Outlook for survivors of childhood in sub-Saharan Africa: adult mortality in Tanzania

BMJ 1996;312:216-220 (27 January)

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Outlook for survivors of childhood in sub-Saharan Africa: adult mortality in Tanzania

Henry M Kitange, specialist physician,^a Harun Machibya, district medical officer,^a Jim Black, public health specialist,^b Deo M Mtasiwa, district medical officer,^a Gabriel Masuki, district medical officer,^a David Whiting, data manager,^c Nigel Unwin, Barclay lecturer in epidemiology,^d Candida Moshiro, statistician,^e Peter M Klima, Mary Lewanga, field supervisor,^a Kgmm Alberti, professor of medicine Donald G McLarty, professor of medicine,^c Donald G McLarty on behalf of the Adult Morbidity and Mortality Project

^a Ministry of Health, PO Box 9083, Dar es Salaam, Tanzania, ^b c/o Redd Bama, PO Box 4581, Harare, Zimbabwe, ^c Department of Medicine, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, ^d Departments of Medicine and Epidemiology and Public Health, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, NE2 4HH, ^e Muhimbili Medical Centre, PO Box 65001, Dar es Salaam, Tanzania

Dar es Salaam Urban Health Project PO Box 63320 Dar es Salaam Tanzania Peter M Kilima, director of preventive services. Correspondence to: Professor D G McLarty, Muhimbili Medical Centre, PO Box 63320, Dar es Salaam, Tanzania.

Abstract

Objective: To measure age and sex specific mortality in adults(15-59 years) in one urban and two rural areas of Tanzania.
Design: Reporting of all deaths occurring between 1 June 1992and 31 May 1995.
Setting: Eight branches in Dar es Salaam (Tanzania's largestcity), 59 villages in Morogoro rural district (a poor ruralarea), and 47 villages in Hai district (a more prosperous ruralarea).
Subjects: 40304 adults in Dar es Salaam, 69964 in Hai, 50465in Morogoro rural.
Main outcome measures: Mortality and probability of death between15 and 59 years of age (45Q15).
Results: During the three year observation period a total of4929 deaths were recorded in adults aged 15-59 years in allareas. Crude mortalities ranged from 6.1/1000/year for womenin Hai to 15.9/1000/year for men in Morogoro rural. Age specificmortalities were up to 43 times higher than rates in Englandand Wales. Rates were higher in men at all ages in the two ruralareas except in the age group 25 to 29 years in Hai and 20 to34 years in Morogoro rural. In Dar es Salaam rates in men werehigher only in the 40 to 59 year age group. The probabilityof death before age 60 of a 15 year old man (45Q15) was 47%in Dar es Salaam, 37% in Hai, and 58% in Morogoro; for womenthese figures were 45%, 26%, and 48%, respectively. (The average45Q15s for men and women in established market economies are15% and 7%, respectively.)
Conclusion: Survivors of childhood in Tanzania continue to showhigh rates of mortality throughout adult life. As the healthof adults is essential for the wellbeing of young and old thereis an urgent need to develop policies that deal with the causesof adult mortality.

Key messages

Key messages
Adult mortality is currently being measured in one urban and two rural areas of Tanzania
Survivors of childhood continue to experience high mortality throughout adult life
Mortality was generally higher in men but was higher in women aged 15 to 39 years in Dar es Salaam and in women aged 25 to 29 in the two rural areas
While childhood mortality in sub-Saharan Africa remains a major problem, mortality in young adults may now be equally serious in many areas in the region and deserving of increased attention by the policy makers

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