The Evolving Demographic and Health Transition in Four Low- and Middle-Income Countries: Evidence from Four Sites in the INDEPTH Network of Longitudinal Health and Demographic Surveillance Systems

Abstract

This paper contributes evidence documenting the continued decline in all-cause mortality and changes in the cause of death distribution over time in four developing country populations in Africa and Asia. We present levels and trends in age-specific mortality (all-cause and cause-specific) from four demographic surveillance sites: Agincourt (South Africa), Navrongo (Ghana) in Africa; Filabavi (Vietnam), Matlab (Bangladesh) in Asia. We model mortality using discrete time event history analysis. This study illustrates how data from INDEPTH Network centers can provide a comparative, longitudinal examination of mortality patterns and the epidemiological transition. Health care systems need to be reconfigured to deal simultaneously with continuing challenges of communicable disease and increasing incidence of non-communicable diseases that require long-term care. In populations with endemic HIV, long-term care of HIV patients on ART will add to the chronic care needs of the community.

Fig 1. Life expectancy at birth by time and site.

Fig 2. Stacked bar chart of causes of death by time and site.

Fig 3. Changes in predicted probability of dying due to cause of death by site and time: individual.

X-axis is reversed to show time-trend across all sites except Agincourt, where mortality has been increasing over time.

Fig 4. Changes in cause of death distribution by site and time: site.

The closer a point is to one of the vertices, the greater the proportion of deaths due to that cause. For instance, in Matlab in 1987, the estimated proportions would be: 68% communicable diseases (ICD), 19% noncommunicable diseases (NCD), and 13% Injuries.