Academic journal article Demographic Research

Adult Mortality in a Rural Area of Senegal: Non-Communicable Diseases Have a Large Impact in Mlomp

Academic journal article Demographic Research

Adult Mortality in a Rural Area of Senegal: Non-Communicable Diseases Have a Large Impact in Mlomp

Article excerpt


This study provides original estimates of adult mortality in Mlomp, a rural population of Senegal which has been monitored for twenty years. Causes of death are assessed through verbal autopsies which are completed by medical information. Between ages 15 and 60, male mortality is much higher than female mortality. Globally, AIDS mortality does not have the tragic impact observed in other regions of Africa, and maternal mortality is relatively low for a rural area, unlike injuries which are common among men. In Mlomp, non-communicable diseases, especially cancers, are predominant. In addition to behavioural factors, infectious diseases may contribute to this situation.

1. Introduction

1.1 Health transition in less developed countries

According to the epidemiologic transition theory, progress in medicine and health care reduces the level of mortality and changes its structure (Omran 1971): the mean age at death increases progressively, and the major infectious and parasitic diseases, which are the main causes of death when mortality is very high, give way to a variety of 'manmade and degenerative diseases' linked both to day-to-day behaviours that present a risk for individuals, and to the biological ageing process. This long-term and ongoing mortality decline is generally qualified as the 'health transition' as the result of progress in health care, but also of social and economic development (Lerner 1973; Preston and Nelson 1974; Caldwell et al. 1990).

Over the long term, the changes follow an identifiable pattern, though certain specific developments may be observed (Frenk et al. 1991; Vallin and Meslé 2004). Yet mortality trends in less developed countries are not identical to those observed in industrialized countries, and mortality in sub-Saharan Africa hasn't decreased since the end of the 1980s and remains high: life expectancy at birth is estimated at 50 years over the period 2005-10, a similar level than twenty years ago (United Nations 2006).

Recent decades have seen the emergence of infectious diseases, the HIV/AIDS pandemic first and foremost, but also the resurgence of other infectious problems such as drug-resistant strains of malaria and tuberculosis closely associated with HIV/AIDS. Furthermore, several cancers are known to be of infectious origin: hepatitis B and C are risk factors for developing a liver cancer, human papilloma virus for cervical cancer, etc. (Prost 2000; Khlat and Le Coeur 2002). The incidence of cancers is not only linked to longer life expectancy but also to infectious diseases. In addition, behaviours such as smoking or alcohol consumption are observed in Southern countries too, increasing risks of injuries, cancers, and cardiovascular diseases (WHO 2002).

Hence, the man-made diseases and diseases linked to ageing which are characteristic of the developed countries also contribute to adult mortality in poor countries (WHO 2003). This is occurring in conjunction with the persistence of infectious and parasitic diseases. Consequently, infectious and parasitic diseases affect children as well as adults, while non-communicable diseases affect adults.

The emergence of AIDS has led to renewed interest in adult mortality, especially given that adults aged between 15 and 60 form the productive and the reproductive group, and are responsible for the welfare of the younger and the older groups (Feachem et al. 1992). This age group represents more than 50 per cent of the population of sub-Saharan Africa (United Nations 2006). But the mortality levels, structures and trends are difficult to estimate due to a lack of reliable data.

1.2 Estimating adult mortality in sub-Saharan Africa

There are several methods for estimating adult mortality. As a general rule, deaths are counted from the vital records and mortality is calculated with respect to the estimated population given by the population census. On the one hand, censuses may be spaced many years apart and the ages reported by individuals are usually inaccurate. …

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