I was born in Kenya and mostly lived in East Africa - Tanzania and Kenya - until I was almost sixteen. Consequently I identify as American and African, and I have oriented the bulk of my career toward research on topics that are important to Africa. Starting in graduate school I have worked continuously until now on a variety of epidemiology and demography studies in or related to Africa.
There are a number of themes that run through these studies: HIV, the epidemographic transition, effects of household composition on mortality, orphan mortality, and cause of death. Those without their own pages are described briefly below.
The HIV epidemic in Africa has killed millions of people and severely affected the lives of millions more. Because HIV is a sexually transmitted infection, it interacts with or affects both mortality and fertility, and consequently, population dynamics and age structure. Likewise, interventions that disrupt HIV transmission - e.g. condoms - also affect fertility and population dynamics. In my PhD I built a stochastic microsimulation model of an HIV epidemic in a population with realistic demography to understand how the epidemiology and demography of HIV interact. Following that I was co-PI of an HIV behavior and seroprevalence study at the Agincourt health and demographic surveillance (HDSS) site in South Africa and participated in a number of studies of the effects of HIV. An example is a study of circular labor migration during the HIV epidemic in South Africa; results are consistent with the idea that terminally ill migrant workers returned to their home villages to die.
- Returning home to die: Circular labour migration and mortality in South Africa
- Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study
- Prevalence of HIV among those 15 and older in rural South Africa
- Ubiquitous burden: the contribution of migration to AIDS and Tuberculosis mortality in rural South Africa
- Cardiometabolic disease risk and HIV status in rural South Africa: establishing a baseline
- Trends in the burden of HIV mortality after roll-out of antiretroviral therapy in KwaZulu-Natal, South Africa: an observational community cohort study
- Tuberculosis mortality and the male survival deficit in rural South Africa: An observational community cohort study
- Sexual behavior and HIV risk across the life course in rural South Africa: trends and comparisons
- HIV Incidence Among Older Adults in a Rural South African Setting: 2010–2015
- Clusters of HIV Risk and Protective Sexual Behaviors in Agincourt, Rural South Africa: Findings from the Ha Nakekela Population-Based Study of Ages 15 and Older
The classic large change phases of both the epidemiological and demographic transitions are still underway in Africa. HIV has created a unique disruption in the traditional epidemiological transition, and fertility remains high and is falling more slowly than it did in many other world regions. There is a complex interaction between these things, and together with a number of colleagues - mostly Chodziwadziwa Kabudula and Brian Houle - I have done a number of studies investigating aspects of these intertwined transitions.
- The Unfolding Counter-Transition in Rural South Africa: Mortality and Cause of Death, 1994–2009
- Migration and the epidemiological transition: insights from the Agincourt sub-district of northeast South Africa
- Social patterns and differentials in the fertility transition in the context of HIV/ AIDS: evidence from population surveillance, rural South Africa, 1993 – 2013
- The Evolving Demographic and Health Transition in Four Low- and Middle-Income Countries: Evidence from Four Sites in the INDEPTH Network of Longitudinal Health and Demographic Surveillance Systems
- Male and female sterility in Zambia
- Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993–2013
- Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis
Effects of Household Composition on Mortality
Household composition - how many people of each type live with you - can affect survival, especially for young children. Health and demographic surveillance systems accumulate detailed information on who is living with who through time, and that data allows unusual, detailed investigations of the effects of household composition on mortality. Again mainly with colleagues Chodziwadziwa Kabudula and Brian Houle, I have contributed to a number of studies of this kind. Perhaps the most consequential is on orphan mortality, described on its own page.
- Childhood mortality among former Mozambican refugees and their hosts in rural South Africa
- Child Mobility, Maternal Status, and Household Composition in Rural South Africa
- Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status
- Assessing Changes in Household Socioeconomic Status in Rural South Africa, 2001–2013: A Distributional Analysis Using Household Asset Indicators