Returning home to die or leaving home to seek health care? Location of death of urban and rural residents in Burkina Faso and Senegal

Abstract

Background: In sub-Saharan Africa, the literature on end of life is limited and focuses on place of death as an indicator of access and utilization of health-care resources. Little is known about population mobility at the end of life. Objective: To document the magnitude, motivations and associated factors of short-term mobility before death among adults over 15 years of age in Burkina Faso and Senegal. Methods: The study was based on deaths of adult residents reported in three Health and Demographic Surveillance System (HDSS) sites in urban (Ouagadougou) and semi-rural areas (Kaya) of Burkina Faso, and rural areas of Senegal (Mlomp). After excluding deaths from external causes, the analysis covered, respectively, 536 and 695 deaths recorded during the period 2012–2015 in Ouagadougou and Kaya. The period was extended to 2000–2015 in Mlomp, with a sample of 708 deaths. Binary logistic regressions were used to examine the effects of socio-demographic characteristics on place of death (health facility or not) and location of death (within or outside the HDSS). Results: In Mlomp, Kaya and Ouagadougou, respectively 20.6%, 5.3% and 5.9% of adults died outside the HDSS site. In Mlomp and Kaya, these deaths were more likely to occur in a health facility than deaths that occurred within the site. The reverse situation was found in Ouagadougou. Age is the strongest determinant of mobility before death in Mlomp and Kaya. In Mlomp, young adults (15–39) were 10 times more likely to die outside the site than adults in the 60–79 age group. In Ouagadougou, non-natives were three times more likely to die outside the city than natives. Conclusions: At the end of life, some rural residents move to urban areas for medical treatment while some urban dwellers return to their village for supportive care. These movements of dying individuals may affect the estimation of urban/rural mortality differentials.

Long-term trends in seasonality of mortality in urban Madagascar: the role of the epidemiological transition

“…Conversely, some residents of Antananarivo may have died outside the city while migratingincluding those seeking supportive care in their home community. Recent research in Burkina Faso suggests migrations out of Ouagadougou from terminally ill adults were more likely when deaths were due to non-communicable diseases, compared to communicable diseases [44]. They may have more time to travel than those affected by acute diseases or diseases requiring intensive care.…”

Migrant health penalty: evidence of higher mortality risk among internal migrants in sub-Saharan Africa

“…Migrants are generally selected in their place of origin as being healthier [ 10 , 11 ], although this ‘healthy migrant’ effect has not been observed among children [ 12 ]. Conversely, ‘return’ migrants have been observed as less healthy compared to origin populations, often moving back home in older ages to seek palliative care since they face difficulties in accessing health services in their migration destinations [ 13 , 14 ]. This generates an unhealthy return migrant effect (also referred to as ‘salmon bias’) which leaves healthier migrants at destinations [ 7 ].…”

The Patterns of Disability in the Peripheral Neighborhoods of Ouagadougou, Burkina Faso, and the Male–Female Health‐Survival Paradox

“…Work-related migrations generally select people in good health. However, health-related migrations involve mixed profiles: on the one hand, the return of migrants to their villages of origin for health reasons results in the selection of healthier migrants who remain in the city (Rossier et al 2014); while, on the other hand, some migrants with disabilities may remain in an urban area to access better health care (Lankoandé et al 2018). In fact, these two dynamics could differ according to gender and could explain patterns of gender differences in the Ouaga HDSS population.…”

“…); while, on the other hand, some migrants with disabilities may remain in an urban area to access better health care (Lankoandé et al. ). In fact, these two dynamics could differ according to gender and could explain patterns of gender differences in the Ouaga HDSS population.…”