Adult Mortality in Africa

  • Georges ReniersEmail author
  • Bruno Masquelier
  • Patrick Gerland
Part of the International Handbooks of Population book series (IHOP, volume 2)


Following an overview of the data and approaches for mortality estimation in African countries, we compare trends in estimates of 45q15 produced by the UN agencies with those derived from reports of sibling survival in the Demographic and Health Surveys. A short discussion of the distribution of causes of death is based on verbal autopsy data coming from a handful of Demographic Surveillance Sites. Despite the sometimes intriguing differences between estimates from different sources, a few general patterns of adult mortality trends are common to most sources. With the exception of northern Africa, declines in adult mortality during the last few decades have been modest, and in some populations drastic mortality reversals have been recorded. These are primarily driven by the HIV/AIDS epidemic, but the extremely high adult mortality rates in some southeastern African countries are due to the triple burden of infectious and chronic diseases and the relatively high level of deaths due to external injuries. In some countries severely affected by the HIV/AIDS epidemic, adult mortality started to decline again, and that occurred well before the large scale availability of antiretroviral therapy.


Acknowledgments and Disclaimer

The authors are grateful to Rob Dorrington, Francois Pelletier, and the volume’s editors for helpful discussions and insightful comments, and all other staff members of the Population Division who worked on the 2008 Revision of the World Population Prospects: Gerhard K. Heilig, Kirill Andreev, Taeke Gjaltema, Vladimira Kantorova, Pablo Lattes, and Nan Li. The authors also thank Mie Inoue for clarifications about the WHO estimation methodology. The views and opinions expressed in this paper are those of the authors and do not necessarily represent those of the United Nations. This chapter has not been formally edited or cleared by the United Nations.


  1. Adjuik, M., T. Smith, S. Clark, J. Todd, A. Garrib, Y. Kinfu, K. Kahn, M. Mola, A. Ashraf, H. Masanja, K. Adazu, J. Sacarlal, N. Alam, A. Marra, A. Gbangou, E. Mwageni, and F. Binka. 2006. “Cause-Specific Mortality Rates in Sub-Saharan Africa and Bangladesh.” Bulletin of the World Health Organization 84(3):181–88.CrossRefGoogle Scholar
  2. Bennett, N.G. and S. Horiuchi. 1984. “Mortality Estimation from Registered Deaths in Less Developed Countries.” Demography 21(2):217–33.CrossRefGoogle Scholar
  3. Bhat, P.N.M. 2002. “Completeness of India S Sample Registration System: An Assessment Using the General Growth Balance Method.” Population Studies 56(2):119–34.CrossRefGoogle Scholar
  4. Bradshaw, D. and I. Timaeus. 2006. “Levels and Trends of Adult Mortality.” In D.T. Jamison, R.D. Feachem, M.W. Makgoba, E.R. Bos, F.K. Baingana, K.J. Hofman, and K.O. Rogo (eds.), Disease and Mortality in Sub-Saharan Africa (2nd ed.). Washington, DC, The World Bank.Google Scholar
  5. Brass, W. 1996. “Demographic Data Analysis in Less Developed Countries: 1946–1996.” Population Studies 50(3):451–67.CrossRefGoogle Scholar
  6. Brass, W. and E. Bamgboye. 1981. The Time Location of Reports of Survivorship: Estimates for Maternal and Paternal Orphanhood and the Ever-Widowed. London, London School of Hygiene and Tropical Medicine, CPS Working Paper.Google Scholar
