The Agincourt demographic and health study - Site description, baseline findings and implications

Objectives. To present baseline results from first-phase demographic and su rveillance in the Agincourt field site, Bushbuckridge. To contrast findings with international data, and comment on their relevance to health developm ent. Design. Multi-round, prospective community-based study. Baseline census, 19 92. Setting. A subdistrict in South Africa's rural north-east, adjacent to the border with Mozambique. Subjects. Entire population of Agincourt subdistrict. Outcome measures. Baseline variables for each resident included age, sex, m onths spent at home during 1991, mother alive/dead, highest educational sta ndard achieved, and refugee status. A full demographic profile was construc ted. Results. In 1992 the subdistrict contained 57 609 persons, 26.4% of whom we re Mozambican, with a population density of 148 persons per km(2). Forty-fo ur per cent were under 15 years of age, and the dependency ratio was 93%. F ertility was declining, along with a moderate decline in adult female morta lity. The approximate total fertility rate was 4,0; teenage parenting was c ommon and almost 40% of 19-year-olds had at least one child. Over 60% of me n and 14% of women in the 30-49-year age group were migrants, resulting in a high proportion of single-parent households. Despite improvements, most c hildren experienced delays in reaching primary school, and less than half m ade the transition to secondary school. Educational levels among Mozambican children were lower than those of local children. Conclusions. Agincourt contains a complex mix of communities comprising mig rant workers, Mozambicans and a more stable permanent population. The area shares features with sub-Saharan Africa, although the mortality and fertili ty transitions have progressed further Reliable, local information is essen tial for managing decentralised health systems.