Demographic Change in Sub-Saharan Africa (1993) / Chapter Skim
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5 Trends in Childhood Mortality
5 Trends in Childhood Mortality
Pages 153-217
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From page 153... ...
a marked overall difference in mortality levels between countries in western and middle Africa and countries in eastern and southern Africa, Althea Hill is at the India Country Department, Population and Human Resources Division, The World Bank.
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From page 154... ...
With regard to this last point, there were indications that this gradient, having been very distinct at the start of the period of study, was becoming progressively blurred as more and more western and middle African countries reduced their mortality levels to near or within the eastern and southern range. However, the picture was still too indefinite for firm conclusions at that time.
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From page 155... ...
In total, new national-level data are available for 16 countries (about 40 percent of all mainland sub-Saharan countries) ; these are Botswana, Burkina Faso, Burundi, Cote d'Ivoire, The Gambia, Ghana, Kenya, Liberia, Malawi, Mali, Nigeria, Senegal, Sudan, Togo, Zaire, and Zimbabwe.
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From page 156... ...
1984 Published Censusb 1984 Partly available Eastern Burundi DHSb 1987 Published Census 1990 Not yet available Ethiopia Demographic survey 1980-1981 Published Census 1984 Not yet available National demographic survey 1990 Partly available Kenya National demographic surveyb 1983 Partly available CPS 1984 Published DHSb 1989 Published Census 1989 Not yet available Malawi National demographic surveyb 1982 Published
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From page 157... ...
b 1988-1989 Published Zambia Census 1980 Not published DHS 1992 Partly available Zimbabwe Censusb 1982 Partly published CPSb 1984 Published Demographic surveyb 1987 Partly published DHSb 1988 Published Southern Botswana Censusb 1981 Published CPSb 1984 Published Demographic survey 1987 Not yet available DHSb 1988 Published Lesotho Census 1986 Not yet available Swaziland Census 1986 Not yet available DHS typed 1986 Not yet available Northern Sudan Censusb 1983 Available DHS (northern only) b 1989-1990 Published 157 aWFS: World Fertility Survey; LSMS: Living Standards Measurement Survey; DHS: Demographic and Health Survey; CPS: Contraceptive Prevalence Survey.
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From page 158... ...
to reflect the different age and sex patterns of mortality derived from historical data from eastern-central, northwestern, Scandinavian, and southern countries of Europe, respectively. The North and South models provide the best fit for the African age pattern of mortality in childhood (see the appendix to this chapter for details)
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From page 159... ...
However, the consistency and plausibility of the results from the 1980s survey data differ sharply between the two countries. For Botswana, provided the South model is used, all the data except the direct DHS reports are highly consistent.
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From page 160... ...
; 1987 Intercensal Demographic Survey (ICDS) (Zimbabwe, 19911; 1988 Demographic and Health Survey (DHS)
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From page 161... ...
The 1988 DHS mortality levels are much too low compared with the other data sources, except perhaps in the most recent few years. The best choice seems to be a combination of the 1987 demographic survey results with those of the two censuses, which would also yield mortality levels similar to those from the DHS around the mid-1980s.
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From page 162... ...
, and rural parts of the southwest region of Angola bordering on Namibia (data from a local socioeconomic-demographic survey in 1988~. The results from these new data sets, combined with the latest available national data, are shown in Tables 5-B.3 and 5-B.4, and summarized graphically in Figures 5-6 and 5-7.
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From page 163... ...
Agricultural (N) 163 FIGURE 5-7 Risk of dying before age 5, Angola and southwestern Angola, North and South models.
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From page 164... ...
The picture is mixed. Results from the 1982 survey, an intercensal national demographic survey, fit well with earlier data, provided the South model is used.
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From page 165... ...
'in a, 165 FIGURE 5-9 Risk of dying before age 5, Zaire, 1935-1990, North and South models. SOURCES: 1955 National Demographic Survey (NDS)
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From page 166... ...
l FIGURE 5-10 Risk of dying before age 5, Burundi, 1955-1990, South model. SOURCES: 1970-1971 National Demographic Survey (NDS)
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From page 167... ...
The new mortality level pushes Uganda from its previous position in the middle of the eastern and southern African mortality range close to the top. Unlike Uganda, Kenya has been relatively peaceful and prosperous since independence in 1962 and has collected a mass of demographic data since its independence, including four censuses, two national demographic surveys, a WFS, a CPS, and a DHS.
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From page 168... ...
; 1977 National Demographic Survey (NDS) (Kenya, 19801; 1977-1978 World Fertility Survey (WFS-indirect)
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From page 169... ...
~ 1989 DHS (direct) 169 FIGURE 5-13 Risk of dying before age 5, northern Sudan, 1955-1990, South model.
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From page 170... ...
surprisingly indicating similar levels of mortality in north and south Sudan, unlike earlier data would bring all Sudan down from its previous position in the upper-middle mortality range for eastern and southern Africa to the lower range at that time. Given the picture presented by data for northern Sudan, this favorable shift for all Sudan could be attributed only to a rapid decline in childhood mortality in the south, presumably immediately after the peace accord in 1973.
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From page 171... ...
The data from the two censuses, which agree extraordinarily well if the South model is used, show a gradual decline during the 1960s that accelerated during the 1970s. They then indicate another plateau in childhood mortality in the early 1980s, but this plateau cannot be regarded as firm because similar plateaus or rises in the Senegal and Mali DHS indirect data (as well as the Mali census)
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From page 172... ...
SOURCES: 1960 National Demographic Survey (NDS) (derriere, n.d.~; 1978 World Fertility Survey (WFS-direct)
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From page 173... ...
SOURCES: 1960-1961 rural national demographic survey (NDS) and 1975 census (Burkina Faso, 1981)
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From page 174... ...
The data for both give a consistent picture astonishingly so for Cote d'Ivoire provided the South model is used. Each country shows a continuous and fairly rapid decline in childhood mortality between 1960 and 1985, with the probability of dying by age 5 being roughly halved from about .300 to .150 or lower during those 25 years.
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From page 175... ...
(Gaisie, 19691; 1970 census postenumeration survey (PES) (Ramachandran, 1979~; 1979-1980 World Fertility Survey (WFS)
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From page 176... ...
~ FIGURE 5-21 Risk of dying before age 5, Cote d'Ivoire, 1960-1990, South model. SOURCES: 1978-1979 National Demographic Survey (NDS)
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From page 177... ...
FIGURE 5-22 Risk of dying before age 5, Liberia, 1950-1990, South model. SOURCES: 1970-1971 National Demographic Survey (NDS)
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From page 178... ...
1963, and 1973, and the national demographic surveys of 1965 and 1980-1981, either collected no data on child survival or never tabulated or analyzed them. The 1971-1972 demographic survey produced child survival data that were too poor to be usable.
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From page 179... ...
FIGURE 5-23 Risk of dying before age 5, Nigeria, 1950-1990, North and South models. SOURCES: 1981-1982 World Fertility Survey (WFS)
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From page 180... ...
Of the four major features found earlier namely, almost universal mortality declines, great variation in decline, great variation in mortality levels, and a marked differential in eastern-southern and western-middle African mortality levels only the first seems unchanged. There appear recently to be few cases of very slow decline; either mortality did not fall at all (in a few cases)
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From page 181... ...