  7. Brass, W. and K. Hill. 1973. Estimating Adult Mortality from Orphanhood. Presented at International Population Conference, Liège.Google Scholar
  8. Cantrelle, P., I.L. Diop, M. Garenne, M. Gueye, and A. Sadio. 1986. “The Profile of Mortality and Its Determinants in Senegal, 1960–1980.” In United Nation (ed.), Determinants of Mortality Change and Differentials in Developing Countries: The Five-Country Case Study Project, pp. 86–116. Department of International Economic and Social Affairs. Population Division and World Health Organization. Division of Health Statistics. New York, NY, United Nations.Google Scholar
  9. Cleland, J. 1996. “Demographic Data Collection in Less Developed Countries 1946–1996.” Population Studies 50(3):433–50.CrossRefGoogle Scholar
  10. Condé, J. 1980. La Mortalité Dans Les Pays En Développement—Mortality in Developing Countries. Paris, New York, NY, Centre de développement de l’Organisation de cooperation et de développement économiques; Division de la population des Nations-Unies.Google Scholar
  11. Davis, K. 1956. “The Amazing Decline of Mortality in Underdeveloped Areas.” The American Economic Review 46(2):305–18.Google Scholar
  12. Diop, I.L. 1990. Étude De La Mortalité À Saint-Louis Du Sénégal À Partir Des Données D’état Civil. University Paris I-Panthéon-Sorbonne.Google Scholar
  13. Dorrington, R., D. Bourne, D. Bradshaw, R. Laubscher, and I.M. Timæus. 2001. The Impact of HIV/AIDS on Adult Mortality in South Africa. Cape Town, Medical Research Council.Google Scholar
  14. Dorrington, R., I. Timaeus, and S. Gregson. 2006. Adult Mortality in Southern Africa Using Deaths Reported by Households: Some Methodological Issues and Results. Presented at Population Association of America Annual Meeting, March 30–April 1, Los Angeles, CA.Google Scholar
  15. Duthé, G. and G. Pison. 2008. “Adult Mortality in a Rural Area of Senegal: Non-Communicable Diseases Have a Large Impact in Mlomp.” Demographic Research 19(37):1419–48.CrossRefGoogle Scholar
  16. Feeney, G. 2001. “The Impact of HIV/AIDS on Adult Mortality in Zimbabwe.” Population and Development Review 27(4):771–80.CrossRefGoogle Scholar
  17. Gakidou, E., M. Hogan, and A.D. Lopez. 2004. “Adult Mortality: Time for a Reappraisal.” International Journal of Epidemiology 33(4):710–17.CrossRefGoogle Scholar
  18. Gakidou, E. and G. King. 2006. “Death by Survey: Estimating Adult Mortality without Selection Bias from Sibling Survival Data.” Demography 43(3):569–85.CrossRefGoogle Scholar
  19. Garenne, M. 1981. “Age Patterns of Mortality in West Africa.” In P.S. Center (ed.), Working Paper. Philadelphia, PA, University of Pennsylvania.Google Scholar
  20. Ghys, P.D., N. Walker, W. McFarland, R. Miller, and G.P. Garnett. 2008. “Improved Data, Methods and Tools for the 2007 HIV and AIDS Estimates and Projections.” Sex Transm Infect 84(Suppl 1):i1–i4.CrossRefGoogle Scholar
  21. Graham, W., W. Brass, and R.W. Snow. 1989. “Estimating Maternal Mortality: The Sisterhood Method.” Studies in Family Planning 20(3):125–35.CrossRefGoogle Scholar
  22. HMD. 2009. Human Mortality Database. Berkeley and Rostock, University of California and Max Planck Institute for Demographic Research, Accessed November 9, 2009Google Scholar
  23. Hallett, T.B. 2010. “Measuring and Correcting Biased Child Mortality Statistics in Countries with Generalized Epidemics of HIV Infection.” WHO Bulletin 88(10):761–8.Google Scholar
