Population Dynamics of Senegal (1995) / Chapter Skim
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5 Mortality
5 Mortality
Pages 113-195
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From page 113... ...
Both health programs and economic development have probably contributed to the mortality decline in African countries. In the past, the development of health services in Senegal mirrored the development in industrialized countries: most individual services were provided through hospitals, supplemented by disease-control public health measures.
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From page 114... ...
Accordingly, it is preferable to focus initially on a simple, robust indicator of child mortality, such as the probability that a newborn will die before the age of five (sq0) , also called the under-5 mortality rate.
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From page 115... ...
and exaggerating age at death. This error may reduce the infant mortality rate relative to young child mortality, but has little effect on our chosen indicator, sqO.
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From page 116... ...
Differentials among the various estimates most likely result from a pronounced underreporting in the census of deaths of children less than 1 year of age. On the other hand, mortality of children aged 1-4 reportedly fell from 114 per 1,000 in 1981-1980 to 83 per 1,000 in 1987-1988, and to 68 per 1,000 in 1988-1992, which is a plausible decline.
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From page 117... ...
Portion of the Bandafassi arrondissement 1988 census 1987-1988 19 90 Mlomp study 1985- 1991 50 71 1988 census 1987-1988 58 117 Banda~ssi study 1986-1991 140 121 NOTES: Method of calculation for the 1988 census: annual mortality rates were calculated as the ratio of the number of deaths in the last 12 months to the average population in the last 12 months. The latter was estimated from the census adjusted downward by 1.5 percent, the annual growth rate of the population being around 3 percent.
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From page 118... ...
Although these measurements result from different surveys and estimation techniques, they are fairly consistent. Broadly speaking, in the 45 years following the end of World War II, child mortality (5q0)
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From page 119... ...
CEstimate calculated using a direct method with data on women's birth histories (status of each child-living or dead and age at death, if deceased)
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From page 120... ...
The mortality of the latter group is higher (Antoine and Diouf, 1992; Garenne et al., 1992~. However, the differential between the level of child mortality for all children from Dakar and the estimated level for the
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From page 121... ...
Dakar-l: Direct estimates of the risk of death by period, based on data from the 1986 Dakar-Pikine Survey [151. Estimates include only children born in Dakar to women residing in Pikine at the time of the survey.
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From page 122... ...
. Overall mortality was probably not as high as that of children born to women residing in Pikine (a relatively low socioeconomic section of Dakar)
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From page 123... ...
, the decline in child mortality began only in the mid-1980s, coincident with the accelerated 1986-1987 EPI (Pison and Desgrees du Lou, 1993) (see the appendix to this chapter for discussion of the EPI)
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From page 124... ...
. dating the start of the child mortality decline for the entire Fissel-Thienaba region covered by the Survey on Child Mortality in the Sahel of 1981-1984 t163.
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From page 125... ...
The educational level of women and household income level were uniformly low in all of these areas during this time, so these factors cannot explain the observed differences in timing. The relatively rapid trend toward declining child mortality in rural
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From page 126... ...
where child mortality is 1.5 times greater.) Despite the overall decline in mortality, the ranking of these three grand regions remained approximately the same between 1968 and 1988 an appreciably lower mortality in the northeast and a higher mortality in the south, with the center remaining in the middle.
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From page 127... ...
The role of this disease in child mortality differentials may have been particularly high
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From page 128... ...
28 P OP ULA TI ON D YNAMI CS OF SENEGAL TABLE 5-5 Annual Mortality Rates for Children Aged 1-4 (per 1,000) by Department and Rural/Urban Residence: Deaths in Last 12 Months According to 1988 Census Region and Department Rural Urban Dakar Dakar 7.6 Pikine 9.2 Rufisque 14 10 Diourbel Bambey 38 22 Diourbel 30 19 Mbacke 33 17 Fatick Fatick 37 20 Foundiougne 29 20 Gossas 27 20 Kaolack Kaffrine 29 12 Kaolack 23 11 Nioro du Rip 30 28 Kolda Kolda 31 14 Sedhiou 33 24 Velingara 24 12 Louga K6bemer 19 1.4 Lingubre 20 18 Louga 19 7.3 Saint-Louis Dagana 20 10 Matam 25 30 Podor 26 2.9 Tambacounda Bakel 20 19 Kedougou 31 23 Tambacounda 27 8.7 Thies Mbour 24 13 Thies 23 9.2 Tivaouane 19 7.5 Ziguinchor Bignona 27 15 Oussouye 23 24 Ziguinchor 28 17 S OURCE: 1988 census (unpublished tables)
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From page 129... ...
