evidence indicate that these frameworks have a number of limitations in describing and explaining trends in demographic and health trajectories in Africa.

In light of these limitations, Defo proposed a new conceptual framework for analyzing African countries, one that he calls an “eco-epidemiologic life-course framework” for understanding the patterns of health and disease in human populations. Defo’s analysis of 60 years of data indicates that Africa is a continent of uncertainties and emergencies where trends in health, disease, and mortality are marked by discontinuities and abrupt changes that reflect the enduring fragility and instability of its countries and the vulnerabilities of its individuals and populations. The analysis also shows that Africa as a whole—and sub-Saharan Africa in particular—remains the poorest of the world’s regions in terms of health improvements and longevity. Specifically, the research demonstrates: (1) a marked variation in trends in health, disease, and mortality patterns as well as in fertility and life-expectancy trajectories among African countries and regions over the past 60 years; (2) a rapid decline in mortality—specifically, declines in infant mortality and increases in life expectancy—throughout the continent from the 1950s through the 1990s, a period during which communicable diseases were responsible for most deaths in Africa; (3) growing rates of adult mortality since the 1990s, which have been mostly ascribed to HIV/AIDS and its comorbidities and which have played a major role in reversing the trend of declining mortality, interrupting improvements in life expectancy, and reversing gender differences in life expectancies in several countries with highest prevalence of HIV/AIDS because of the disease’s disproportionate impact on women; and (4) the major role that wars have played in reversing the trends in underfive mortality decline in sub-Saharan countries in the 1990s and beyond, notably in middle Africa and Eastern Africa.



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement