Demographic Change in Sub-Saharan Africa (1993) / Chapter Skim
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6 Adult Mortality
6 Adult Mortality
Pages 218-255
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From page 218... ...
A very incomplete picture emerges. Both the coverage and the accuracy of the data on which the chapter draws are far more limited than those for other components of African population dynamics such as child mortality or fertility.
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, as well as other inquiries mounted by the statistical organii"White," "Colored," "Asian," and "Black" are legal statuses defined in South African apartheid legislation and used in South African official statistics.
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Almost no information is available from the 1990 round of censuses at present, and some data collected in the 1980 round of censuses, including the orphanhood data from the 1985 census of Sierra Leone and 1986 census of Lesotho, could not be obtained for this study. Thus, although data have been collected to update- by a decade many of the estimates presented here for the mid-1970s, it may be impossible to do the actual updating for several more years.
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From page 221... ...
2Some of these data exhibit signs of having been adjusted already, without it being documented in the sources from which they were obtained for this study. 30nly summary measures of e15 the number of years that a person who survives to age 15 can expect to live have been published for Senegal, so reevaluation of the data was impossible and 45P15- the probability of surviving from exact age 15 to exact age 60 had to be inferred from a model life table.
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223 8 ~ ~ o ~ ~ 3 Fit o o o ,= ~ ~ ~ 3 ~ ~ ~ Ct ~ ~ ~ o ~ Cal Cd Cal ~ o o a ~ ~ ~ ~ hi C)
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4The mortality rates obtained from direct data on adult deaths were smoothed by fitting a two-parameter logit model life table based on the general standard (Brass, 1971) to observed survivorship from age 15.
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, which has been adopted in a recent World Bank volume as the preferred index of adult mortality (Feachem et al., 19921. Perhaps the most striking feature of the results shown in Table 6-1 is that large differences exist in the level of adult mortality between different African countries.
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From page 226... ...
Latin American and general families of model life tables and the four families of Princeton model life tables (Coale and Demeny, 19831. Only in two countries is there any evidence of excess female adult 5When making the estimates, I attempted to consider each set of data for men and women on its own merits and not to look for patterns in the results until they were all available.
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From page 227... ...
The four southern African countries included in Figure 6-1 stand out as having high mortality among adult men. The differential is somewhat attenuated in South Africa due to the more usual mortality patterns among the "White" population.
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From page 228... ...
Age Patterns of Mortality Figure 6-2 compares the estimates of adult survivorship from Table 6-1 with corresponding estimates of the probability of surviving to age 5, 1~51.6 In many sub-Saharan African countries the relationship between the overall levels of child and adult mortality falls within the range of experience of the developed world during its mortality transition as encapsulated in the Coale and Demeny (1983) regional model life tables.
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From page 229... ...
and 45P15 in each population.7 The ~ parameter of the fitted life tables measures the relationship between adult and early child mortality, and the ~ parameter measures the overall level of mortality.8 In an initial model ~ was regressed on ot, by weighting each life table by an estimate of annual births in the population concerned. The residuals are generally negative (observed ~ less than predicted)
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From page 230... ...
On average, South models represent the relationship between child and adult mortality well in western African populations with a life expectancy at birth of about 50 years. A typical eastern or middle African population with this life expectancy at birth, however, has higher adult, and lower child, mortality than the corresponding South model.
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From page 231... ...
Unfortunately, the countries for which we can estimate the trend in mortality include only one of those in Table 61 with very high adult mortality: Sierra Leone. The uniformity of the rate of improvement in adult female survivorship between different countries and in different decades is striking.
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The four populations in Figure 6-3 that experienced little improvement in adult female survivorship during the 1960s and 1970s comprise the two southern African states for which data are available (Lesotho and Swaziland) , northern Sudan, and Kenya in eastern Africa.
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From page 233... ...
The relationship is much clearer in western and middle Africa than in other regions of Africa, particularly Kenya and northern Sudan, where the slow declines in adult mortality again stand out as anomalous. In addition, the increase in adult survivorship in The Gambia of nearly 2 percent per year seems implausibly rapid.
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From page 234... ...
In much of Central Province, adult mortality in the 1970s was even lower than in Ghana or Zimbabwe. On the other hand, in parts of the sparsely populated north and east of the country, adult mortality was nearly as high as in the least healthy African countries for which we have data.
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From page 235... ...