  24. Hill, K. 1987. “Estimating Census and Death Registration Completeness.” Asian Pacific Population Forum 1(3):8–13, 23–24.Google Scholar
  25. Hill, K. 2003. Adult Mortality in the Developing World: What We Know and How We Know It. Presented at Training Workshop on HIV/AIDS and Adult Mortality in Developing Countries, United Nations, Department of Economic and Social Affairs, 8–13 September, New York, NY.Google Scholar
  26. Hill, K. and A. Amouzou. 2006. “Trends in Child Mortality, 1960–2000.” In D.T. Jamison, R.D. Feachem, M.W. Makgoba, E.R. Bos, F.K. Baingana, K.J. Hofman, and K.O. Rogo (eds.), Disease and Mortality in Sub-Saharan Africa, (2nd ed.). Washington, DC, The World Bank.Google Scholar
  27. Hill, K., Y. Choi, and I. Timaeus. 2005. “Unconventional Approaches to Mortality Estimation.” Demographic Research 13:281–300.CrossRefGoogle Scholar
  28. Hill, K., A.D. Lopez, K. Shibuya, and P. Jha. 2007. “Interim Measures for Meeting Needs for Health Sector Data: Births, Deaths, and Causes of Death.” Lancet 370(9600):1726–35.CrossRefGoogle Scholar
  29. Hill, K. and J. Trussell. 1977. “Further Developments in Indirect Mortality Estimation.” Population Studies 31(2):313–34.CrossRefGoogle Scholar
  30. Hill, K., D. You, and Y. Choi. 2009. “Death Distribution Methods for Estimating Adult Mortality.” Demographic Research 21(9):235–54.CrossRefGoogle Scholar
  31. INDEPTH Network. 2004. Indepth Model Life Tables for Sub-Saharan Africa. Aldershot, Aldershot Ashgate Pub Ltd.Google Scholar
  32. Katzenellenbogen, J., D. Yach, and R.E. Dorrington. 1993. “Mortality in a Rural South African Mission, 1837–1909: An Historical Cohort Study Using Church Records.” International Journal Epidemiology 22(6):965–75.CrossRefGoogle Scholar
  33. Lopman, B.A., R. Barnabas, T.B. Hallett, C. Nyamukapa, C. Mundandi, P. Mushati, G.P. Garnett, and S. Gregson. 2006. “Assessing Adult Mortality in HIV-1-Afflicted Zimbabwe (1998–2003).” Bull World Health Organ 84(3):189–97.CrossRefGoogle Scholar
  34. Mahapatra, P., K. Shibuya, A.D. Lopez, F. Coullare, F.C. Notzon, C. Rao, and S. Szreter. 2007. “Civil Registration Systems and Vital Statistics: Successes and Missed Opportunities.” Lancet 370(9599):1653–63CrossRefGoogle Scholar
  35. Mathers, C.D., D.M. Fat, M. Inoue, C. Rao, and A.D. Lopez. 2005. “Counting the Dead and What They Died from: An Assessment of the Global Status of Cause of Death Data.” Bulletin of the World Health Organization 83(3):171–77.Google Scholar
  36. Mayosi, B.M., A.J. Flisher, U.G. Lalloo, F. Sitas, S.M. Tollman, and D. Bradshaw. 2009. “The Burden of Non-Communicable Diseases in South Africa.” Lancet 374(9693):934–47.CrossRefGoogle Scholar
  37. Moser, K., V. Shkolnikov, and D.A. Leon. 2005. “World Mortality 1950–2000: Divergence Replaces Convergence from the Late 1980s.” Bulletin of the World Health Organization 83(3):202–9.Google Scholar
  38. Murray, C.J.L., B.D. Ferguson, A.D. Lopez, M. Guillot, J.A. Salomon, and O. Ahmad. 2003. “Modified Logit Life Table System: Principles, Empirical Validation, and Application.” Population Studies 57(2):165–82.CrossRefGoogle Scholar
  39. Murray, C.J.L., J.K. Rajaratnam, J. Marcus, T. Laakso, and A.D. Lopez. 2010. “What Can We Conclude from Death Registration? Improved Methods for Evaluating Completeness.” PLoS Med 7(4):e1000262.CrossRefGoogle Scholar
