IMPACT OF THE HIV EPIDEMIC ON MORTALITY IN SUB-SAHARAN AFRICA - EVIDENCE FROM NATIONAL SURVEYS AND CENSUSES

Objective: To measure recent trends in all-cause child and adult morta lity 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 o f dying before age 5 years (under-five mortality). For adult mortality , it is the probability of dying between ages 15 and 60 years. Mortali ty trends are assessed in three ways: (i) by comparison of data collec ted in the 1990s with those from the 1980s; (ii) using the retrospecti ve 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: Unde r-five mortality is stagnant or rising in several African countries. I n some countries, however, adverse trends developed too early in the 1 980s to be attributable to HIV. In most countries, the three approache s to monitoring adult mortality yield consistent results. Adult death rates doubled or tripled between the 1980s and mid-1990s in Uganda, Za mbia, and Zimbabwe. Mortality also rose substantially elsewhere in Eas t and Central Africa but not in West Africa. Increases in mortality ar e 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 mo nitor the mortality impact of HIV in Africa. Such data have begun to d ocument the differential impact of the epidemic. In those countries wi th data in which HIV became prevalent by the late 1980s, massive rises in adult mortality occurred by the mid-1990s. (C) 1998 Lippincott-Rav en Publishers.