, but fails to decrease emotion experience, and actually impairs memory. Suppression also increases physiological responding for suppressors and their social partners. This review concludes with a consideration of five important directions for future research on emotion regulation processes. Chris: You are absolutely right—there are definitely some conservative leadership skills that are valuable and effective.
I was merely pointing out to Dr Larry that he was misattributing the traits described in the article to the wrong cohort. I understand that this is science and there are no final answers, but why so much about why these findings are not conclusive? Obviously, this is a very exciting area, albeit a work in progress. I also hope we can finally begin to bring out into the open those ideas that we have learned from torturing millions of our chimp cousins and seeing how they mining the studies might help us out of the world mess we are in! So when a conservative receives an information stimulus that causes anger—e.
Chris 60 , you ask the most important question! My opinion is that you cannot judge a philosophy and that what conservatism is and its adherents based solely on the size of one portion of the brain any more than you can judge the intelligence of certain races or nationalities.
There was one study that showed that gay men had enlarged amygdala. Does this mean that gay men are conservative thinkers? Many conservatives I know are constantly suppressing their emotions because of their grief on seeing the destruction of a way of life, or holding back anger at being called stupid, racist, or uncaring—when none of these things are true empirically or anecdotally. Extraordinary claims require extraordinary evidence—neither these studies nor Andrea do this, especially when castigating so many.
Conservatives are stupid because they have slightly larger amygdala? Goes with what I have been saying for quite some time. Then, once something has become common, they embrace it and then act like they invented it.
We tried unfettered capitalism back in the day. It was a disaster. Imagine that. I enjoyed your post, but it is flawed by assuming the conclusion. You imply that people we consider stereotypical conservatives are emotional and anti-change, while those we consider liberal are logical and pro-change. None of these 3 stereotypes, change, logic need be correlated. We currently have affirmative action, social security, and a budget deficit.
These have been around for the lifetime of most people. But the people who want change—elimination of these things—are generally ones we would label conservative. And the liberals who are working hard to defend these ideas. Only problem I have with your reasoning is that you say liberal style of thinking is more in line with scientific thinking.
Another Discover magazine blogger Razib at GNXP recently wrote a few posts on how conservatives and republicans are more sceptical about astrology than liberals and democrats. This would be in line with conservative thinking being against change and liberal thinking leaning towards novelty. I have some issues with this article. For example, conservatives in America are ardently against federal programs like Social Security, even though the program has been around for as long as just about anyone alive in America can remember and its a tremendously stable system of consistency, that provides not only individual stability in old age, but stability to the entire American economy.
Free-market capitalist industrialization is radical, it is the driving force of radical social transformation. I think that some of those extrapolations generally derive from a lack of understanding that, in the US today, there is a large and growing gap between the actual definition of a sociopolitical term, and both its usage by politicians, and its assumed meaning by the average voter.
This is the same focus of the Meyers-Briggs and other personality tests: when we learn how others perceive the world and make decisions, we can at least deal with one another on the basis of that understanding, as opposed to blind opposition. Similarly, A can try to understand that B is thinking and speaking more generally, trying to take all factors into consideration equally. I think this is also far from being in any way judgmental, and actually, a highly useful tool for improving how we relate to, and work with, others. Kuszewski, Andrea, fantastic post!
I plan on sharing this! It was quite an interesting read. I completely agree with your final part of the post, that we must learn to communicate better. The observed earlier lower sensitivity among young adult females compared to males is related to earlier household change for females largely due to early onset of marriage.
There were no apparent sex differences in sensitivity values for children aged less than 5 years, as their movements are largely dependent on their parents or guardians. The longer the duration of follow-up, the greater the misclassification of contact status due to increased household dynamics. This shows that the likelihood for an actual earlier contact to go unrecognised can be great leading to high contact status misclassification. It is therefore important to appreciate that, when dealing with household contact-associated spread of diseases, such as leprosy and tuberculosis, much of the new disease observed during follow-up may well be attributable to unobserved earlier household contact.
