The Mortality Situation in Cameroun

In this article, we examine the mortality situation in Cameroon in relation to other countries of the sub-continent. Evidence for the overall childhood mortality rate suggests that 13 percent of the newborn babies are expected to die before their fifth birthday, a decline of 6 percent points from the 1978 value. This, compared to other Sub-Saharan African countries, appears to be moderate but is very high by other developing countries' or world's standard. In fact, the decline has not yet reached a reasonable minimum that could suggest noticeable improvement in the health status of the population at both macro and micro levels. The adult mortality situation on the other hand is very high even by Sub-Saharan African standards. About 35 percent of those who survive childhood hazards up to age 15 are not expected to celebrate their 60th anniversary compared to barely 20 percent for some other countries of the sub-continent. Even when compared to the childhood mortality situation, Cameroon is a country with very poor health for adults. It appears that children in Cameroon have benefitted more than adults from the reduction of overall mortality to a "moderate" level. Consequently, as year 2000 approaches it is clear that Cameroon is still far from attaining the goal of "Health for All" and it is becoming very uncertain whether the target will be attained. As the results suggest, not only is there need for greater efforts to improve the survival of children in the country, but in addition, it is also necessary to institute strategies to maintain their health when they survive childhood

Estimating Adult Mortality in Cameroon from Census Data on Household Deaths: 1976-1987

Many African countries lack conventional data sources for systematic assessment of adult mortality. Studies of mortality in Cameroon have mainly been concerned with infant and child survival, while levels and structure of adult mortality have rarely been investigated. This paper employs the Generalized Growth Balance method to estimate adult mortality in Cameroon using data from 1976 and 1987 censuses. More specifically, we use data on household deaths during the 12 months preceding the 1976 and 1987 censuses to assess the adult mortality situation in Cameroon prior to the onset of HIV/AIDS pandemic. Results suggest that overall adult mortality in Cameroon prior to the HIV/AIDS era was high even by African standards. Ignoring potential methodological and data differences, a comparison of age-specific death rates from the two censuses to those from the recent DHS results portray a recent increase in mortality during the peak productive and reproductive years. However, a complete and reliably operational vital registration system remains the ultimate solution to estimating and fully understanding the trends in adult mortality. In the meantime, consistently collecting census data on household deaths can enhance knowledge and inform policy intervention

Spatial Differentials in Childhood Mortality in South Africa: Evidence from the 2001 Census

This study examines spatial differentials in childhood mortality in South Africa using data from the 2001 population census. Of the complex routes of geographical area hierarchy maintained by South Africa, one route links provinces to Magisterial Districts (MDs). There are in all 354 MDs and nine provinces. Our analyses are conducted mainly at the level of MDs. The results show that provincial level indicators mask huge disparities in child health experienced by certain segments of the population. Children born in MDs such as Tabankulu, Lusikisiki, Bizana, Flagstaff, Libode and in the Eastern Cape Province in general are the most threatened early in life. Under prevailing mortality conditions, more than 10% of the children born in these districts are unlikely to celebrate their fifth anniversary. Most of the high mortality MDs form clusters that sometimes cut across provincial boundary. As it is to be expected, most of these high risk districts are among the poorest in the country as measured by average monthly expenditure. However, the worse-off districts, health-wise, are not necessarily the poorest and similarly, the best child health achievers are not necessarily the most economically well-off. On the basis of these findings, implementing policies targeting such high risk districts would seem a more rational way to help close the within country disparities in child mortality and thereby speed up progress toward the MDGs targe

How Early is the Timing of Family Formation in Rural Cameroon?

