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Re-estimation of structural parameters to obtain estimates of mortality in developing countries
Abstract
The introduction of new models of mortality is intended to provide a representation of age/sex patterns of mortality which are closer to those underlying the mortality experience of developing countries. With the publication of new model life tables for developing countries by the UN, it is now possible to provide more reliable formulations for indirect mortality measurements. This paper provides improved regression equations for transforming survivorship of kin statistics into measures of infant, early childhood and adult mortality. After a short description of the mortality models upon which the new methods are based, the 1st section covers the treatment of estimation of mortality in infancy and childhood. The 2nd section is devoted to transformations of orphanhood data into conditional probabilities of surviviorship for adults. Finally the 3rd section provides an illustrative application of the new equations to the case of Peru (1960-1978). Emphasized throughout the paper is the quite different issue of not just selecting between appropriate mortality models but also between appropriate techniques.
... Instead of indexing an assumed fertility pattern we employ the observed age distribution of children surviving in the household. Biases due to changes in mortality will be eliminated by applying well-established corrections procedures proposed by Palloni and Feeney (Palloni, 1981; Palloni and Heligman, 1985; Feeney, 1978). Finally, we will use the new UN model mortality patterns (instead of the Coale-Demeny models) as they are more suitable to capture age patterns of mortality in Latin American countries (Palloni and Heligman, 1985). ...
... Biases due to changes in mortality will be eliminated by applying well-established corrections procedures proposed by Palloni and Feeney (Palloni, 1981; Palloni and Heligman, 1985; Feeney, 1978). Finally, we will use the new UN model mortality patterns (instead of the Coale-Demeny models) as they are more suitable to capture age patterns of mortality in Latin American countries (Palloni and Heligman, 1985). The resulting estimates-and associated standard errors--will characterize the country, entire regions, major cities, and large agglomerations of rural villages. ...
... The second adjustment is to estimate the expected proportion of children dead after adjusting for past mortality changes. This can be done in a straightforward manner using the methodology proposed by Palloni and Heligman (1985). Finally, rather than using linear models for the analysis of the indicator, we propose the use of non linear models of the following type. ...
... The idea of obtaining indirect estimates of adult mortality from the proportions of people with parents who have died originated with Henry (1960 UN, 1983;Palloni and Heligman, 1986). ...
... An alternative series of equations for estimating female mortality from maternal orphanhood has been developed by Palloni and Heligman (1986). They simulated proportions orphaned using a slightly different set of Coale and Trussell fertility models, ...
... One practical disadvantage of the regression models in UN (1983) Manual X is that they have only been estimated for respondents aged between 15 and 50, whereas, with the weighting and Palloni and Heligman (1986) methods, an attempt can be made to estimate more recent mortality from data on children. While none of regression approaches has been extended to the estimation of male mortality from paternal orphanhood, the Brass and Hill (1973) weights can be used to obtain strictly comparable results for the two sexes. ...
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.
... It relates the proportions of respondents with living mothers or fathers in two adjoining age groups to measures of life-table survivorship by means of a system of weighting factors whose values depend on the mean age of child-bearing. Subsequent to the derivation of these weighting factors, several regression-based approaches to the estimation of women's mortality from data on maternal orphanhood have been proposed (Hill and Trussell, 1977;Palloni and Heligman, 1985;United Nations, 1983). Equivalent methods for the estimation of men's mortality from paternal orphanhood have not been developed because of the lack of a satisfactory, flexible model of male fertility and persistent scepticism about the robustness of the method (Brass, 1975;Hill and Trussell, 1977;Hill, 1984;Palloni and Heligman, 1985). ...
... Subsequent to the derivation of these weighting factors, several regression-based approaches to the estimation of women's mortality from data on maternal orphanhood have been proposed (Hill and Trussell, 1977;Palloni and Heligman, 1985;United Nations, 1983). Equivalent methods for the estimation of men's mortality from paternal orphanhood have not been developed because of the lack of a satisfactory, flexible model of male fertility and persistent scepticism about the robustness of the method (Brass, 1975;Hill and Trussell, 1977;Hill, 1984;Palloni and Heligman, 1985). ...
... First, Brass and Hill do not explain why they adopt a series of weighting factors for estimating adult mortality from orphanhood, rather than the system of multiplying factors that Brass had proposed originally (Brass, 1975). Secondly, although it is widely assumed that the paternal orphanhood method is less robust than the maternal orphanhood method, neither the reasons why this is so nor the accuracy of the results have been investigated in detail (Brass, 1975;Hill and Trussell, 1977;Hill, 1984, Palloni andHeligman, 1985). Thirdly, Brass and Hill (1973) do not demonstrate that the relationship between the Pb ratios and sSx proportions, which they estimate using Brass's General Standard, holds at other levels of mortality. ...
