The study of mortality in the African context

The demographic study of mortality in Subsaharan Africa is dominated by two paradoxes. The first has to do with the recognition awarded to the topic. The persistence of high mortality levels--higher probably than in any other large world region--makes it a potentially burning social issue. The people of the area are concerned about access to modern medicine and the eradication of diseases. If a field calls for the development of accurate statistics, this is it. We know little about mortality levels and their distribution over space; we know even less on trends, and virtually nothing about mortality differentials by social and economic circumstances. There are no major breakthroughs in morbidity and cause of death statistics. Africa is still far from the stage reached in Europe 150 years ago in the study of mortality. When William Farr organized the collection of vital statistics in England and Wales his concern and that of his contemporaries was with the fight against disease. Farr, a mere Compiler of Abstracts at the Registrar General\u27s Office, was hailed as the foremost medical statistician of his time; it was said that after him pestilence no longer walketh in the dark. The use of the data he helped to collect was decisive in the conquest of the major scourge of the time, cholera. He provided information on the location of the most unsanitary sections of the country and identified the most dangerous occupations. We doubt that the demographic statistics that are collected today in Africa are used very much in the same way, to identify areas of infection and classes of the population specially vulnerable to specific diseases. Despite the importance of these issues, and despite the universal desire to prolong life and to eliminate the human wastage of early death, little effort goes into the collection of demographic data on morta1ity. This becomes more apparent if we compare research on mortality to the much more active interest in fertility, although the latter topic is not widely recognized in the area itself as a burning issue. Out aim is certainly not to suggest that less research should be directed towards fertility and its determinants. Rather, we find it paradoxical that mortality research does not elicit more attention