~^ ~ 0-1 . _ FIOURE 5-6 Dcpartmcutal variations in annual morlalLy rate (per thousand)
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From page 130... ...
Figure 5-7 compares the infant and child mortality patterns with the historical patterns embodied in the Coale-Demeny (1983) model life tables, plotting 4q~ against ~q0- The unusual nature of the Senegalese age pattern of child mortality is immediately evident, as is the recent convergence toward the historical norms.
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From page 131... ...
Child mortality (for ages 1-4) is also high due to malaria.
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From page 132... ...
This fact explains the more rapid decline in 4q1 than in 1qO. The particular situation of Mlomp, where pregnancy monitoring and delivery in TABLE 5-6 Age Pattern of Child Mortality: National- and Regional Level Variation and Change, 1955-1992 Level and lqO 4ql 5qO Year or Period per 1,000 per 1,000 per 1,000 National Level 1963-1967a 119 198 293 1968- 1972a 123 183 283 970b 102 199 281 1971-1975C 120 189 287 1973- 1977a 112 170 262 1976- 1980C 96 155 236 1978d 94 149 229 1978-1982e 90 119 199 1981-1985C 86 114 191 1983- 1987e 84 109 185 1987-1988f - 83 1988-1992e 68 68 131 Dakar 1973 58 75 128 1980 60 43 101 1987- 1988 36 Saint-Louis 1955-1959 124 142 249 1960-1964 117 136 237 1965-1969 109 112 209 1970-1974 101 112 202 1975-1979 82 85 160 1980-1985 73 65 133 1986-1988 42 24 66 Ngayokheme 1963-1967 223 340 485 1968-1972 214 342 480 1973-1977 182 291 421 1978-1980 167 242 369 1984-1986 101 202 282 1987-1991 104 142 230
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From page 133... ...
A portion of early deaths was thus eliminated well before the other health programs had the time to produce an effect on later deaths. Sex-Related Differences in Mortality The national surveys, the 1978 WFS, 1986 DHS-I, and 1992-1993 DHSII, and the 1988 census reveal an excess mortality among boys as compared with girls, which appears to increase as mortality declines (see Table 5-8~.3 This excess mortality of boys could be tied to an underreporting of the mortality of girls in the surveys.
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From page 134... ...
Louis ~/~/ ~East Probability of Dying by Age 1 l 300 FIGURE 5-7 Comparison of the pattern of infant and child mortality versus historical patterns embodied in the Coale-Demeny model life tables. to be a problem (Niakhar/Ngayokheme t11]
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From page 137... ...
The proportion of children aged 6-36 months in whom the weight/height ratio was more than two standard deviations below the reference median was only 6 percent in 1986 and 12 percent in 1992-1993 (Table 5-9~. The prevalence of stunting was more frequent: nearly one in four of DHS-I and DHS-II children aged 6-36 months had a height for age more than two standard deviations below the reference median (Table 5-101.
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From page 138... ...
Diarrhea, malaria, acute respiratory infections, and measles were the leading causes of death for children between 1 and 4, accounting for 73 percent of childhood deaths (Boerma et al., 1994~. Data on causes of child mortality, based largely on verbal autopsy techniques, are also available from rural population studies such as those at Mlomp t10]
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From page 139... ...
as causes of mortality is spectacular in Mlomp, and it again reflects the effectiveness of health programs, especially the antimalaria campaign and vaccinations. Associations Between Socioeconomic Factors and Child Mortality As with the fertility data reported in Chapter 4, the 1978 WFS, 1986 DHS-I, and 1992-1993 DHS-II allow the study of child mortality differentials by some important socioeconomic characteristics, such as place of residence, ethnicity, and level of instruction.
