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The life and labour of 'illegal' and deportable people: undocumented Zimbabwean migrants living and working in Witbank, South Africa
(2019-03) Machinya, Johannes
This study is based on ethnographic research among undocumented Zimbabwean migrants living and working in Witbank, South Africa. It explores and analyses the existential and juridical condition of migrant 'illegality' by examining how state enforcement of immigration laws helps to constitute a pervasive sense of 'illegality' and deportability, which is the state of living with deportation as a ubiquitous possibility for undocumented migrants, even if not actually effected. Migrant 'illegality' is produced at the intersection of state efforts to make migration flows legible or readable to the state and migrants' attempts to deal with the state's ability to control migration flows, which highlights the dialectical relation in and adds nuance to the theorisation of the production of migrant 'illegality' and deportability. Deportability inundates undocumented migrants' lives with anxiety and uncertainty over the indeterminacy of the materialisation of actual arrest and deportation. This is markedly characterised by undocumented migrants' inability to determine with certainty what might (or might not) happen to them in their encounters with the regime of immigration law enforcement, whether they would be arrested and deported, or not. This indeterminacy and uncertainty speak to the temporal irregularity that emerges from the unpredictability of arrest and deportation. The threat of deportation registers a vivid awareness among undocumented migrants that one day they will get deported and this translates into a hideous form of anticipatory anxiety over the possibility of something happening without needing it to happen -deportation. I argue that living fearfully anticipating, although without hankering for, the materialisation of actual deportation provides a pervasive sense of 'waiting' for eventual deportation. By underlining the anxieties and uncertainties that emanate from the possibility of deportation, I show how the awareness of being 'illegal' and deportable shapes the everyday lives and work experiences of undocumented migrants. I argue that migrant 'illegality' as well as the threat and fear of deportation are powerful determining conditions that write themselves enduringly into the fabric of undocumented migrants' everyday lives and significantly alter the pattern of their everyday existence and work experiences. This thesis thus also focuses on the sociotemporal implications of living and working under the constant threat and expectation of deportation, which reminds undocumented migrants that their time in South Africa is ephemeral and indefinitely terminable; and this fear infiltrates and shapes undocumented migrants' everyday lives and work experiences. The thesis further looks at undocumented migrants' responses to the challenges that emanate from being 'illegal' and deportable in the face of such adversity. I demonstrate how the responses oscillate between visibility, and therefore engaging directly with state officials on the one hand, and social non-visibility or undetectability on the other, with migrants avoiding interactions with state officials who possess powers to arrest and deport those migrants who are in violation of the country's immigration law.
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Association of alcohol use and multimorbidity among adults aged 40 years and above in rural South Africa
(2023-05-14) MafunoG. Mpinganjira; Tobias Chirwa; Chodziwadziwa.W. Kabudula; Francesc XavierGómez‑Olivé; StephenTollman3; Joel Msafri Francis1
We assessed the prevalence of reported alcohol use and its association with multimorbidity among adults aged 40 years and above in a rural, transitioning South African setting. Findings could potentially inform alcohol interventions integration in the prevention and treatment of chronic conditions. We analysed data from the frst wave of The Health and Ageing in Africa—a longitudinal Study in an INDEPTH community (HAALSI) nested within the Agincourt Health and Demographic Surveillance Systems, conducted between November 2014 and November 2015 (n= 5059). We computed descriptive statistics and performed univariate analysis to determine factors independently associated with multimorbidity. Age, Body Mass Index, education, sex, and household wealth status and variables with a p-value < 0.20 in univariate analysis were included in multivariable Modifed Poisson regression models. Any factors with a p-value of < 0.05 in the fnal models were considered statistically signifcant. The frst wave of HAALSI was completed by 5059 participants aged 40 years and above and included 2714 (53.6%) females. The prevalence of reported ever alcohol use was 44.6% (n= 2253) and of these 51.9% (n= 1171) reported alcohol use in the last 30 days. The prevalence of HIV multimorbidity was 59.6% (3014/5059) and for multimorbidity without HIV 52.5% (2657/5059). Alcohol use was associated with HIV multimorbidity among all participants (RR: 1.05, 95% CI: 1.02– 1.08), and separately for males (RR: 1.05, 95% CI: 1.00–1.10) and females (RR: 1.06, 95%CI: 1.02– 1.11). Similarly, alcohol use was associated with multimorbidity without HIV among all participants (RR: 1.05, 95% CI: 1.02–1.09), and separately for males (RR: 1.06, 95% CI: 1.00–1.12) and females (RR: 1.06, 95% CI: 1.01–1.11). Reported alcohol use was common and associated with HIV multimorbidity and multimorbidity without HIV among older adults in rural northeast South Africa. There is a need to integrate Screening, Brief Interventions, and Referral for alcohol Treatment in the existing prevention and treatment of multimorbidity in South Africa.
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The economic burden of RSV-associated illness in children aged < 5 years, South Africa 2011–2016.
