Academic journal article Bulletin of the World Health Organization

Health Transitions in Sub-Saharan Africa: Overview of Mortality Trends in Children under 5 Years Old (1950-2000)/transitions Sanitaires En Afrique Sub-Saharienne : Presentation Succincte Des Tendances De la Mortalite Chez Les Enfants De Moins De 5 Ans (1950-2000)/transiciones Sanitarias En El Africa Subsahariana: Panorama De Las Tendencias De la Mortalidad En Los Menores De 5 Anos (1950-2000)

Academic journal article Bulletin of the World Health Organization

Health Transitions in Sub-Saharan Africa: Overview of Mortality Trends in Children under 5 Years Old (1950-2000)/transitions Sanitaires En Afrique Sub-Saharienne : Presentation Succincte Des Tendances De la Mortalite Chez Les Enfants De Moins De 5 Ans (1950-2000)/transiciones Sanitarias En El Africa Subsahariana: Panorama De Las Tendencias De la Mortalidad En Los Menores De 5 Anos (1950-2000)

Article excerpt

[TEXT NOT REPRODUCIBLE IN ASCII]

Introduction

The health transition, defined as a steady decline in mortality, has been one of the most important features of demographic changes in the twentieth century, and has had many economic and social consequences. (1-5) In sub-Saharan Africa, the health transition began somewhat later than in other countries. Although much change has occurred there since 1930, most African countries still have high levels of infant and child mortality compared with other regions, with much variation between countries.

To judge the health transition in Africa fairly, it seems most appropriate to consider trends in mortality rather than simply looking at current mortality. In countries where the health transition started later, a relatively high death rate after a period a steady decline in mortality could still indicate a favourable health transition, as is the case in some west African countries. By contrast, a situation of increasing mortality, but with a relatively low current mortality could hide a negative change, as is the case in some countries in southern Africa.

Documentation of mortality trends will allow a better understanding of the status of the health transition in Africa, and help to identify gaps where further action is needed. The monitoring of mortality trends is particularly important in children younger than 5 years old, a group that is the main target of public health policies and the most common indicator of mortality levels in developing countries.

Comprehensive vital registration data remain the best source for assessing mortality trends, but these data are not currently available in most African countries. To assess mortality trends, analysts rely on data from demographic sample surveys, or other sources such as mortality data collected in censuses. (6-10) A synthesis of indirect mortality estimates in Africa was conducted at the World Bank for the period before 1985, (11-12) and showed a steady decline in mortality in almost all countries investigated. This study was repeated and extended to other countries, and included new estimates for African countries. (13-14) However, these syntheses suffer from the lack of precision associated with the use of indirect methods to estimate trends, and especially trend reversals. Ahmad et al. have completed analysis using direct and indirect estimates, and reconstructing trends by 5-year periods from 1955-59 to 1995-99. (15) This compendium made better use of all available data, in particular direct estimates provided by Demographic and Health Surveys (DHS). However, although the use of 5-year time periods provided reasonable estimates of mortality levels and major trends, it often obscured the specific time periods when changes in mortality trends occurred. Being able to establish the precise date of reversals in mortality trends is important if the cause of these changes is to be identified.

In this study we aimed to provide new estimates of trends in mortality in children younger than 5 years in African countries with data from demographic sample surveys. The rationale of this analysis is to identify periods of monotonic change, and precise times at which trend changes occur. Here, we present a synthesis of our work; more details at country level are provided in a companion working paper. (16)

Methods

To reconstruct mortality trends, we used data from demographic sample surveys with maternity histories. These data provide dates of birth, and when applicable, age at death, for large samples of live births, which allowed us to compute age-specific death rates for periods many years before the survey. A total of 56 DHS and 10 World Fertility Surveys (WFS) were selected, covering 32 sub-Saharan Africa countries. In addition, a Multiple Indicator Cluster Survey (MICS) was included to cover Angola, which had no DHS or WFS survey. This MICS survey was based on a simplified methodology: only birth histories of the last three pregnancies were included, which shortens the retrospective period for estimating mortality trends. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.