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From page 140... ...
140 50 o ._ 3 o 4 a, Cal a)
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From page 141... ...
141 o _ ~ Go rid 0 1 1 I_ A_ ~ Cal _ ~ 1 ~ Cal ~ ~ o - _ Cal a, ~4 ~ _ CM ¢ Cal o Cal A: o ._ ~ Go Us ~ .
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From page 143... ...
143 o _ ~ oo ~o 1 1 ~ 1 A Go o ~s .
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From page 146... ...
TABLE 5-13 Change in Child Mortality (sqO) According to Mother's Literacy and Ethnicity 1968-1972 Characteristic 1976-1985 sqo Ratioa sQo Ratioa Literacy Mother knows how to read 112 106 Mother does not know how to read 277 2.5 Ethnicity 225 2.1 Wolof 254 197 Poular 231 0.9 212 1.1 Serer 289 1.1 226 1.1 Mandingo 392 1.5 261 1.3 Total 264 209 NOTE: Results are from univariate analysis of data from national surveys 1978 WFS, 1986 DHS-I.
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From page 147... ...
147 C~ ax C~ oo oo C~ C)
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From page 148... ...
(1986) , who concluded, based on an analysis of data from the WFS, that the most important factor determining child mortality was urban or rural residence, and that the educational level of the parents, in particular of the mother, exerted only a modest influence.
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From page 149... ...
reveal that regional differences, in particular the lower mortality in the western grand region in relation to the three other grand regions, stem from the larger urban population and higher level of maternal education in the former. However, urbanization and maternal education do not fully explain the child mortality differences.
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From page 150... ...
Ethnic Differences Compared with differences stemming from educational level or urban or rural residence, differences among ethnic groups are neither very pronounced nor very consistent at the national level. However, the excess mortality of Mandingo children in rural areas should be noted (Tables 5-15 and 5-16~.
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From page 151... ...
Quality of Housing and Household Facilities Multivariate analysis of the data from the 1986 DHS-I shows a correlation between child mortality and the type of dwelling, toilet, and household water supply (see Table 5-171. Once these characteristics are considered, the type of place of residence, whether urban or rural, becomes insignificant, implying that the beneficial influence of living in urban as opposed to rural areas results largely from access to clean water and sanitation, as well as to better dwelling conditions.
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From page 154... ...
Not surprisingly, the correlation coefficients7 between child mortality and all the socioeconomic indicators are negative; a higher socioeconomic status is related to lower child mortality (see Table 5-18~. In rural areas, the strongest indicator of child mortality seems to be whether households have electricity.
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From page 155... ...
negative relationship between child mortality and socioeconomic status. Here, data for rural and urban residences for each department are shown.
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From page 156... ...
In the 1970s and 1980s, the principal differences in child mortality
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From page 157... ...
Second, the 1988 census collected information on household deaths in the year before the census, by age and sex. In combination with the census populations, the information on deaths can be used to calculate age-specific mortality rates (ASMRs)
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From page 158... ...
158 o C~ 5 ._ 5 C~ C~ oo C~ Ct ~ oo C~ C)
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From page 159... ...
The corrective measures taken into account for the 12-year intercensal period, as well as for age misreporting, allow comparison of the survival ratios with the Coale-Demeny West family of model life tables. Along with the 1976-1988 survivorship ratios from the censuses, Figure 5-10 shows the survivorship ratios from levels 5, 10, 15, and 20 of the Coale-Demeny West family of model life tables.
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From page 160... ...
4J lo cr o c 2 O :: 2 in o . ~1 en O , 10 20 30 40 Initial Age t 1 10 20 1 30 40 Initial Age Male Intercensal Survival 1976-88 I ~ '~4~ ~ _ 50 60 70 t 50 60 70 FIGURE 5-10 Observed single-year survivorship ratios and ratios from various levels of Coale-Demeny "West" life tables.
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From page 161... ...
