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South Africa

Measuring Social Connection and Well-Being in Agincourt

Randall at a Meeting

Social connections are important determinants of health, education, nutrition and other dimensions of well-being—particularly in youth and old age.

The most common measure of social connection in population and public health research is co-residence, which has critical limitations. Failure to attend to the full range of social relationships limits our ability to understand the social context of health and well-being.

Non-household relationships are particularly important under conditions of extreme social or epidemiologic transition, as in the post-Apartheid South African context of high rates of unemployment, labor mobility and HIV/AIDS.

To redress this failure, we are using existing ethnographic data and longitudinal demographic data from rural South Africa to develop new measures of social connection that can be used in social surveys.

The ethnographic data are from an intensive fieldwork investigation of children's networks of support in the Children's Well Being and Social Connection project (CWSC), which we conducted from 2002 to 2004.

The quantitative data is the result of 14 rounds of a population-wide census in a sub-district population of 70,000 people conducted by the Agincourt Health and Demographic Surveillance System (AHDSS).

We are using histories of prior coresidence, union or parenthood status to reconstruct the constellation of relationships affecting an individual. We will then use these indicators to test for improved explanatory power in models of the social determinants of nutrition, schooling and residence.

This research will increase the utility of the AHDSS and other population-based data systems for understanding the social dimensions of well-being.

This project is a collaboration among Nicholas Townsend of the Brown University Population Studies and Training Center, Sangeetha Madhavan of the University of Maryland, and Mark Collinson and Paul Mee of the Agincourt Health and Population Unit.

It is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and further supported by the University of Colorado at Boulder African Population Studies Research and Training Program—which is supported by the William and Flora Hewlett Foundation.



Map of Matlab, Bangladesh

This project explores the long-term, multigenerational effects of randomized interventions in mother and child immunization, disease outreach and family planning introduced in the rural Matlab area of Bangladesh.

Between 1977 and 1989, the International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B) introduced a block-randomized Maternal and Child Health/Family Planning (MCH/FP) program that produced well-documented improvements in disease mortality and family size over the initial experimental period.

This study and the Matlab field site represent one of the few opportunities in the world to fully understand the social and economic benefits of targeted investments in health and family planning in poor countries and the potential long-term and sustainable impacts of today's widely publicized global disease control efforts.

These interventions and others in poverty alleviation and environmental protection pertain to four of the eight UN Millennium Development Goals.

We will also address the impacts of ongoing improvements in microcredit, education, women's autonomy, irrigation and migration that some have dubbed the "Bangladesh Miracle."

The 1996 Matlab Health and Socioeconomic Survey (MHSS-1) found medium-term improvements in education and cognition among those who benefitted from the interventions.

In 2012, an interdisciplinary team from GHA, the University of Colorado at Boulder, ICDDR,B, Brown University, RAND and Mitra and Associates will collect MHSS-2, which will measure long-term improvements in the health, job and marriage prospects, women's autonomy, and migration associated with the program. The team is also looking at intergenerational effects on the health of children whose parents received the services. This project is supported by the U.S. National Institute on Aging grant R01 AG033713-01A1 and further support from the International Initiative for Impact Evaluation (3ie).

In 2014, a research team from ICDDR,B and GHA began a study to test the feasibility of scaling-up proven maternal-child health interventions to government health facilities.


  • Marriage Market Effects of a Wealth Shock in Bangladesh (Mushfiq Mobarak, Randall Kuhn, Christina Peters)
  • The Logic of Letting Go: Family and Individual Migration from Rural Bangladesh (Randall Kuhn)
  • Effects of Family Planning and Child Health Interventions on Adolescent Cognitive Functioning: Evidence from Matlab in Bangladesh (PDF) (Tania Barham)
  • The Implications of Family Systems and Economic Context for Intergenerational Transfers in Indonesia and Bangladesh (PDF) (Elizabeth Frankenberg and Randall Kuhn)
  • Migrant Social Capital and Education in Migrant-Sending Areas of Bangladesh: Complements or Substitutes? (Randall Kuhn and Jane Menken)
  • The Hidden Cost of Migration: Effect of Brother's Migration on Sister's Marriage Outcomes in Rural Bangladesh (PDF) (Ali Protik and Randall Kuhn)