Most recent demographic studies suggest that women are postponing marriage to their twenties. However, data from the 1978 Cameroon Fertility Survey and 1991 Demographic and Health survey suggest that an average rural woman in Cameroon experiences marriage and motherhood very early in life even by Sub-Saharan African standards. By the time a cohort of women is celebrating its 20th anniversary; very few are single. While marriage is closely tied with motherhood experience, an appreciable number of rural women do start sexual relationships and have their first births even before contracting a socially recognized marital union. Marriage does not seem to be the prerequisite for childbearing as 21% of the never married women (mostly teenagers) were already into motherhood.La plupart des \ue9tudes en d\ue9mographie ont montr\ue9 que les femmes diff\ue8rent leur mariage jusqu'\ue0 l'\ue2ge de vingt ans. Cependant, pour une femme du milieu rural du Cameroun, tout indique qu'elle se marie ou commence la maternit\ue9 tr\ue8s t\uf4t dans sa vie m\ueame par comparaison aux normes en usage en Afrique sub-saharienne. Quand un groupe de femme c\ue9l\ue8bre son vingti\ue8me anniversaire, seules quelques rares parmi elles sont encore c\ue9libataires. M\ueame si le mariage est \ue9troitement li\ue9 \ue0 leur exp\ue9rience en tant que m\ue8re, beaucoup de femmes commencent \ue0 avoir des rapports sexuels et enregistrent leur premi\ue8re naissance bien avant qu'elles ne contractent un mariage socialement accept\ue9. Donc, le mariage ne semble pas \ueatre une condition pour le d\ue9marrage d'une vie sexuelle ou de la maternit\ue9 puisque 21 % des femmes qui n'ont jamais \ue9t\ue9 mari\ue9es (dont la plupart sont des adolescentes) \ue9taient d\ue9j\ue0 m\ue8res

Does the contribution of women to household expenditure explain contraceptive use? An assessment of the relevance of bargaining theory to Africa

This paper draws on the concept of bargaining theory to interpret contraceptive decision-making among women who express a desire to limit or space children. Bargaining theory assumes conflict in decision making within households and posits that such conflict is resolved through bargaining. Women’s bargaining power is said to increase with more control of resources. The underlying assumption is that household decisions are governed by economics. This paper acknowledges that economics may influence reproductive decisions, but posits that African social norms and institutions are more important in defining conjugal roles than spousal relative economic contribution to family expenditure. Findings from seven African countries show that women who contribute more income to household expenditure are no more likely to adopt family planning as predicted by bargaining theory. These results bring into question theoretical perspectives that are sometimes promoted as generic explanatory models without validation in specific cultural settings

Assessing levels and trends of adult mortality in Sub Saharan Africa using INDEPTH health and demographic surveillance systems

International audienceThere is still a considerable dearth of knowledge regarding adult mortality and premature deaths in Sub-Saharan Africa (SSA). Attempts to measure adult mortality using censuses and cross-sectional surveys rely mainly on indirect techniques that are affected by common biases. The growing number of Health and Demographic Surveillance Systems (HDSSs) offer a mediumterm solution to the dearth of knowledge regarding adult mortality and the main causes in Africa. This paper compares adult mortality estimates from 16 HDSSs in nine countries in SSA based on publicly available data on INDEPTHStats. We use Life Table techniques to examine differences in adult mortality trends and to identify mortality clusters and sex differentials. Results reveal distinctive mortality trends for the three regions of Africa with the Southern and Eastern African regions having relatively higher mortality than the West African region

Gender-based violence and its association with mental health among Somali women in a Kenyan refugee camp: a latent class analysis

background In conflict-affected settings, women and girls are vulnerable to gender-based violence (GBV). GBV is associated with poor long-term mental health such as anxiety, depression and post-traumatic stress disorder (PTSD). Understanding the interaction between current violence and past conflict-related violence with ongoing mental health is essential for improving mental health service provision in refugee camps. Methods Using data collected from 209 women attending GBV case management centres in the Dadaab refugee camps, Kenya, we grouped women by recent experience of GBV using latent class analysis and modelled the relationship between the groups and symptomatic scores for anxiety, depression and PTSD using linear regression. Results Women with past-year experience of intimate partner violence alone may have a higher risk of depression than women with past-year experience of non-partner violence alone (Coef. 1.68, 95% CI 0.25 to 3.11). Conflict-related violence was an important risk factor for poor mental health among women who accessed GBV services, despite time since occurrence (average time in camp was 11.5 years) and even for those with a past-year experience of GBV (Anxiety: 3.48, 1.85–5.10; Depression: 2.26, 0.51–4.02; PTSD: 6.83, 4.21–9.44). Conclusion Refugee women who experienced past-year intimate partner violence or conflict-related violence may be at increased risk of depression, anxiety or PTSD. Service providers should be aware that compared to the general refugee population, women who have experienced violence may require additional psychological support and recognise the enduring impact of violence that occurred before, during and after periods of conflict and tailor outreach and treatment services accordingly

