Causes of Death

Excerpt

Consistent estimates of cause-specific mortality are essential for understanding the overall epidemiological profile of disease in a population. The principal data source for these estimates is civil registration systems. Adequately functioning systems that produce statistics on causes of death on a regular basis exist in only about one-third of all countries of the world (Lopez et al. 2002). In Sub-Saharan Africa, very little information has been available on cause-specific mortality, let alone data from civil registration systems, as described in the previous edition of this book (Feachem and Jamison 1991). Estimates at that time were derived largely from independent disease-specific epidemiological studies and were not examined within the context of an overall demographic "envelope" of mortality, as is required to ensure that claims about causes of death are not exaggerated.

Over the past decade, much progress has been made in the collection of mortality statistics from a wide array of sources. These include data from previously existing sources that were uncovered during a systematic search, as well as data from new data collection ventures that were established to fill these data gaps. Although we are still a long way from having satisfactory empirical data that can be directly used to derive national and regional cause-specific mortality estimates, the expansion in available data suggests that estimates of causes of death can now be made with somewhat greater confidence. The absence of complete vital registration data in virtually all countries of the region nonetheless means that we need to rely on epidemiological research and demographic surveillance to generate model-based estimates of deaths by cause.

Such an estimation process is complex and involves two stages. First, a demographic estimate of overall mortality by age and sex is required. Second, a cause-specific mortality structure is fitted to this estimate. Many assumptions are required, and an attempt has been made here to delineate these clearly, so that they can be kept in mind when interpreting the results.