The effect of household change may be reduced by conducting studies on infection transmission within households for shorter periods of follow-up and for only those areas where the household change rates are low, thus ensuring minimum contact status misclassification. However, where such conditions are not possible, estimations of misclassification values from this study are useful in obtaining reliable estimates of risk of disease associated with household contact in the same or similar population settings.
This study has shown the extent of household contact misclassification in a rural African setting in northern Malawi. The demographic trends and issues that drive mobility in various African countries are similar 39 — 45 and the findings are generally applicable regionally. However, availability of good quality data to derive parameters for modelling to generate reliable estimates of risk of disease is a challenge.
Currently, there is an increase in longitudinal studies, especially demographic surveillance sites 19 , 46 — 48 , where such data is increasingly available for use in more appropriate dynamic contact networks modelling. Appendices available online under Reading Tools. The authors have not received any funding or benefits from industry or elsewhere to conduct this study.
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Although there are significant numbers of people displaced by war in Africa, very little is known about long-term changes in the fertility of refugees. Refugees of the Mozambican civil war — settled in many neighbouring countries, including South Africa. The AHDSS data provide a unique opportunity to study changes in fertility over time and the role that the fertility of self-settled refugee populations plays in the overall fertility level of the host community, a highly relevant factor in many areas of sub-Saharan Africa.
To examine the change in fertility of former Mozambican self-settled refugees over a period of 16 years and to compare the overall fertility and fertility patterns of Mozambicans to host South Africans. Prospective data from the AHDSS on births from to were used to compare fertility trends and patterns and to examine socio-economic factors that may be associated with fertility change.
There has been a sharp decline in fertility in the Mozambican population and convergence in fertility patterns of Mozambican and local South African women. The convergence of fertility patterns coincides with a convergence in other socio-economic factors. The fertility of Mozambicans has decreased significantly and Mozambicans are adopting the childbearing patterns of South African women. The decline in Mozambican fertility has occurred alongside socio-economic gains.
There remains, however, high unemployment and endemic poverty in the area and fertility is not likely to decrease further without increased delivery of family planning to adolescents and increased education and job opportunities for women. Africa is home to about a fifth of the world's refugees, most of whom have been victims of forced migration 1. Most studies of migration and fertility in Africa have focussed on examining the impact of rural to urban migration on fertility or, less common, the impact of circular migration on fertility in rural populations 2 — 4.
War and resettlement can place both upward and downward pressure on fertility in the short term. Upward pressure may come from the desire to replace those lost in war, while downward pressure on fertility may come from the disruption of life and relationships caused by war 5. Studies of these effects over the short term find that many factors — including social characteristics of people prior to war — determine fertility levels in the short- and medium-term after war 5 , 6.
Biological factors such as sub-fecundity caused by malnutrition can also play a role in suppressing refugee fertility in the short term. Studies on forced migration and resettlement suggest that fertility of refugees in the long run is influenced by the same social and demographic factors that impact on fertility for everyone, such as education, age, socio-economic status, and urban or rural residence 5.
However, most studies on refugee fertility are conducted in refugee camps and the situation may differ for refugees not living in camps. Populations that settle in host countries without residing in camps are likely to be different from those in refugee camps since they are not served directly by aid programs.
Many studies of the fertility of self-settled refugees exist in developed countries with vital registration systems. However, studies of self-settled refugee populations in Africa where vital registration systems are lacking are rare. Prospective data from the Agincourt sub-district in Mpumalanga Province in rural northeast South Africa provide an opportunity to examine the change in fertility of self-settled Mozambican refugees over a period of 16 years — and to examine their impact on overall fertility levels in the area.
Earlier research using data from the Agincourt health and socio-demographic surveillance site AHDSS found that Mozambican refugees in Agincourt contributed to a noticeable increase in the average number of children borne total fertility rate — TFR by women in the s measured retrospectively through birth histories 7. Subsequently, the TFR for all of Agincourt has dropped from 3. This fertility decline is similar to that across rural South Africa during the same period 6 , 7. Fertility decline in South Africa generally is attributed in part to the widespread use of modern contraceptives.