Research challenges in evaluating gender-based violence response services in a refugee camp

This article presents a case study of research in Dadaab, Kenya to highlight some of the relevant challenges encountered while conducting gender-based violence research in humanitarian settings. A longitudinal mixed-methods design was used to evaluate a comprehensive case-management intervention in the refugee complex near the border of Kenya and Somalia. We present an overview of both expected and unexpected challenges during preparation and implementation of the research, adaptations made to the research design, and lessons learned for future research in similar contexts. Some of the key challenges were attributed to the highly securitized and remote environment of Dadaab refugee camp, like many refugee camp settings, which created limitations for sampling designs, interview locations, and also created particular burdens for the research team members conducting interviews. In addition to the camp environment, the dynamic nature of events and trends in the camp setting created barriers to follow-up with longitudinal cohort participants as well as uncertainty on how to plan for future implementation of research design phases in response to camp changes. Conducting research in humanitarian settings requires a flexible approach to accommodate the challenges that can impact both service delivery and research activities. The discussion presented in this article contributes to the evolving practical guidance on conducting research in humanitarian settings

The association between health insurance status and utilization of health services in rural Northern Ghana: evidence from the introduction of the National Health Insurance Scheme

Background: Many households in low- and middle-income countries face financial hardships due to payments for health care, while others are pushed into poverty. Risk pooling and prepayment mechanisms help to lessen the impact of the costs of care as well as assisting to achieve universal health coverage (UHC). Ghana implemented the National Health Insurance Scheme (NHIS) for the promotion of access to health services for all Ghanaians. In this paper, we examined the association between health insurance status and utilization of outpatient and inpatient health services in rural poor communities. Methods: The study was a cross-sectional household survey conducted in the Kassena-Nankana districts of Northern Ghana. We conducted interviews in 11,175 households and collected data on 55,992 household members. Multiple logistic regression models were used to identify factors associated with the utilization of outpatient and inpatient health services. The dependent variables were the utilization of outpatient and inpatient health services. We adjusted for several potential socio-demographic factors associated with utilization and health insurance status. Results: Significantly, the insured had 2.51 (95% CI 2.3\u20132.8) and 2.78 (95% CI 2.2\u20133.6) increased odds of utilizing outpatient and inpatient health services respectively. Respondents with a history of recent illness or injury [32.4 (95% CI 29.4\u201335.8) and 5.72 (95% CI 4.6\u20137.1)] and poor or very poor self-reported health status [2.08 (95% CI 1.7\u20132.5) and 2.52 (95% CI 1.9\u20133.4)] and those on chronic medication [2.79 (95% CI 2.2\u20133.5) and 3.48 (95% CI 2.5\u20134.8)] also had increased odds of utilizing both outpatient and inpatient health services respectively. Among the insured, the poorest use the Community-based Health Planning and Services (CHPS) compounds, while the least poor use private clinics and public hospitals for outpatient health services. The uninsured predominately use pharmacies or licensed chemical shops (LCSs). For inpatient health services, the insured largely use public hospitals, with the uninsured using private clinics or public health centres. Conclusion: The findings suggest that being insured with the NHIS is associated with increased utilization of outpatient and inpatient health services in the study area. Overall, the NHIS can be an effective tool for achieving UHC and hence pragmatic efforts should be made to sustain it

The INDEPTH Data Repository: An International Resource for Longitudinal Population and Health Data From Health and Demographic Surveillance Systems

The International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) is a global network of research centers that conduct longitudinal health and demographic evaluation of populations in low- and middle-income countries (LMICs) currently in 52 health and demographic surveillance system (HDSS) field sites situated in sub-Saharan Africa (14 countries), Asia (India, Bangladesh, Thailand, Vietnam, and Indonesia), and Oceania (Papua New Guinea). Through this network of HDSS field sites, INDEPTH is capable of producing reliable longitudinal data about the lives of people in the research communities as well as how development policies and programs affect those lives. The aim of the INDEPTH Data Repository is to enable INDEPTH member centers and associated researchers to contribute and share fully documented, high-quality datasets with the scientific community and health policy makers