TRENDS IN CHILDHOOD MORTALITY TABLE 5-2 Summary Trends in Childhood Mortality in Sub-Saharan African Countries with 1980s Data Sets 181 Estimated Coale-Demeny Date of Probability of Country Model Used Reference Dying Before Age 5 Western Burkina Faso South 1948.5 .421 1956.4 .423 1963.7 .300 1971.4 .275 1973.2 .264 1981.3 .212 Cote d'Ivoire South 1966.9 .256 1972.4 .219 1977.0 .194 1979.7 .164 1984.1 .138 The Gambia South 1960.6 .349 1967.0 .345 1973.4 .278 1979.1 .240 Ghana South 1935.9 .371 1948.0 .301 1955.4 .241 1959.2 .233 1967.1 .199 1975.1 .178 1980.6 .164 1985.0 .163 Liberia South 1957.3 .321 1965.6 .281 1974.0 .250 1981.3 .242 Mali South 1949.9 .382 1954.8 .377 1974.6 .336 1979.4 .307 1983.2 .271 Senegal South 1946.2 .373 1951.6 .343 1956.2 .296 1968.1 .289 1974.5 .270 1978.4 .239 1982.9 .213 Togo South 1949.9 .347 1957.2 .328 1963.5 .262 1968.0 .227 1976.9 .196 1984.2 .163 continued
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From page 182... ...
(.188) Zimbabwe North 1957.5 .162 1964.0 .154 1971.1 .147 1978.4 .136 1983.4 .115 1985.9 .092 Southern Africa Botswana South 1959.0 .177 1967.4 .159 1970.2 .145 1979.9 .096 1984.4 .059 Northern Sudan South 1958.9 .223 1964.7 .204 1969.7 .214 1970.6 .168 1976.0 .147 1980.1 .146
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From page 183... ...
500 450 400 350 300 250 200 150 100 50 o 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 Year Risk of Dying before Age 5 (per 1,000) ~_ \ ~—Burkino Faso —Cote d'lvoire The Gambia ~ Ghana Liberia I ~1 Mali Senegal Togo + Zaire FIGURE 5-25 Risk of dying before age 5, selected western and middle African countries, 1935-1990.
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From page 184... ...
If political and economic turmoil, however, make data collection difficult or impossible, these questions may not be answered until well into the next century. APPENDIX A: SUMMARIZATION PROCESS FOR TABLE 5-2: COUNTRY NOTES General Note on Methodology The basic technique employed in this analysis was the Trussell variant of the Brass child survival method, as described in the U.N.
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From page 185... ...
could have been examined. However, in practice, North and South models are usually found to best fit African age patterns of mortality in childhood, because both incorporate relatively high levels of mortality between 1 and 5 years of age, a feature undoubtedly existing in most if not all African populations.
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From page 186... ...
Again there was a problem with overlapping trend lines, and also with the inconsistency of all but the most recent DHS data with earlier data sets. The final selection was groups of the earliest three and the second and third latest points from the 1969 census; the earliest three and the latest three points from the 1982 census; the latest three points from the 1987 ICDS; and the latest two points from the 1988 DHS indirect data (which come out somewhat higher than the latest direct data point)
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From page 187... ...
, the 1982 national demographic survey (good) , and the direct and indirect data from the 1984 family formation survey (FFS; poor)
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From page 188... ...
Western Africa For Burkina Faso, the sources considered and used were the 1960-1961 rural national demographic survey (fair) , the 1961 Ouagadougou demographic survey (fair)
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From page 189... ...
The DHS data were summarized in the same way, disguising the clear 1980s stall in the full indirect data, but the alternative of three groups of two points each yields a clear rise not visible in the South model results or in the direct data, which show a continued decline. For Mali, the sources considered were the 1960-1961 NDS (fair)
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From page 190... ...
, the 1971 census PES (fair) , and the 1988 DHS direct and indirect data (poor)
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From page 191... ...
(Botswana, 1985) ; 1988 Demographic and Health Survey (DHS)
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From page 192... ...
(Zimbabwe, 1985b) ; 1987 Intercensal Demographic Survey (ICDS)
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From page 193... ...
; 1987 Maputo Fertility Survey (MFS) (WFStype survey)
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From page 194... ...