A national family planning programme was started in in large part due to an ideological response by the apartheid regime to the spectre of rapid population growth among the African population. The programme provided free modern contraceptives in public health clinics, including oral and injectable contraceptives 6 , 7. The Demographic and Health Survey found that Despite the observed decrease in fertility in the AHDSS since the early s, little is known about the fertility of Mozambican women over time in Agincourt — if, when, and how fast their fertility decreased since the early s.
In this study, we examine changes in fertility levels and patterns over time through a comparative analysis between the two main population groups in Agincourt — South Africans and Mozambicans. We examine 1 TFRs, 2 age specific fertility rates ASFR , 3 timing of first and second births, and 4 trends in selected socio-economic characteristics likely to influence changes in fertility of Mozambican women in Agincourt. Most of the people, both South Africans and Mozambicans, in this area belong to the Shangaan Speaking. Agincourt itself is only about 40 km west of the southern Mozambique border. About a third of the population living in the area covered by the AHDSS are Mozambican, most having entered the country as refugees in the early to mids during the Mozambican civil war between and Despite voluntary repatriation programmes in , a large proportion of refugees elected to stay in the area.
Therefore, the AHDSS arguably contains the largest population of self-settled refugees under health and demographic surveillance in the world Our analysis is based on 21 villages covered by the AHDSS from — and uses data from women aged 15—49 who gave birth in Agincourt. Additional data on individuals and households are collected through special modules in the annual census update. The education of individuals is updated regularly and our analysis uses the highest level of education recorded for women.
Women's employment status was captured in , , and Household asset status has been measured every second year since and is used to create measures of household wealth. The standard method for estimating the age pattern of fertility technically referred to as ASFR and the level of fertility measured by the TFR are used to examine fertility trends. The latter is defined as the average number of children that a woman would have by the end of her reproductive life if the current age pattern of fertility were to remain unchanged.
Descriptive statistics are used to describe changes in the age pattern of fertility over time. A discrete time event framework is used to evaluate women's progression from a first to a second birth within five years and smoothed survival curves are presented. Other socio-economic trends are examined by estimating levels of employment, household wealth, and formal education. Figure 1 is based on prospective data beginning in which shows fertility declining significantly in both population groups in the early s.
Figure 1 also shows that Mozambican refugees had higher fertility rates than South Africans until late s, 20—29 years after their initial influx. Fertility levels were quite different in the two populations during the s, with Mozambican women maintaining higher fertility than South Africans. Thereafter, the two populations increasingly exhibit similar fertility levels, converging from when the confidence intervals around the fertility estimates for the two groups started overlapping.
Figure 1 also suggests a stall in the fertility decline of both populations since This corroborates research suggesting that fertility decline may have stalled in South Africa 6 , The convergence of total fertility of the two population groups is driven primarily by the decline in fertility among Mozambican women to the levels of South African women. This suggests that Mozambican women were adopting fertility behaviours similar to those of the host population. To test this hypothesis we compared age-specific fertility rates and the timing of first and second births between the two populations at the beginning and end of the observation period.
Figure 2 compares the age-specific fertility rates of Mozambican and South African women in and Panel A of Fig. In contrast, South Africans have fairly constant fertility rates across women aged 15—34 until they begin to fall and continue a downward trend at older ages. However, by , Panel B of Fig. The gap between the age-specific fertility rates of the two groups found in disappears due to significantly lower fertility rates for Mozambican women at ages 20— The age-specific fertility rates suggest similarly high levels of adolescent fertility for Mozambican and South African women.