(2022-06-21) Jocelyn Moyes; Stefano Tempia; Sibongile Walaza; Meredith L. McMorrow3; Florette Treurnicht4 Nicole Wolter; Anne von Gottberg; Kathleen Kahn6; Adam L Cohen; Halima Dawood; Ebrahim Variava; Cheryl Cohen
Introduction Data on the economic burden of RSV-associated illness will inform decisions on the programmatic implementation of maternal vaccines and monoclonal antibodies. We estimated these costs in fine age bands to allow more accurate cost-effectiveness models to account for limited duration of protection conferred by short or long acting interventions. Methods We conducted a costing study at sentinel sites across South Africa to estimate out-of-pocket and indirect costs for RSV-associated mild and severe illness. We collected facility-specific costs for staffing, equipment, services, diagnostic tests and treatment. Using case-based data we calculated a patient day equivalent (PDE) for RSV-associated hospitalisations or clinic visits; the PDE was multiplied by the number of days of care to provide a case-cost to the healthcare system. We estimated the costs in 3-month age intervals in children aged <1 years and as a single group for children aged 1-4 years. We then applied our data to a modified version of the World Health Organization tool for estimating mean annual national cost burden, including medically and non-medically attended RSV-associated illness. Results The estimated mean annual cost of RSV-associated Illness in children aged <5 years was United States dollars ($)137 204 393, of which 81% ($111 742 713) were healthcare system incurred, 6% ($8 881 612) were out of pocket expenses and 13% ($28 225 801) were indirect costs. Thirty-three percent ($45 652 677/$137 204 393) of the total cost in children aged <5 years was in the <3-month age group, of which 52% ($71 654 002) were healthcare system incurred. The costs of non-medically attended cases increased with age from $3 307 218 in the <3-month age group to $8 603 377 in the 9-11-month age group. Conclusion Among children <5 years of age with RSV in South Africa, the highest cost burden was in young infants; therefore, interventions against RSV targeting this age group are important to reduce the health and cost burden of RSV-associated illness.
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The attributable fraction of respiratory syncytial virus among patients of different age with influenza-like illness and severe acute respiratory illness in a high HIV prevalence setting, South Africa, 2012-2016 Running title: The attributable fraction of RSV in South Africa (all ages), South Africa 2012- 2016
(2022-11-22) Jocelyn Moyes; Stefano Tempia; Sibongile Walaza; Meredith L. McMorrow; Adam L. Cohen; Florette Treurnicht; Orienka Hellferscee; Nicole Wolter; Anne Von Gottberg; Halima Dawood; Ebrahim Variava; Kathleen Kahn; Shabir A. Madhi; Cheryl Cohen
Introduction The detection of respiratory syncytial virus (RSV) in upper airway samples does not necessarily infer causality of illness. Calculating the attributable fraction (AF) of RSV in clinical syndromes could refine disease burden estimates. Methods Using unconditional logistic regression models, we estimated the AF of RSV-associated influenza-like illness (ILI) and severe-acute respiratory illness (SARI) cases by comparing RSVdetection prevalence among ILI and SARI cases to those of healthy controls in South Africa, 2012-2016. The analysis, stratified by HIV serostatus, was conducted in the age categories <1, 1-4, 5-24, 25-44, 45-64, ≥65 years. Results We included 12,048 individuals: 2,687 controls, 5,449 ILI cases and 5,449 SARI cases. RSVAFs for ILI were significant in <1, 1-4, 5-24, 25-44-year age groups: 84.9%(95% confidence interval (CI) 69.3%-92.6%), 74.6%(95%CI 53.6%-86.0%), 60.8%(95%CI 21.4%-80.5%) and 64.1%(95%CI 14.9%-84.9%), respectively. Similarly, significant RSV-AFs for SARI were 95.3%(95%CI 91.1%-97.5) and 83.4%(95%CI 70.9-90.5) in the <1 and 1-4-year age groups respectively. In HIV-infected persons, RSV was significantly associated with ILI cases versus controls in individuals aged 5-44 years. Conclusion High RSV-AFs in young children confirm RSV detection is associated severe respiratory illness in South African children, specifically infants. These estimates will assist with refining burden estimates and cost effectiveness models
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Incidence and Transmission Dynamics of Bordetella pertussis Infection in Rural and Urban Communities, South Africa, 2016‒2018
(2023-02-02) Fahima Moosa; Stefano Tempia; Jackie Kleynhans; Meredith McMorrow; Jocelyn Moyes; Mignon du Plessis; Maimuna Carrim; Florette K. Treurnicht; Orienka Helfersee; Thulisa Mkhencele; Azwifarwi Mathunjwa; Neil A. Martinson; Kathleen Kahn; Limakatso Lebina; Floidy Wafawanaka; Cheryl Cohen; Anne von Gottberg; Nicole Wolter
We conducted 3 prospective cohort studies (2016–2018), enrolling persons from 2 communities in South Africa. Nasopharyngeal swab specimens were collected twice a week from participants. Factors associated with Bordetella pertussis incidence, episode duration, and household transmission were determined by using Poisson regression, Weibull accelerated time-failure, and logistic regression hierarchical models, respectively. Among 1,684 participants, 118 episodes of infection were detected in 107 participants (incidence 0.21, 95% CI 0.17–0.25 infections/100 person-weeks). Children <5 years of age who had incomplete vaccination were more likely to have pertussis infection. Episode duration was longer for participants who had higher bacterial loads. Transmission was more likely to occur from male index case-patients and persons who had >7 days infection duration. In both communities, there was high incidence of B. pertussis infection and most cases were colonized.