194 DEMOGRAPHIC CHANGE IN SUB-SAHARAN AFRICA TABLE 5-B.4 Child Survival Analysis Results, Angola Coale-Demeny North Model Coale-Demeny South Model Probability Probability Reference of Dying Reference of Dying Data Set Date Before Age 5 Date Before Age 5 1940 census 1924.06 .3299 1922.99 .3605 1927.13 .3334 1926.29 .3606 1930.43 .3256 1929.83 .3472 1933.63 .3403 1933.29 .3565 1936.44 .3625 1936.32 .3681 1938.70 .4240 1938.71 .4227 1988 demographic- 1971.78 .1484 1970.70 .1716 socioeconomic 1974.74 .1637 1973.90 .1834 survey, 1977.90 .1924 1977.29 .2097 Southwest 1981.00 .2121 1980.62 .2238 region—rural, 1983.78 .1962 1983.63 .1981 pastoral 1986.12 .2817 1986.11 .2757 1988 demographic- 1971.57 .1757 1970.46 .2009 socioeconomic 1974.57 .1921 1973.70 .2142 survey, 1977.84 .2083 1977.21 .2268 Southwest 1981.05 .2018 1980.67 .2130 region rural, 1983.92 .2314 1983.77 .2339 settled 1986.29 .2861 1986.29 .2795 population SOURCES: 1940 census (Heisel , 1968) ; 1988 rural survey (RDS)
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From page 195... ...
; 1982 National Demographic Survey (NDS) and 1984 Family Formation Survey (FFS)
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From page 196... ...
196 DEMOGRAPHIC CHANGE IN SUB-SAHARAN AFRICA TABLE 5-B.6 Child Survival Analysis Results, Zaire Coale-Demeny North Model Coale-Demeny South Model Probability Probability Reference of Dying Reference of Dying Data Set Date Before Age 5 Date Before Age 5 1955 NDS 1940.72 .2923 1939.74 .3196 1943.57 .2741 1942.84 .2970 1946.40 .2949 1945.87 .3139 1949.13 .2790 1948.79 .2931 1951.62 .2622 1951.46 .2676 1953.77 .2485 1953.75 .2422 1984 census 1971.18 .2181 1970.40 .2407 1974.00 .2120 1973.48 .2293 1976.44 .2037 1976.08 .2162 1978.62 .1996 1978.40 .2060 1980.58 .1984 1980.48 .1980 1982.26 .2093 1982.24 .2006 SOURCES: 1955 National Demographic Survey (NDS) (Romaniuk, 1968)
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From page 197... ...
SOURCES: 1970-1971 National Demographic Survey (NDS) (Burundi, 1974)
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From page 198... ...
SOURCES: 1969 census (Uganda, 1969) ; 1988-1989 Demographic and Health Survey (DHS)
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From page 199... ...
TRENDS IN CHILDHOOD MORTALITY TABLE 5-B.9 Child Survival Analysis Results, Kenya 199 Coale-Demeny North Model Coale-Demeny South Model Probability Probability Reference of Dying Reference of Dying Data Set Date Before Age 5 Date Before Age 5 1962 census 1947.71 .2579 1946.80 .2831 1950.55 .2546 1949.90 .2753 1953.24 .2392 1952.77 .2551 1955.76 .2285 1955.47 .2383 1958.05 .2171 1957.92 .2187 1960.02 .2100 1960.00 .2016 1969 census 1955.07 .2320 1954.19 .2563 1957.94 .2179 1957.31 .2371 1960.59 .2068 1960.15 .2211 1963.07 .1962 1962.80 .2039 1965.30 .1869 1965.18 .1872 1967.19 .1853 1967.17 .1764 1977 national 1962.77 .1874 1961.92 .2101 demographic 1965.63 .1735 1965.03 .1905 survey 1968.25 .1598 1967.83 .1718 1970.65 .1550 1970.40 .1607 1972.82 .1353 1972.70 .1342 1974.65 .1377 1974.63 .1285 1977-1978 WFS 1963.82 .1795 1962.98 .2017 1966.66 .1577 1966.08 .1737 1969.22 .1579 1968.82 .1696 1971.56 .1547 1971.31 .1602 1973.66 .1562 1973.55 .1556 1975.45 .1643 1975.44 .1556 1979 census 1964.77 .1893 1963.87 .2129 1967.67 .1773 1967.01 .1953 1970.43 .1641 1969.96 .1770 1973.01 .1601 1972.73 .1666 1975.33 .1506 1975.21 .1502 1977.29 .1589 1977.27 .1498 1983 national 1968.58 .1519 1967.71 .1733 demographic 1971.47 .1427 1970.85 .1583 survey 1974.15 .1330 1973.72 .1440 1976.63 .1290 1976.37 .1339 1978.85 .1201 1978.74 .1186 1980.71 .1275 1980.70 .1183 continued
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From page 200... ...