Further analysis of the age distribution of first births for Mozambican women Table 1 shows increases in the proportion of first births to adolescents over time. This suggests that Mozambicans are following a pattern found in the area by previous research 16 of consistently high adolescent fertility despite a decline in overall fertility. Significance test for difference between Mozambican and South African. Table 1 also shows that more recently in the period —, Mozambican women have a statistically significant higher percentage of first births occurring to adolescents For that same period, the average age at first birth for Mozambican women is below 20 While adolescent fertility appears to be decreasing for South African women, it appears to be increasing for Mozambican women.
Further analysis also suggests lower contraceptive use by Mozambican women prior to their first birth. At the time of their first birth, Mozambican women consistently reported lower contraceptive use prior to conceiving than South African women. Five per cent of Mozambican women compared to 9.
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High adolescent fertility has been a source of concern in South Africa and so it is important to recognise the lower use of contraception before a first birth as well as the increase in the percentage of first births to adolescents for Mozambican women Previous research on the fertility of host South Africans has shown that fertility decline for African South Africans has been driven by significant widening of birth intervals explained primarily by increases in the use of modern contraception Wide birth intervals may also be a result of adolescent non-marital fertility followed by late marriage and low marital fertility Contraceptive use in Agincourt has been shown through qualitative research to be used primarily after the first birth to delay subsequent births 16 , 18 , In the early s, a majority of South African women in Agincourt delayed second births for more than five years, while a majority of Mozambican women did not.
Over time, however, the pattern of second births among Mozambican women has become similar to that of South African women. Panel B of Fig. Smoothed discrete survival function curves showing the percentage of women with no second births up to 5 years after a first birth in two time periods — and — by nationality. The changes in age-specific fertility rates, timing of first births and extended first birth intervals indicate that Mozambican women are achieving lower fertility by adopting patterns of childbearing typical for South African women in Agincourt.
Increases in education, labour force participation and income have been found to reduce fertility 20 — Historically, Mozambicans have been socially and economically disadvantaged in the Agincourt sub-district. However, over time their socio-economic status has improved and policy changes in enabled Mozambicans as permanent residents to access South African state resources such as child grants and old-age pensions This demonstrates the economic gains of Mozambicans and their convergence with South Africans over time.
Increased access to formal education likely contributed to the decrease in fertility for Mozambican women. The very high unemployment of both groups suggests limited formal economic opportunities for women, which might have contributed to the recently observed stall in fertility decline. Education and wealth indicators suggest that over the period of study Mozambican women's status improved and converged with that of South African women.
However, these gains are relatively modest and Mozambican women remain disadvantaged, particularly in relation to formal employment, within the relatively poor population of the rural setting. Approximately 20 years after the civil war in Mozambique, demographic characteristics of self-settled refugees of Mozambican origin in Agincourt are converging with those of their South African hosts. Both population groups now show similar fertility patterns, with a high proportion of first births in the 15—19 age range and delayed childbearing thereafter.
The findings of this study suggest adaptation of the Mozambican refugees in the AHDSS to the fertility patterns of their host community.
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Adaptation theory states that exposure to cultural norms and local costs of childbearing will lead migrants to change their fertility behaviour to converge with that of natives in the destination This appears to be the case, particularly through when the majority of the population of Mozambican women in Agincourt were former refugees. The fertility of more recent Mozambican migrants might additionally be suppressed due to the disruption caused by migration. The adaptation of Mozambican refugees to the lower fertility regime in South Africa has important implications for many areas of sub-Saharan Africa hosting refugee populations.
The adaptation of Mozambicans in South Africa is likely facilitated by a shared language and culture. Self-settled refugees are also probably more likely to be exposed to and adjust to the local norms of childbearing compared to refugees living in camps. Access to contraception through the South African health system is a key component of the decrease in fertility of Mozambicans.
Another important component is the improvement in socio-economic status partly attributable to access to education and host government social grants. Reducing the economic disadvantage of refugees and integrating refugees into local programmes and services encourages adaptation and can compensate for other factors that may otherwise increase the fertility of refugees such as poverty, lack of education, and lack of reproductive health services.
Integration encourages adaptation and will likely benefit host communities by lowering the fertility of refugees. Overall fertility decline in Agincourt over the past few decades has been driven primarily by the decline in fertility of Mozambican women.
South African women's total fertility declined primarily in the early s and has been wavering around 2. Fertility decline has also been minimal for Mozambican women since With fertility decline stalling in both groups it remains to be seen if fertility will go below replacement level 2. Further research is needed to determine the impact of factors such as infant mortality, changing marriage patterns, migration, and HIV on fertility in Agincourt and throughout South Africa. Findings presented here suggest a few areas of future intervention that would be helpful in settings such as Agincourt.
The pattern of childbearing in Agincourt shows that delaying first births could reduce overall fertility rates. Others have argued that family planning programmes in South Africa need to be reoriented to address the contraceptive needs of adolescents before first births Since contraception and family planning advice are provided largely by nurses working from primary health care facilities, strengthening the adolescentfriendly and responsiveness of clinic-based services is important. Programmes in Agincourt should pay special attention to Mozambican adolescents, whose reported contraceptive use is lower than that of South Africans.
Increasing contraceptive use before age 20 will lower adolescent fertility and overall fertility rates. Furthermore, if programmes can successfully increase condom use, they may have the added benefit of reducing HIV transmission. In other settings, increasing access to family planning and reproductive health programmes for all women has been shown to improve women's economic and health outcomes and to enhance economic growth However, the lingering effects of apartheid policies of differential development are evident in the low education and very high unemployment of women in Agincourt. Programmes that improve education and create job opportunities for all women, particularly Mozambican women, are needed to complement improvements in family planning and reproductive services in order to overcome endemic poverty in the area.
Efforts to improve reproductive health services and improve the socio-economic status of women are likely to be synergistic, with each encouraging lower fertility and economic growth. The primary limitations of our study are data driven. We do not have information on important variables such as prospective data on marriage, fertility desires, or detailed information on contraceptive use, to run models examining the proximate determinants of fertility.
We thank Christie Sennott and John B. Casterline for comments on earlier drafts. Mellon Foundation, USA. Since some Mozambicans have migrated voluntarily into the area and are included in the analysis with Mozambican refugees. However the percentage of in-migrants was minimal for the majority of the study period. By , A set of these household assets can be used to develop a wealth SEP index for each household The sum of these assets was used to create an absolute asset count for each household. This score was then used to define three socio-economic strata based on tercile cut-offs and categorised: more poor, poor, less poor Many thousands of Mozambicans entered South Africa as refugees during and after the civil war during the s and into the s.
Most who settled in the vicinity of Agincourt sub-district chose to remain and this was facilitated by common kinship and family ties. Today, a high proportion of these former Mozambican refugees are eligible for and have accessed South African ID documents and enjoy all the rights of South African citizenship. Their children, born in South Africa, are regarded as fully South African. There is a lack of reliable data in developing countries to inform policy and optimise resource allocation.
Health and socio-demographic surveillance sites HDSS have the potential to address this gap. Mortality levels and trends have previously been documented in rural South Africa. However, complex space—time clustering of mortality, determinants, and their impact has not been fully examined. To integrate advanced methods enhance the understanding of the dynamics of mortality in space—time, to identify mortality risk factors and population attributable impact, to relate disparities in risk factor distributions to spatial mortality risk, and thus, to improve policy planning and resource allocation.
Agincourt HDSS supplied data for the period — Multivariable Bayesian models were used to assess the effects of the most significant covariates on mortality. Disparities in risk factor profiles in identified hotspots were assessed. Increasing HIV-related mortality and a subsequent decrease possibly attributable to antiretroviral therapy introduction are evident in this rural population.
Distinct space—time clustering and variation even in a small geographic area of mortality were observed. Several known and novel risk factors were identified, and population impact was quantified.