  40. INDEPTH Network. 2002. Population and Health in Developing Countries. Population, Health, and Survival at Indepth Sites, Volume 1. Ottawa, Canada, International Development Research Centre.Google Scholar
  41. Notkola, V., I.M. Timaeus, and H. Siiskonen. 2000. “Mortality Transition in the Ovamboland Region of Namibia, 1930–1990.” Population Studies 54(2):153–67.CrossRefGoogle Scholar
  42. ORSTOM, INSEE, and INED. 1967. Afrique Noire, Madagascar, Comores Texte—Démographie Comparée. Paris, I.N.S.E.E.Google Scholar
  43. Obermeyer, Z., C.J. Murray, and E. Gakidou. 2008. “Fifty Years of Violent War Deaths from Vietnam to Bosnia: Analysis of Data from the World Health Survey Programme.” BMJ 336(7659):1482–86.CrossRefGoogle Scholar
  44. Obermeyer, Z., J.K. Rajaratnam, C.H. Park, E. Gakidou, M.C. Hogan, A.D. Lopez, and C.J. Murray. 2010. “Measuring Adult Mortality Using Sibling Survival: A New Analytical Method and New Results for 44 Countries, 1974–2006.” PLoS Med 7(4):e1000260.CrossRefGoogle Scholar
  45. Omran, A.R. 1971. “The Epidemiologic Transition. A Theory of the Epidemiology of Population Change.” Milbank Memorial Fund Quarterly 49(4):509–38.CrossRefGoogle Scholar
  46. Palloni, A. and L. Heligman. 1985. “Re-Estimation of Structural Parameters to Obtain Estimates of Mortality in Developing Countries.” Population Bulletin of the United Nations 18:10–33.Google Scholar
  47. Pison, G. 1982. Dynamique D’une Population Traditionnelle: Démographie, Apparentement Et Mariage Dans Une Population D’effectif Limité: Les Peul Bandé (Sénégal Oriental). Paris, Presses Universitaires de France.Google Scholar
  48. Pison, G. 1995. Population Dynamics of Senegal. Washington, DC, National Academy Press.Google Scholar
  49. Pison, G. and A. Desgrees du Loû. 1993. “Bandafassi (Sénégal) – Niveaux Et Tendances Démographiques. 1971–1991.” Paris, Institut National d’Etudes Démographiques. Dossiers et Recherches nr. 40.Google Scholar
  50. Pison, G. and A. Langaney. 1985. “The Level and Age Pattern of Mortality in Bandafassi (Eastern Senegal): Results from a Small-Scale and Intensive Multi-Round Survey.” Population Studies 39(3):387–405.CrossRefGoogle Scholar
  51. Preston, S., A.J. Coale, J. Trussell, and M. Weinstein. 1980. “Estimating the Completeness of Reporting of Adult Deaths in Populations That Are Approximately Stable.” Population Index 46(2):179–202.CrossRefGoogle Scholar
  52. Reed, H. and C.B. Keely. 2001. Forced Migration and Mortality. Washington, DC, National Academy Press.Google Scholar
  53. Reniers, G., T. Araya, G. Davey, N. Nagelkerke, Y. Berhane, R. Coutinho, and E.J. Sanders. 2009. “Steep Declines in Population-Level Aids Mortality Following the Introduction of Antiretroviral Therapy in Addis Ababa, Ethiopia.” AIDS 23(4):511–18.CrossRefGoogle Scholar
  54. Reniers, G. and J. Eaton. 2009. “Refusal Bias in HIV Prevalence Estimates from Nationally Representative Seroprevalence Surveys.” AIDS 23(5):621–29.CrossRefGoogle Scholar
  55. Seedat, M., A. Van Niekerk, R. Jewkes, S. Suffla, and K. Ratele. 2009. “Violence and Injuries in South Africa: Prioritising an Agenda for Prevention.” Lancet 374(9694):1011–22.CrossRefGoogle Scholar
  56. Sen, K. and R. Bonita. 2000. “Global Health Status: Two Steps Forward, One Step Back.” Lancet 356(9229):577–82.CrossRefGoogle Scholar