; 1983 National Demographic Survey (NDS) (unpublished data)
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From page 201... ...
TRENDS IN CHILDHOOD MORTALITY TABLE 5-B.10 Child Survival Analysis Results, Sudan 201 Coale-Demeny North Model Coale-Demeny South Model Probability Probability Reference of Dying Reference of Dying Data Set Date Before Age 5 Date Before Age 5 1973 census, 1958.22 .2016 1957.31 .2256 national 1961.09 .2009 1960.42 .2203 1963.82 .1886 1963.35 .2030 1966.40 .1966 1966.10 .2051 1968.73 .2036 1968.60 .2048 1970.72 .2310 1970.70 .2230 1973 census, 1958.52 .1807 1957.63 .2036 northern 1961.38 .1815 1960.73 .1997 Sudan 1964.04 .1675 1963.59 .1804 1966.54 .1701 1966.26 .1771 1968.80 .1713 1968.67 .1717 1970.73 .1946 1970.71 .1859 1979 WFSa 1965.15 .1303 1964.32 .1502 household 1968.07 .1529 1967.48 .1687 survey 1970.72 .1386 1970.32 .1493 1973.13 .1534 1972.90 .1584 1975.26 .1502 1975.17 .1486 1977.01 .1782 1977.01 .1685 1979 WFSa 1964.53 .1380 1963.64 .1588 individual 1967.49 .1360 1966.84 .1516 survey 1970.30 .1369 1969.86 .1482 1972.92 .1381 1972.66 .1430 1975.22 .1348 1975.12 .1328 1977.10 .2178 1977.10 .2075 1983 census 1969.84 .1469 1969.07 .1671 1972.70 .1540 1972.18 .1690 1975.16 .1383 1974.81 .1484 1977.35 .1417 1977.14 .1458 1979.29 .1438 1979.21 .1420 1980.92 .1585 1980.91 .1494 1989-1990 DHSa 1977.66 .1212 1977.02 .1391 1980.16 .1527 1979.80 .1662 1981.91 .1332 1981.64 .1424 1983.39 .1467 1983.18 .1519 1984.87 .1384 1984.71 .1398 1986.36 .1102 1986.30 .1046 continued
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From page 202... ...
Coale-Demeny North Model DEMOGRAPHIC CHANGE lN SUB-SAHARAN AFRICA Coale-Demeny South Model Probability Probability Reference of Dying Reference of Dying Data Set Date Before Age 5 Date Before Age 5 Reference Date Equivalent Value of qS 1989-1990 DHSa 1975-1979 .1431 Direct data 1980-1984 .1468 1985- 1990b .1234 1978-1979 WFSa 1965-1969 .1428 Direct data 1970-1974 .1359 1975- 1979 .1473 aWFS and DHS data for Sudan refer only to northern Sudan. bIncludes calendar year 1990 up to the month preceding the date of interview.
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From page 203... ...
(derriere, n.d.) ; 1978 World Fertility Survey (WFS-direct)
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From page 204... ...
(Mali, n.d.) ; 1987 Demographic and Health Survey (DHS)
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From page 205... ...
; 1961 Ougadougou (Burkina Faso, n.d.) ; 1985 census (unpublished data)
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From page 206... ...