Thus, the national and rural adult mortality estimates vary far more between countries than those of urban mortality. Little is known about differentials in adult mortality in Africa accordng to factors such as occupation and income that have received attention in the literature on mortality in developed countries and child mortality in the developing world.
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From page 236... ...
suggests that adult survivorship in sub-Saharan Africa is also related to GNP per capita. Figures 6-6 and 6-7 compare estimates of adult female survivorship in the mid-1970s for 21 mainland countries with GNP per capita and secondary-school enrollments at the same date (World Bank, 19881.
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Region: + Western and Middle X Eastern and Sudan (N) ~ Southern FIGURE 6-7 Secondary schooling and female survivorship in adulthood, mid-1970s.
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The first aspect of Table 6-5 that deserves emphasis is that although communicable disease and reproductive mortality are more important than in lower-mortality populations elsewhere in the world, they still account for only a minority of adult deaths in these four populations. The proportion of such deaths ranges from about one-fifth in Cape Verde to slightly more than 1lWestern Sierra Leone is the area around Freetown, which represented about two-thirds of the area's population in the early 1970s.
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From page 239... ...
Not only the overall level of mortality, but the level of noncommunicable disease mortality, is broadly similar in the other three populations. In other respects, the cause of death structure experienced by "Colored" adults in South Africa is 12The prevalence of liver disease appears to vary greatly across Africa.
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240 o o V C7\ ~ _ Cal ~ ._ .= ¢ ~ ,= 4 o V)
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cd .~ ¢ o an .
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These predictions are based on data from 56 nonAfrican populations, including 23 from the developing world. Although the results are presented for levels of adult mortality comparable with those in Africa, all the data used to generate the predictions are from populations with lower mortality than that in Bamako, Western Sierra Leone, or South Africa.
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From page 243... ...
Third, and of significance for health planning at the national level, the limited information available suggests that large areal, residential, and socioeconomic differentials in adult mortality exist in at least some African countries. Fourth, only in southern Africa do neighboring countries appear to have closely linked levels, trends, and patterns of mortality.
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From page 244... ...
Until 1980, adults usually benefited more than children in those African countries that managed to reduce overall mortality to a moderate level. During the 1980s, vigorous promotion of universal immunization and other measures to improve child survival, together with the AIDS epidemic, may have begun to reverse this pattern.
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From page 245... ...
Figure 6-A.1 illustrates the application of Preston et al.'s (1980) method to registration data on male deaths among "Blacks" in South Africa in 1985.
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From page 246... ...
A similar analysis for "Black" South African women suggests that relative to the census, about 59 percent of adult female deaths were registered in 1985. Once the degree to which reports of adult deaths are incomplete is known, it is a straightforward matter to adjust them upward before calculating age-specific death rates and life table measures of mortality and survivorship.
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From page 247... ...
This procedure yields a line with an intercept of -0.34, implying an overall level of adult mortality among "Black" women in South Africa that is a little lower than in the standard, and a slope of 1.26, implying relatively heavy mortality in middle age compared with early adulthood. The probY(x)
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From page 248... ...
Each 5-year age group yields a separate estimate of adult mortality. Although the estimates refer to different age ranges, they can all be converted to 45pi5 by using any one-parameter system of model life tables, without reducing their precision greatly.
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From page 249... ...
Similar inconsistencies characterize the data on several other eastern African countries that have asked about orphanhood more than once. They include Kenya, Malawi, northern Sudan, and Tanzania.
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Life table survivorship is estimated from the proportion of each age group in this synthetic cohort with a living mother (or father) by using regression coefficients developed for the purpose (Timaeus, l991b)
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From page 251... ...
Finally, in several countries, only one set of orphanhood data was available for this study and the supplementary question on whether respondents were orphaned before or after marriage was not asked. In some of them, useful data on recent deaths were available, but in Benin, Sierra Leone, and Zimbabwe they were not.
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From page 252... ...
Coale, A.J., and P Demeny 1983 Regional Model Life Tables and Stable Populations, 2nd ed.
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1980 Mortality Levels and Differentials in Sierra Leone, Vol.
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Voorburg, Netherlands: International Statistical Institute, Central Bureau of Statistics. South Africa 1988 South African Statistics, 1988.
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From page 255... ...
1979 Analysis of mortality by cause of death for the western area in Sierra Leone, 1972 1975. Unpublished M.Sc.
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