IJE vol.33 no.4 © International Epidemiological Association 2004; all rights reserved.
Book Review |
Population and Health in Developing Countries. Volume 1, Population, Health, and Survival at INDEPTH Sites. INDEPTH Network. Ottawa: International Development Research Centre, 2002, pp. 356, (PB) $40.40 ISBN: 0-88936-948-8.
Demographic data for Sub-Saharan African countries are often limited to those based on decennial censuses, infrequent household surveys, and incomplete outputs from health management information systems. As a result, knowledge of the demographic characteristics of populations is inadequate for the majority of countries in Sub-Saharan Africa for formulating health and other policies in which demographic aspects need to be considered. The quality and usefulness of the existing information also leaves much to be desired: demographic and health surveys, for example, produce national estimates of limited use for district-level decision making, do not provide enough detail to observe changes in mortality rates other than for the youngest age groups, and trends in cause-specific mortality are almost never available. Frequently, demographers are relying on models based on the experience of statistically more developed countries in other parts of the world to estimate basic indicators such as life expectancy, without any assurance that such models accurately capture patterns of mortality in Sub-Saharan African settings.
The first volume in a series by the International Network for the continuous Demographic Evaluation of Populations and Their Health (INDEPTH), Population and Health in Developing Countries shows how long-term commitments of teams of dedicated epidemiologists, demographers, and administrators, with the support of national governments and donors, are generating demographic and health statistics that are accurate and relevant for health policy. The volume describes the experiences of demographic surveillance systems that belong to the INDEPTH Network, focusing on mortality and age structure. Of the 22 sites for which demographic data are presented, 19 are located in Sub-Saharan African countries, with the remaining 3 in Bangladesh and Vietnam. Some of the sites, such as Gwembe in Zambia, Bandafassi in Senegal, and Matlab, in Bangladesh have been in operation for several decades, whereas others, such as several sites in Tanzania, first started collecting demographic data and vital events in the 1990s.
The volume consists of three parts. The first part is essentially an introduction to the concepts and operations of demographic surveillance systems, which are defined as the data collection and tabulation of health and demographic events of an entire population within a circumscribed geographical area (usually called ‘sites’). This part of the volume, written by several authors with practical experience, is essential reading for anyone less familiar with demographic surveillance systems. It is a concise introduction to measurement of demographic rates in surveillance sites, to data collection and processing, and assessing the quality of the data. The material is easily accessible for anyone with a minimal knowledge of epidemiology or demography.
The second part of the volume consists of two quite different chapters. The first chapter in this part is descriptive, showing the mortality rates, death rates, and life expectancies as measured in the INDEPTH sites for the late 1990s. It includes an Annex with a full set of abridged life tables—possibly the first compilation of empirically based life tables for Sub-Saharan populations. The tables show very large differences among the sites in both childhood mortality indicators (with the under-5 mortality rate varying between 33 in Agincourt, South Africa, to over 200 in some Western African sites). The chapter also documents the very high adult mortality rates (here defined somewhat unusually as 30q20- the probability of surviving from age 20 to age 50), which are up to six to seven times higher in some of the African sites when compared with the Matlab, Bangladesh site, reflecting the high impact of AIDS mortality in many of the African sites. While the tables allow comparison among the sites for the late 1990s, it is disappointing that the authors of this chapter did not also include mortality estimates for the earlier periods for sites for which such data are available. Trends over time in mortality in the sites for which multiple periods are available would certainly be of great interest to those analysing mortality patterns in African populations.
The second chapter of Part II of the volume is the most analytical chapter in the volume, and one that demonstrates the value of empirically based life tables. On the basis of a statistical analysis of the collected mortality data from the African surveillance sites, seven different patterns of age-specific mortality for a given level of life expectancy are derived. These are then contrasted with the commonly used Coale-Demeny and United Nations model life tables, which are found to be a poor fit at different age groups. As life tables constructed by agencies such as the United Nations are the basis for widely used demographic projections, the chapter implies the need for caution in relying on those international models for African populations. While the absence of African patterns may until now have been a justification for using existing model life tables, the analysis presented in this volume argues convincingly for the use of the African models.
Part III describes in separate chapters each of the 22 demographic surveillance sites that are part of INDEPTH, written by teams of authors from the sites. This provides at the same time the richest information for understanding the conditions in which demographic surveillance systems operate, as well as some repetitve information, and shows considerable variation in the quality of individual contributions. Clearly, an attempt to standardize these chapters has also led to some duplication (for example, about data collection approaches) as well as some omission of additional information that is available from some of the sites.
This is an important volume. It brings together the findings of all the demographic surveillance systems in one convenient volume, and adds important analysis to the literature on age patterns of mortality. Planned volumes on other findings from the sites, on fertility, reproductive health, and equity in health, should be awaited eagerly.
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