Advances in the Measurement of Adult Mortality from Data on Orphanhood

The premature death of adults is a major, but poorly documented, health problem in developing countries. The inadequacy of registration statistics and difficulty of collecting accurate data directly in surveys mean that indirect methods of analysis, particularly those based on orphanhood, represent an important source of adult mortality estimates. Assessments of the orphanhood method have expressed concern about the robustness of the procedures used to estimate life table indices from orphanhood data, particularly for males, about under-reporting of orphanhood, particularly among children (the ‘adoption effect’), and about the ways that complete life tables are derived from indirect estimates. Investigation of the estimation procedures suggests that they are very robust for female mortality and acceptably so for male mortality. Small increases in accuracy would accrue from use of a regression based method to estimate male mortality, that incorporates a more sophisticated fertility model than the original method. Such a procedure is presented, together with one for female mortality based on consistent assumptions. Existing methods for fitting life tables to indirect estimates are sometimes less satisfactory. An alternative approach is proposed and assessed. In some countries, orphanhood estimates are seriously biased by the adoption effect. Such errors can be reduced by techniques that analyze data on orphanhood in adulthood. Two such methods are developed and tested. The first estimates mortality from period data on orphanhood after age 20; the second uses data on orphanhood since first marriage. The methods are sensitive to age exaggeration, but data on young adults are a promising source of recent estimates of adult mortality. Finally, procedures are presented for analyzing data on orphanhood prior to marriage. In countries where adults report this information accurately, it can be used to measure adult mortality up to 35 years before the data were collected

Mortality of HIV-Infected Patients Starting Antiretroviral Therapy in Sub-Saharan Africa: Comparison with HIV-Unrelated Mortality

Comparing mortality rates between patients starting HIV treatment and the general population in four African countries, Matthias Egger and colleagues find the gap decreases over time, especially with early treatment

The International Network for the Demographic Evaluation of Populations and their Health (INDEPTH), the Importance of Core Support

INDEPTH is a network of 37 health and demographic surveillance system (HDSS) sites based in the developing world that was set up by its members to raise their research productivity by sharing experience and skills and mounting multi-site research projects. This vision has proved relevant. INDEPTH has developed into a well-established network over the past decade and made effective progress toward these goals, but needs to continue to promote the conduct of more and better quality research using these HDSS data. This report suggests some changes to INDEPTH’s structures and working procedures that should enable it to function more efficiently. It also identifies some challenges that the Network should address in order to enhance its achievements and further increase its scientific and policy impact