INDEPTH Network

1. Understanding the Demographic and Health Transitions in Developing Countries using Health, Health System and Demographic Surveillance Data Participating sites Agincourt and Navrongo (Africa); Matlab and Filabavi (Asia) Prepared for presentation at the 9th INDEPTH AGM, Pune, India, Oct 26-29, 2009 INDEPTH Network

2. Background/motivation • The shift from high to low levels of mortality and fertility now famously called the demographic transition occurred over a century ago in the developed world. • The transition, it is argued, starts with a drop in mortality followed by fertility • Decline attributed to several factors

3. Although the demographic transition is underway in a number of countries, it has been argued that the pattern and structure of the current transition is substantially different from what occurred in historical Europe. • Fertility decline stalled mid-stream (in Africa) • Mortality decline also stalled or reversed in a number of African countries • “Double burden” of infectious and degenerative and non-communicable diseases.

4. Strategic role of INDEPTH • Longitudinal data on fertility, mortality (including causes of death) • Characterize changing age-structural patterns of mortality associated with increasing prevalence of non-communicable diseases • How different is the transition in developing countries from what happened in the current developed world.

5. Objectives: • Explore demographic and health transitions at selected INDEPTH sites • Document changes in health and demographic transitions using data from the participating sites • Compare transitions between the African and Asian sites and between different sub-regions in Africa. • Compare the experience in the developing country-settings to what happened in the developed countries. • Examine the implications of the transitions on the health care systems (to consider the possible cost implications: infrastructure – human and physical; health financing; education awareness and promotion implications)

6. Proposed analyses • Analyze trends in fertility, mortality and diseases patterns in the initial sites. The aim shall be to describe changes in fertility, mortality and disease pattern in these sites • Analyse fertility and mortality trends over time as birth interval analysis to determine the pace and speed of fertility decline • For mortality, we shall examine trends in both childhood and adult mortality as well as the age-patterns of mortality. INDEPTH Network

7. Verbal autopsy (VA) data shall be used to describe the major causes of death over time. • Examine the relative contributions of communicable vrs non-communicable causes, and external (injury) causes over time. • We shall examine age, sex and socio-economic differences in disease distributions and how these change over time INDEPTH Network

8. The First Meeting at Accra on September 17-18, 2009 • Discussed detailed data requirements and major roles • Specified analysis plan and major outcomes • Discussed data structure and started with the creation of data files • All sites have made data available for the project • We bought software each site • Meeting scheduled for further discussions. INDEPTH Network

9. Acknowledgement Funded provided by International Development Research Centre (IDRC), Canada. INDEPTH Network