In Her Lifetime Female Morbidity and Mortality in Sub-Saharan Africa (1996) / Chapter Skim
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Appendix A: Demographic Overview and State of the Data
Appendix A: Demographic Overview and State of the Data
Pages 283-298
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From page 283... ...
DATA ON FEMALE MORTALITY AND MORBIDITY ACROSS THE LIFE SPAN Data on Mortality Sources and Measures Demographers have long incorporated a life span perspective in data collection and analysis through either cohort measures or measures based on stable populations that reflect the fertility or mortality experience of a birth cohort as it ages. Most common is the use of a synthetic cohort, where fertility or mortality is expressed as the level that would be experienced by a cohort of males or females living through the age-specific rates prevailing at a given time.
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From page 284... ...
Whether there is a selective underreporting of female versus male deaths through use of these me~.~'lr~.~ in ~'n~Prtnin r ~ ~ ^ A _ ~ _ ~ A ~ A-_ V _ A A A ~ ~ V ~ A _ V A V ~ A l-~ 1 L ~11 1 A Procedures to estimate adult mortality are still being developed and refined, spurred on by more recent recognition that child and adult mortality are not as closely associated as had been thought; thus, traditional methods of estimating adult mortality based on child mortality are no longer considered accurate. The most direct approach to ask about deaths in a household in a fixed previous time period has not proved very useful in developing countries, because it requires large sample sizes to yield sufficient numbers of observations.
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From page 285... ...
It is not surprising, therefore, that the WFS concentrated on women in the reproductive ages at the time of the survey, and thus provided substantial data primarily on marital fertility and infant and child mortality. The DHS, in turn, has an expanded focus on health-related behaviors related to child mortality, nutrition, and morbidity, but provides little or no information on adult mortality.
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From page 286... ...
By 1984, there was only a small amount of excess female mortality at ages 10-14 years. In Algeria, there was excess female mortality at ages 1-24 years in 1970, but by 1988 there was only slight excess among female children at ages 1= and adult females aged 25-29 years.
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From page 287... ...
Less is known about gender differentials in adolescent and adult mortality, although aggregate estimates for the ages 15 to 60 years suggest that the favorable mortality experience in the female child continues through adulthood. These limited findings, coupled with the evidence from Europe and North Africa cited above, suggest that if there is significant excess female mortality in Sub-Saharan Africa, it is likely concentrated in the reproductive years.
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From page 288... ...
since mortality rises rapidly with age after age 40, any excess female mortality under age 40 may be counterbalanced in aggregate mortality measures by excess male mortality at ages 40-60, where the mortality rates are higher. rr~=l=~c' Rid I I To leant ~+ I 1 C 4~ ~1~ ~ [a ~1~ ~ ~ `~ ~ -_ _1 _ _ ·__ 1_ _ `1_ _ _ , · .
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From page 289... ...
; northern Sudan (Sudan, 1982) ; Tanzania (Tanzania, 1982 and provisional 1988 census tables)
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These are also the four countries that had the lowest estimated mortality rates for females in the early 1960s. The other eastern African countries included in Figure A-3 had more rapid declines in female mortality (Timaeus, 19934.
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From page 291... ...
presents cause-specific data for adults within broad age groups from four small studies in Cape Verde, Mali, western Sierra Leone, and South Africa. For females, the risk of death in the age group 1S-44 from communicable and reproductive diseases ranges from 13 to 72 per 1,000, the highest risk being in western Sierra Leone.
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From page 292... ...
Unlike maternal mortality, analyses of adult mortality, based on retrospective questions about adult survival, do not yet capture the growing role of HIV/AIDS in the mortality profile of Sub-Saharan Africa because of its long period from infection to death and its rapidly increasing incidence over the past decade. HIV may show an increasingly adverse effect on women in Sub-Saharan Africa because of its long incubation period, the rapid heterosexual spread of the virus, and the characteristics of the existing social structure in Sub-Saharan Africa, which may exacerbate the vulnerability of females to infection by HIV (see Chapters 2 and 11~.
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From page 293... ...
Understanding Mortality and Morbidity Across the Life Span Demographic data collection in the past has yielded substantial information regarding infant and child mortality in Sub-Saharan Africa, and more recently it has begun to yield aggregate information about the probability of survival across the middle of the life span, ages 15 to 60. Morbidity data collection, however, with its focus on specific diseases, has not yet encompassed a life span perspective, except perhaps in early childhood, when the combined effect of infectious and parasitic disease and nutritional status have been examined together.
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From page 294... ...
While past demographic data collection has provided substantial information on infant and child mortality, and current efforts have begun to yield aggregate information about the probability of survival across the middle of the life span, ages 15 to 60; morbidity data collection, with its past focus on specific disease conditions, has not yet encompassed a life span perspective. Further understanding of the interrelationships among diseases and disabilities and their longer-term sequelae coupled with advances in the conceptual and methodologic means of data collection and analysis will be required for a better understanding of health status and disease risk across the life span.
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From page 295... ...
· Survey efforts should focus, to the extent possible, on the tracking of defined cohorts of individuals over time, since such prospective data can provide not only reliable measures of disease incidence and mortality, but also the best picture of how diseases, disabilities, and future disease determinants interact to influence health over the life span. The use of such "population laboratories" in the past has provided important contributions to understanding mortality and morbidity dynamics in Sub-Saharan Africa, but the quality of these studies has been uneven.
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From page 296... ...
1989. Biases and errors in the orphanhood method of estimating adult mortality: An empirical examination.
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From page 297... ...
1992. Excess female mortality in Northern Africa since 1965: a description.
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