Since we know from the various small-scale studies that age patterns of adult mortality resemble the models quite closely, the census data are probably distorted by substantial age exaggeration, particularly from middle age onwards. The Preston-Bennett technique has been applied to the three intersurvey periods, 1960-1970, 1970-1976, and 1976-1988.
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From page 162... ...
162 Ct ~ ^X oo oo ~o o~ Ct L~ .
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From page 163... ...
However one interprets the relative coverage of the various sources, it remains the case that essentially no conclusions about levels or trends of adult mortality can be obtained from the available sequence of population estimates or counts. Age-Specific Mortality Rates Based on Deaths Reported in the Year Before the 1988 Census The 1988 census included a series of questions on deaths in the household in the previous 12 months.
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From page 164... ...
. However, the evidence discussed above that reporting of deaths of children aged 1-5 was close to complete, combined with the consistency of the age-specific estimates between the ages of 15-70, suggest that the 1988 death data are of usable quality for ages after infancy.
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From page 165... ...
The orphanhood estimates combined with the 1988 life table indicate substantial declines in adult mortality. For males, the probability of dying between 15 and 60 fell from 37 to 30 percent from the early 1970s to the late 1980s.
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From page 168... ...
age patterns of mortality and broad patterns of change over time may well reflect a wider reality than the areas themselves. Table 5-24 shows the Coale-Demeny West model life-table levels implied by the expectation of life at each age from 15-75 for the life tables from Ngayokheme ~ 1963- 1981)
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From page 169... ...
For females between the same ages, the range is 14.7 to 19.8 for Ngayokheme 1963-1981, 16.5 to 17.1 for Niakhar-II 1984-1991; 10.3 to 11.9 for Bandafassi 1971-1991, and 17.2 to 19.0 for Mlomp 1985-1990. At the national level, orphanhood estimates indicate a level of about 12.6 in the early 1970s, and the 1987-1988 census life table implies a West level of about 16.4.
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From page 171... ...
MORTALITY a 0 4 -6- . 171 Males 0 Ax ~ Coale-Demeny North Coale-Demeny West - Coale-Demeny EasVSouth i ~ -41 1 20 Females 1 ' 40 Age 0 Mx ~ Coale-Demeny North r 60 ~ Coale-Demeny West -Coale-Demeny EasVSouth ~~ ~0 i I i 1 , 0 20 40 60 80 Age FIGURE 5-1 la Ngayokheme life table 1963-1981 versus Coale-Demeny level 8 models.
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From page 172... ...
72 POPULATION DYNAMICS OF SENEGAL Males -2 -6 -2 _ _ 1 O Mx Coale-Demeny North ~ Coale-Demeny West -Coale-Demeny EasVSouth ~/~ o 1 ~ 20 40 60 80 Age I o Mx l ° Coale-Demeny North ~ Coale-Demeny West -Coale-Demeny EasVSouth iv 1 - 1 i ~ 0 20 40 60 so Age FIGURE S-llb Niakhar life table 1984-1991 versus Coale-Demeny level 13 models.
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From page 173... ...
~ r - 20 l 40 Age 60 so FIGURE 5-1 lo Bandafassi life table 1970-1990 versus Coale-Demeny level 9 (males) and level 8 (females)
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From page 174... ...
0 50 Age . ~ 100 FIGURE 5-lid Mlomp life table 1985-1990 versus Coale-Demeny level 17 (males)
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From page 175... ...
First, the age pattern of adult mortality in Senegal is fairly well approximated by the Coale-Demeny West family of model life tables. Second,
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From page 176... ...
For adult male mortality, indicators of reference date, Coale-Demeny level, and implied 45q~5 have been obtained by averaging the results for two broad age groups a "recent" estimate based on respondents aged 10-14 to 25-29, and an "earlier" estimate based on age groups 25-29 to 40-44. The presentation is similar for female adult mortality, except that the two age ranges used are 20-24 to 30-34 for the "recent" estimate, and 35-39 to 4549 for the "earlier" estimate.
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From page 178... ...
Figure 5-14 compares regional estimates of adult mortality with regional estimates of child mortality, in both cases using deaths in 1987-1988. Both for male and female adult mortality, there is a fairly clear positive relationship between child and adult mortality, though child mortality varies more in relative terms among regions than does adult mortality.
