The absence of adult mortality data for sub-Saharan Africa: a practical solution

Abstract

Information on cause of death among adults in sub-Saharan Africa is essentially nonexistent. Published sources provide statistics on both cause-specific and overall rates of mortality, but closer examination reveals that these data consist mostly of extrapolations and outright guesses. In the absence of accurate and comprehensive registries of vital events for the majority of the region's inhabitants, longitudinal studies of defined population-based cohorts represent the only realistic strategy to fill this void in basic public health information. The advantage of longitudinal studies is particularly clear for chronic diseases, the category for which the least is known. Noncommunicable diseases account for a significant portion of adult deaths in sub-Saharan Africa, yet the empirical bases for public health policies and interventions are essentially absent. Verbal autopsy has great potential to contribute to understanding about the cause of death among African adults. This method is discussed in the present article, and practical considerations for longitudinal studies using this methodology are reviewed.

PIP: This article reviews the major weaknesses contained in estimates of mortality in Africa south of the Sahara. The need for adult mortality data from developing countries has led researchers to propose estimates derived from model-based extrapolations of questionable sources such as outdated studies, nonrepresentative samples, and studies of insufficient size. Although longitudinal, community-based studies provide the best option for obtaining vital statistics in Africa, virtually all such studies have emphasized infectious diseases and childhood morbidity and mortality. Information about chronic diseases and trauma is especially limited despite the fact that they cause a sizable portion of adult deaths in the region. Reliance on longitudinal surveys requires use of verbal autopsy as a means of determining cause of death. This method assumes that it is possible to classify deaths into useful categories based on analysis of retrospective interviews and is associated with considerable difficulties. To assess the feasibility of a potential methodology for collecting cause-specific adult mortality data, the derived estimates must be generalizable; the technical requirements must be reasonable; and the responding community must be large enough (5000-10,000 adults), must cooperate with the survey process and be stable enough to provide long-term data (3-5 years). Intelligent and productive health interventions in the region will depend upon development of the adequate data base that can be collected with appropriate effort.