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A complex interaction of highly attributable multilevel factors continues to demonstrate differential space—time influences on mortality risk especially for HIV. High-risk households and villages displayed differential risk factor profiles. This integrated approach could prove valuable to decision makers. Tailored interventions for specific child and adult high-risk mortality areas are needed, such as preventing vertical transmission, ensuring maternal survival, and improving water and sanitation infrastructure.
This framework can be applied in other settings within the region. This has had a substantial impact on mortality in the region. Reliable mortality data are a prerequisite for planning health interventions, yet such data are often not available or reliable in developing countries, including those in sub-Saharan Africa 3. In many instances, health and socio-demographic surveillance systems HDSS , though not representative at the national level, are often the only means to assess and more clearly understand population levels, trends, and determinants on a prospective basis 4 , 5.
Recent advances in data availability and analytic methods have created new opportunities to improve the analysis and modelling of diseases on a local, national, or regional basis 6 , 7. Spatial analysis and, for example, Bayesian geostatistical modelling are powerful and statistically robust tools for identifying high-mortality areas in a heterogeneous and imperfectly known environment and associated determinants 6 , 8. An increasing body of literature on spatial analysis of health outcomes in developing countries has been motivated by the availability of geo-referenced data and by the recent advances in methods and software that can implement such complex models 7 , 9.
The identification of geographical clusters of high-risk mortality is an important policy issue that has received limited attention, especially the ability to identify individuals, households, and villages at elevated risk. This study contributes to other literature that investigates mortality and its risk factors that are important from a public health perspective The study also provides guidance regarding the distribution of health services and other spatially-targeted interventions for disease control, mortality reduction, and resource allocation in rural South Africa and has application to broader sub-Saharan Africa.
Addressing health inequities in populations is a major challenge 11 , and research that documents and quantifies inequities is needed to inform policies to close health gaps in the developing world. Evidence on reducing inequities within countries is growing. Successful approaches include those that improve geographic access to health interventions in poor communities, subsidize health care and health inputs for the poor, and empower poorer communities This study aims to describe and develop a framework that captures the space—time dynamics and determinants of age-specific mortality in rural South Africa.
There was a baseline census in that collected data on all individuals and households in the population This has been followed by annual updates of births, deaths, and in- and out-migrations. It is a poor rural sub-district that includes former Mozambican refugees, temporary migrant workers, and a more stable permanent population The site at present covers an area of about km 2 and contains 25 villages, 13, households, and 84, individuals. There is a full geographic information system GIS , containing locations of all households within the site, which is updated annually.
A household is defined as a group of people who reside and eat together, plus the linked temporary migrants who would eat with them on return. A full VA is conducted on every death recorded during the annual census update and is administered to the closest caregiver of the deceased by a trained fieldworker Three medical practitioners assess VAs to determine likely cause of death.
The main cause of death was used in these analyses. Data from four new villages added to the site since were also not included in the analysis as they contributed minimal data to the study period. The dichotomous age-specific mortality outcomes were defined as follows:. Person time was defined as time in years contributed by an individual during the study period until right censoring 0 or death 1. The time to right censoring was set to either the date of permanent out-migration during the study period or as 31 December if the individual was present and alive.
Demographics gender, nationality , time period, season, maternal factors former refugee status, age at pregnancy, death of mother during their off-springs infancy or childhood, education and fertility factors parity, birth intervals, sibling death , household factors size mortality experience, household head demographics, socio-economic status based on household assets, food security , health seeking distance to nearest health facility, antenatal clinic attendance , migration patterns, and household elevation climatic proxy were included as explanatory variables.
Household socio-economic status SES was based on living conditions, assets and services including building materials of main dwelling, water and energy supply, ownership of modern appliances and livestock, and means of transport. These assets were used to construct an SES index using a multivariate statistical technique for categorical data, namely multiple correspondence analysis MCA A preliminary bivariate risk factor analysis was conducted to assess the relationship between mortality and each covariate.