  57. D.S. Senegal. 1981. Analyse Des Donnees De L’état Civil De La Region Du Cap-Vert (1978). Dakar, Direction de la Statistique.Google Scholar
  58. Setel, P.W., S.B. Macfarlane, S. Szreter, L. Mikkelsen, P. Jha, S. Stout, and C. Abouzahr. 2007. “A Scandal of Invisibility: Making Everyone Count by Counting Everyone.” Lancet 370(9598):1569–77.CrossRefGoogle Scholar
  59. Setel, P.W., O. Sankoh, C. Rao, V.A. Velkoff, C. Mathers, Y. Gonghuan, Y. Hemed, P. Jha, and A.D. Lopez. 2005. “Sample Registration of Vital Events with Verbal Autopsy: A Renewed Commitment to Measuring and Monitoring Vital Statistics.” Bulletin of the World Health Organization 83(8):611–17.Google Scholar
  60. Soleman, N., D. Chandramohan, and K. Shibuya. 2006. “Verbal Autopsy: Current Practices and Challenges.” Bulletin of the World Health Organization 84(3):239–45.CrossRefGoogle Scholar
  61. Stanton, C., N. Abderrahim, and K. Hill. 2000. “An Assessment of DHS Maternal Mortality Indicators.” Studies in Family Planning 31(2):111–23.CrossRefGoogle Scholar
  62. Stolnitz, G.J. 1965. “Recent Mortality Trends in Latin America, Asia and Africa: Review and Re-Interpretation.” Population Studies 19(2):117–38.CrossRefGoogle Scholar
  63. Stover, J., P. Johnson, B. Zaba, M. Zwahlen, F. Dabis, and R.E. Ekpini. 2008. “The Spectrum Projection Package: Improvements in Estimating Mortality, Art Needs, PMTCT Impact and Uncertainty Bounds.” Sexually Transmitted Infections 84(Suppl 1):i24–i30.CrossRefGoogle Scholar
  64. Timæus, I.M. 1991a. “Estimation of Mortality from Orphanhood in Adulthood.” Demography 28(2):213–27.CrossRefGoogle Scholar
  65. Timæus, I.M. 1991b. “Measurement of Adult Mortality in Less Developed Countries: A Comparative Review.” Population Index 57(4):552–68.CrossRefGoogle Scholar
  66. Timæus, I.M. 1991c. New Estimates of Adult Mortality from DHS Data on the Timing of Orphanhood Relative to Marriage. Presented at Demographic and Health Surveys World Conference, August 5–7, 1991, Washington, DC.Google Scholar
  67. Timæus, I.M. 1993. “Adult Mortality.” In K.A. Foote, K.H. Hill, and L.G. Martin (eds.), Demographic Change in Sub-Saharan Africa, pp. 218–55. Washington, DC, National Academy Press.Google Scholar
  68. Timæus, I.M. 1999. Adult Mortality in Africa in the Era of Aids. Presented at 3rd African Population Conference: The African Population in the Twenty-first Century.Google Scholar
  69. Timæus, I.M. and M. Jasseh. 2004. “Adult Mortality in Sub-Saharan Africa: Evidence from Demographic and Health Surveys.” Demography 41(4):757–72.CrossRefGoogle Scholar
  70. Timæus, I.M., B. Zaba, and M. Ali. 2001. “Estimation of Adult Mortality from Data on Adult Siblings.” In B. Zaba and J. Blacker (eds.), Brass Tacks: Essays in Medical Demography. A Tribute to the Memory of Professor William Brass, pp. 43–66. London, England, Athlone Press.Google Scholar
  71. Tollman, S.M., K. Kahn, B. Sartorius, M.A. Collinson, S.J. Clark, and M.L. Garenne. 2008. “Implications of Mortality Transition for Primary Health Care in Rural South Africa: A Population-Based Surveillance Study.” Lancet 372(9642):893–901.CrossRefGoogle Scholar
  72. Trussell, J. and G. Rodriguez. 1990. “A Note on the Sisterhood Estimator of Maternal Mortality.” Studies in Family Planning 21(6):344–46.CrossRefGoogle Scholar
  73. UN. 1975. World Population Prospects as Assessed in 1973. New York, NY, United Nations, Department of Economic and Social Affairs.Google Scholar