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From page 179... ...
LL .2.1 OO O o o o of) o o o 1 1 1 1 1 T O .1 .2 .3 .4 .5 .6 Male 45q15 Deaths in Year Before 1988 Census o o o to o o o O .1 .2 .3 Male 45q15 .4 .5 FIGURE 5-12 Comparison of regional estimates of male and female adult: mortality (4sqls)
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From page 180... ...
Table 5-28 shows the correlation coefficients between adult mortality and the same socioeconomic indicators discussed above by region. As is the case for child mortality, all of the relationships between adult mortality and socioeconomic indicators are negative.
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From page 181... ...
Table 5-28 also shows the correlation coefficients between the same socioeconomic indicators and adult mortality for all the regions except Dakar. It is clear that the relatively high socioeconomic status of Dakar, coupled with the relatively low adult mortality, accounts for the relatively strong correlations seen in Table 5-28.
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From page 182... ...
Regions with very high mortality in the early 1970s apparently enjoyed large survivorship gains, while regions with low adult mortality experienced only small gains.
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From page 183... ...
aThese coefficients are calculated using data from the regional level, n = lo. SOURCE: l 988 census (unpublished tabulations)
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From page 184... ...
Intercensal survival methods applied to the 1960, 1970, 1976, and 1988 surveys and censuses lead to very variable estimates of mortality. The estimates appear to have been affected by changes in population coverage from 1970-1976, and again from 1976-1988, the latter change being estimated on the order of 20 percent.
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From page 185... ...
Beginning in 1978, the primary health care policy led to the construction of a large number of such clinics in rural areas. In 1988, there were nearly as many rural maternity clinics as dispensaries, according to health statistics.
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From page 186... ...
Two of these specific programs, the antimalaria campaign and vaccinations, are discussed in greater detail below. Antimalaria Campaign Malaria, which is endemic in Senegal and one of the major causes of child mortality, was the focus of specific eradication programs beginning in 1953 (Cantrelle et al., 1986~.
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From page 187... ...
Thereafter, malaria prevention was incorporated into primary health care. Vaccinations Until the Expanded Programme on Immunization (EPI)
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From page 188... ...
Organization The EPI was initiated in Senegal in 1981. The program was designed to extend vaccination coverage to rural areas, which were at that time not well served, and to improve coverage in urban areas.
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From page 189... ...
The vaccination coverage surveys show that the percentage of children aged 12-23 months who were completely vaccinatedi5 increased from 18 percent in July 1984 to 35 percent in July 1987, and to 55 percent in June 1990 (see Table 5-31~. The 1987 and 1990 percentages probably represent maxima for the period 1987-1990.
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From page 190... ...
The coverage rate for measles vaccine increased only slightly from 63 to 76 percent. Vaccination coverage appears to have declined between June 1990 and December 1992-March 1993.
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From page 191... ...
By region in the order of children completely vaccinated in 1990, Table 5-32 gives the proportions of children aged 12-23 months who were vaccinated against measles in 1987 and 1990, along with the proportion of children completely vaccinated in the same years. The regions receiving the poorest overall coverage in 1990 were Tambacounda, which also had the lowest coverage in 1987, Saint-Louis, Diourbel, Kaolack, and Louga.
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From page 192... ...
TABLE 5-33 Change in Vaccination Coverage of Children Aged 12-23 Months (in percent) Between 1984 and 1987, According to Residence Percentage of Children Completely Vaccinated Region July 1984 July 1987 Region of Dakar 32 39 Urban (outside of Dakar)
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From page 193... ...
Complete vaccination coverage, which was close to zero before 1987, rose to 45 percent for children aged 12-23 months (and 85 percent for children receiving at least one vaccination) after the first acceleration campaign in early 1987.
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From page 194... ...
5. The departments of Kebemer and Podor have surprisingly low urban mortality rates, for unknown reasons.
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From page 195... ...
14. Routine health service statistics are available, but they are not reliable and show a strong tendency to overestimate actual vaccination coverage (OCCGE-Muraz, 1990)
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