Impact of the HIV epidemic on mortality in sub-Saharan Africa: evidence from national surveys and censuses

Abstract

Objective: To measure recent trends in all-cause child and adult mortality in national populations in sub-Saharan Africa.

Design: Secondary analysis of data collected in national household surveys and censuses.

Methods: The index of infant and child mortality is the probability of dying before age 5 years (under-five mortality). For adult mortality, it is the probability of dying between ages 15 and 60 years. Mortality trends are assessed in three ways: (i) by comparison of data collected in the 1990s with those from the 1980s; (ii) using the retrospective reports of the survival of women's children and siblings collected by Demographic and Health Survey inquiries; and (iii) by comparing the latter estimates with estimates from data on orphanhood.

Results: Under-five mortality is stagnant or rising in several African countries. In some countries, however, adverse trends developed too early in the 1980s to be attributable to HIV. In most countries, the three approaches to monitoring adult mortality yield consistent results. Adult death rates doubled or tripled between the 1980s and mid-1990s in Uganda, Zambia, and Zimbabwe. Mortality also rose substantially elsewhere in East and Central Africa but not in West Africa. Increases in mortality are concentrated among young adults. In general, men are worst affected, but in Uganda the rise in women's mortality is greater.

Conclusions: Data can be collected in national household surveys and censuses to monitor the mortality impact of HIV in Africa. Such data have begun to document the differential impact of the epidemic. In those countries with data in which HIV became prevalent by the late 1980s, massive rises in adult mortality occurred by the mid-1990s.

PIP: Measures of mortality during the 1990s are presented for the African countries which have collected census and survey data on mortality in their national populations. Mortality trends are assessed in the following manners: by comparing data collected during the 1990s with those from the 1980s, using the retrospective reports of the survival of women's children and siblings collected in Demographic and Health Surveys (DHS), and by comparing the DHS estimates with estimates made from data on orphanhood. Under-five mortality is either stagnant or rising in several African countries. However, in some countries, such adverse trends developed too early in the 1980s to be attributable to HIV. The three described approaches to monitoring adult mortality have yielded consistent results in most countries. Adult death rates doubled or tripled between the 1980s and mid-1990s in Uganda, Zambia, and Zimbabwe, while levels of mortality also rose considerably elsewhere in East and Central Africa, but not in West Africa. Increases in mortality are concentrated among young adults, with men being the worst affected overall, although in Uganda the increase in women's mortality is greater.