  74. UN. 1982. Model Life Tables for Developing Countries. New York, NY, United Nations, Department of International Economic and Social Affairs.Google Scholar
  75. UN. 1983. Manual X: Indirect Techniques for Demographic Estimation. New York, NY, United Nations Population Division, Department of international Economic and Social Affairs.Google Scholar
  76. UN. 1991. World Population Prospects: The 1990 Revision. New York, NY, United Nations Population Division, Department of Economic and Social Affairs.Google Scholar
  77. UN. 2002. Methods for Estimating Adult Mortality. New York, NY, United Nations Population Division, Department of Economic and Social Affairs.Google Scholar
  78. UN. 2005. World Population Prospects: The 2004 Revision (CD-Rom Edition). New York, NY, United Nations Population Division, Department of Economic and Social Affairs.Google Scholar
  79. UN. 2007. World Mortality Report 2007 (CD-Rom Edition). New York, NY, United Nations Population Division, Department of Economic and Social Affairs.Google Scholar
  80. UN. 2009. World Population Prospects: The 2008 Revision (CD-Rom Edition). New York, NY, United Nations Population Division, Department of Economic and Social Affairs.Google Scholar
  81. UN. 2010. “World Population Prospects: The 2008 Revision. Highlights.” New York, NY, United Nations, Department of Economic and Social Affairs, Population Division.Google Scholar
  82. UNAIDS. 2008. Report on the Global Aids Epidemic. Geneva, Joint United Nations Programme on HIV/AIDS, Accessed 9 November 2009.Google Scholar
  83. Unwin, N., P. Setel, S. Rashid, F. Mugusi, J.C. Mbanya, H. Kitange, L. Hayes, R. Edwards, T. Aspray, and K.G. Alberti. 2001. “Noncommunicable Diseases in Sub-Saharan Africa: Where Do They Feature in the Health Research Agenda?” Bulletin of the World Health Organization 79(10):947–53.Google Scholar
  84. Vallin, J. and F. Meslé. 2004. “Convergences and Divergences in Mortality. A New Approach to Health Transition.” Demographic Research S2(2):9–43.Google Scholar
  85. WHO. 2008a. The Global Burden of Disease: 2004 Update. Geneva, World Health Organization.Google Scholar
  86. WHO. 2008b. Life Tables for Who Member States for 1990, 2000 and 2006: Indicator Definitions and Metadata of Life Expectancy at Birth. Accessed 16 November 2009 [see also the 2007 World Health Report].
  87. Waltisperger, D. and T. Rabetsitonta. 1988. Un Bilan De Trente Ans De Mesures Directes De La Mortalite Adulte En Afrique. Presented at African Population Conference – Congres Africain de population, Dakar, Senegal.Google Scholar
  88. Wilson, C. 2001. “On the Scale of Global Demographic Convergence, 1950–2000.” Population and Development Review 27(1):155–71.CrossRefGoogle Scholar
  89. Zlotnik, H. and K. Hill. 1981. “The Use of Hypothetical Cohorts in Estimating Demographic Parameters under Conditions of Changing Fertility and Mortality.” Demography 18(1):103–22.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Georges Reniers
    • 1
    Email author
  • Bruno Masquelier
    • 2
  • Patrick Gerland
    • 3
  1. 1.Department of Sociology and Office of Population ResearchPrinceton UniversityPrincetonUSA
  2. 2.Centre de Recherches en Démographie et Sociétés, Université Catholique de LouvainLouvainBelgium
  3. 3.Population Policy Section, Population DivisionUnited NationsNew YorkUSA

Personalised recommendations