206 DEMOGRAPHIC CHANGE IN SUB-SAHARAN AFRICA TABLE 5-B.14 Child Survival Analysis Results, The Gambia Coale-Demeny North Model Coale-Demeny South Model Probability Probability Reference of Dying Reference of Dying Data Set Date Before Age 5 Date Before Age 5 1973 census 1958.55 .3232 1957.68 .3489 1961.31 .3344 1960.69 .3556 1963.81 .3256 1963.36 .3425 1966.15 .3367 1965.85 .3518 1968.32 .3296 1968.17 .3387 1970.26 .3363 1970.23 .3377 1983 census 1968.70 .2605 1967.84 .2849 1971.43 .2740 1970.82 .2941 1973.87 .2555 1973.43 .2712 1976.15 .2581 1975.86 .2697 1978.29 .2445 1978.13 .2495 1980.20 .2356 1980.17 .2305 SOURCES: 1973 census (The Gambia, 1976) ; 1983 census (The Gambia, 1987)
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From page 207... ...
TRENDS IN CHILDHOOD MORTALITY TABLE 5-B.15 Child Survival Analysis Results, Ghana 207 Coale-Demeny North Model Coale-Demeny South Model Probability Probability Reference of Dying Reference of Dying Date Before Age 5 Date Before Age 5 1948 census 1934.00 .3555 1933.21 .3800 1936.64 .3432 1936.10 .3624 1938.84 .3543 1938.45 .3700 1940.86 .3321 1940.58 .3467 1942.80 .2915 1942.63 .3004 1944.61 .2483 1944.56 .2460 1960 census 1945.99 .2632 1945.14 .2876 PESa 1948.75 .3242 1948.16 .3446 1951.22 .2541 1950.80 .2693 1953.52 .2453 1953.24 .2555 1955.63 .2391 1955.49 .2426 1957.50 .2310 1957.47 .2247 1970 census 1957.02 .2196 1956.14 .2436 PESa 1959.91 .2141 1959.28 .2333 1962.61 .2076 1962.17 .2219 1965.13 .2082 1964.86 .2162 1967.38 .1981 1967.26 .1982 1969.27 .1918 1969.26 .1826 1979- 1980 WFS 1964.98 .1488 1964.09 .1702 1967.87 .1369 1967.22 .1524 1970.58 .1232 1970.13 .1341 1973. ~ 1 .1280 1972.84 .1331 1975.38 .1254 1975.27 .1242 1977.30 .1507 1977.29 .1417 1988 DHS 1974.34 .1679 1973.52 .1895 1977.20 .1513 1976.63 .1668 1979.75 .1499 1979.36 .1611 1982.07 .1613 1981.83 .1668 1984.15 .1613 1984.04 .1605 1985.90 .1751 1985.89 .1662 Reference Date Equivalent Value of qS 1988 DHS 1973-1977 .1872 Direct data 1978- 1982 .1524 1983- 1987b .1547 continued
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From page 208... ...
; 1979- 1980 World Fertility Survey (WFS) (Owusu, 1984)
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From page 209... ...
(Adognon, 1980) ; 1988 Demographic and Health Survey (DHS)
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From page 210... ...
; 1980-1981 World Fertility Survey (WFS) (Cote d'Ivoire, 1984)
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From page 211... ...
; 1974 census (Liberia, 1977) ; 1986 Demographic and Health Survey (DHS)
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From page 212... ...
; 1990 Demographic and Health Survey (DHS) (Nigeria, 1992)
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From page 213... ...
Gabarone: Central Statistical Office. 1985 Botswana Family Health Survey 1984.
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From page 214... ...
Rutenberg 1989 Botswana Family Health Survey II, 1988. Gaborone: Central Statistics Office, Ministry of Finance and Development Planning; Family Health Division, Ministry of Health; Columbia, Md.: Institute for Resource Development/Macro Systems, Inc.
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From page 215... ...
1984 Evaluation of the Ghana Fertility Survey, 1978-80. In World Fertility Survey Scientific Reports.
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From page 216... ...
Working Group on the Effect of Child Survival and General Health Programs on Mortality 1993 The Effects of Health Programs on Child Mortality in Sub-Saharan Africa, D.C. Ewbank and J.N.
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From page 217... ...
Intercensal Demographic Survey, Round 1, 1987. Preliminary report.
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