Given the inherent spatial and temporal correlation of longitudinal HDSS data, problems arise when using standard statistical methods as they assume independence of outcome measures e. Objects in close proximity are often more alike, and common exposures measured or unmeasured may influence adult mortality similarly in households of the same geographical area, introducing spatial correlation in mortality outcomes. Including the spatial effect of proximity is important for an efficient estimation of parameters and prediction Ignoring this correlation introduces bias in the risk factor analysis as the standard error of the covariates is underestimated, thereby overestimating the significance of the risk factors.
Geostatistical models relax the assumption of independence and assume that spatial correlation is a function of distance between locations. They are highly parameterised models, and their full estimation has only become possible in the last decade by formulating them within a Bayesian framework 17 and estimating the parameters via Markov chain Monte Carlo MCMC simulation.
With the development of MCMC methods and software such as WinBUGS 18 , Bayesian approaches are being applied to the analysis of many social and health problems in addition to disease mapping and modelling or kriging Thus, Bayesian geostatistical multivariable models are needed to analyse longitudinal data in order to address these problems.
Different analytical dataset structures were used for the various age groups. This dictated the corresponding modelling approach to examine the multivariable association between the significant covariates and age-specific mortality. For infants, a negative binomial model selected due to over dispersion was used with an offset of time in days contributed in the first year given their higher risk earlier on. For children 1—4 years , a monthly discrete time logistic or event history approach was used to track any changes of selected covariates in the given intervals.
A monthly time interval was used as it was a better approximation of the risk than using a yearly interval. For the adult models, a continuous time to event or survival approach Weibull parametric model was adopted that split episodes of time for any relevant changes in selected covariates, for example, change of location or household.
For a detailed comparison of the strengths and weaknesses of each analytical approach, please see Appendix 1. Details of the infant and child statistical models and selected results have been published previously 20 , However, the infant results in this paper include important additional variables mother death due to HIV or non-HIV, breastfeeding not used previously. A spatial random effect at the village level was included to take account of spatial correlation and was modelled using a multivariate Gaussian distribution with a covariance matrix expressed as a parametric function of the distance between pairs of village centroids points Furthermore, an unstructured household-level random effect was included to take into account repeated household observations where time episodes were split to incorporate any time varying issues such as change of household physical location.
MCMC simulation 22 was employed to estimate the model parameters. Detailed formulation of the models as well as the WinBUGS codes to implement each can be found in Appendices 2 and 3 , respectively. The deviance information criterion DIC was used to assess the various Bayesian multivariable models The Kulldorff spatial scan statistic 24 was used to identify significant spatial clustering of mortality.
Simulation-based Bayesian Poisson kriging 25 was also used to produce smoothed maps of all-cause mortality risk within the whole HDSS area. All-cause and cause-specific baseline models used included a constant and spatial random effect only. All identifying features such as village centroids, boundaries have been removed from the maps to ensure confidentiality and avoid stigmatisation of potentially high-risk villages.
The HIV and tuberculosis mortality risk map is also not shown for the abovementioned reason. Model spatial estimates were exponentiated to give relative risk RR. Risk maps were developed using a heat scale of the location specific RR prediction. Darker areas reflect increasingly higher RR, while increasingly lighter areas indicate lowering RR. A simple map showing potentially high-risk areas as a function of straight-line distance to nearest health facility was constructed using a circular buffer zone around health facilities based on significant cut-off found in the risk factor analysis.
Risk maps were constructed in MapInfo Professional version 9. The demographic and mortality profile of the study samples are provided in Table 1. Overall 9, deaths occurred during —, based on 1,, person-year time contributed, at an overall crude mortality rate of 8. The highest mortality rates occurred among infants followed by the older adult 50—64 years age group 29 and 19 per 1, person-years, respectively. The mortality rate among children and younger adults 15—49 years was similar at 5. Among infants deaths occurred during the perinatal 1 period and in the neonatal 2 period, that is, the majority occurred in the perinatal or early neonatal phase.
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