Evaluating the adequacy of the method of using vital registration and census data in estimating adult mortality when applied sub-provincially

In developing countries, vital registration is the best source of death data that can be used to estimate adult mortality provided they are sufficiently complete. However, they are usually insufficient for estimating mortality sub-nationally due to incomplete registration. This research adapts a method used by Dorrington, Moultrie and Timæus at the provincial level to determine whether it is adequate for estimating adult mortality at the district municipality level in the year prior to the 2001 census. The method uses registration data adjusted for completeness of registration to scale (up or down) the deaths reported by households in the census by age group for each sex. The process of correcting the registered deaths in the year prior to the 2001 census involves estimating intercensal completeness for each population group and each sex between 1996 and 2001 using the average of results from the GGB and the SEG+δ methods. Thereafter, the results are used to estimate the completeness in each of the years within the intercensal period. Thus, an estimate of completeness is obtained in the year prior to the 2001 census for correcting the registered deaths at the population group level. These registered deaths are then used to obtain population group specific adjustment factors to correct the deaths reported by households at the district level, and thereafter to estimate adult mortality rates. Most districts in Kwa-Zulu-Natal have amongst the highest rates of adult mortality, while most districts in the Western Cape have amongst the lowest rates. Results show the Buffalo metropolitan municipality to have higher mortality than that expected for most of the district metropolitan municipalities for both sexes. The same is true for women in Mangaung metropolitan district. It is suspected that HIV prevalence had a significant impact on different levels of adult mortality in the districts, although some adults in the more urban provinces may have died in other provinces. At the provincial level, the method produces marginally higher estimates of adult mortality than the other sources. Provinces that reflect a higher level of mortality appear to deviate more from other research findings than those reflecting lower mortality. In conclusion, the method produces district estimates of ₄₅q₁₅ that are consistent with provincial estimates from other sources and with estimates of HIV prevalence at the district level