"This article proposes a new procedure for estimating men's mortality from paternal orphanhood which generally yields more accurate results than the existing approach. A procedure for estimating mortality from maternal orphanhood data based on consistent assumptions is also presented. The theory underlying these methods is outlined.... The article also points out an error made in the tabulation of the weighting factors used until now to estimate mortality from paternal orphanhood. Investigations using simulated data are presented which support the theoretical arguments that suggest that the paternal orphanhood method is more robust than has often been assumed and which confirm that the new approach usually produces more accurate estimates than the weighting factors."
... The estimate is weighted for expected population distributions. Moreover, it is expected that the population can be considered as unchanging, with a growth rate appropriate for the demographic parameters 11 For all age groups, is estimated by multiplying the right-hand side of the equation by 19 . ...
... These errors can be as a result of many sources; for instance an interviewer error, sampling error, data entry or editing errors, etc. The threats for children of women aged [15][16][17][18][19] and the indirect estimate of child mortality constructed on children ever born (CEB) and children dead (CD) for this age group are repeatedly high. But sometimes the population average is also high. ...
Background:
In sub-Saharan African countries, the chance of a child dying before the age of five years is high. The problem is similar in Ethiopia, but it shows a decrease over years.
Methods:
The 2000; 2005 and 2011 Ethiopian Demographic and Health Survey results were used for this work. The purpose of the study is to detect the pattern of under-five child mortality overtime. Indirect child mortality estimation technique is adapted to examine the under-five child mortality trend in Ethiopia.
Results:
From the result, it was possible to see the trend of under-five child mortality in Ethiopia. The under-five child mortality shows a decline in Ethiopia.
Conclusion:
From the study, it can be seen that there is a positive correlation between mother and child survival which is almost certain in any population. Therefore, this study shows the trend of under-five mortality in Ethiopia and decline over time.
... The mortality of HIV-negative individuals is defined by the life table resulting from a logit transformation of a single standard life table ( Brass 1971;Brass 1975). Following Palloni and Heligman (1986), a two-sex, single-year 'General' UN life table with a life expectancy of 54 years is used as the standard. The level parameter of this model is varied between -0.5 and +0.4, ...
... For life tables which include mortality caused by HIV, this ratio can be shown to vary substantially with underlying mortality levels, even for a constant prevalence of HIV. 9 The difference between estimated and true q(z) values, n(z), offers a better basis for correction in the estimates since it varies somewhat less with underlying mortality than do the multipliers and can be used additively rather than multiplicatively. The difference, n(z), is regressed onto a set of independent variables 9 This occurs despite proportionality of q(z) t values across all levels of underlying mortality, for z<25, which is a sufficient condition for constancy of the multipliers within a family of life tables in populations unaffected by HIV (Palloni and Heligman 1986). The variability of the multipliers is a consequence of the underrepresentation of the children of HIV-positive mothers in the reported proportions dead. ...
The children surviving/children ever born technique is an important method of estimating child mortality levels in many developing countries. The HIV epidemic threatens the validity of the technique in a number of ways, principally through the correlation of mothers' mortality with that of their children. This paper describes the use of stable population modelling to simulate the application of the technique in populations with HIV and to assess the extent of the resulting biases. It also shows that corrected estimates can be derived given information on seroprevalence in the population on the assumption of population and epidemic stability.
... In addition, a range of new methods that can be used to evaluate data on recent deaths was devised (Brass, 1979;Courbage and Fargues, 1979;Preston and Hill, 1980;Preston et al., 1980;Bennett and Horiuchi, 1981). The United Nations' (1983) manual on indirect estimation incorporated much of this work and marked the coming of age of the field: during the 1980s attention has focused on the refinement and assessment of existing methods of estimation (Blacker, 1984;Blacker and Mukiza-Gapere, 1988;Hill, 1984;Palloni and Heligman, 1986;Palloni et al., 1984;Timaeus, 1986Timaeus, , 1987Timaeus, , 1991a. ...
... In an extension of methods proposed for analysing data on lifetime orphanhood (Hill and Trussell, 1977;United Nations, 1983;Palloni and Heligman, 1986;Timaeus, 1992), regression models have been estimated for the calculation of conditional survivorship in adulthood from proportions of female respondents with parents surviving to the respondents' first marriage and since their marriage. The models are presented in Table 5.A2. ...
... In addition, a range of new methods that can be used to evaluate data on recent deaths was devised (Brass, 1979; Courbage and Fargues, 1979; Preston and Hill, 1980; Preston et al., 1980; Bennett and Horiuchi, 1981). The United Nations' (1983) manual on indirect estimation incorporated much of this work and marked the coming of age of the field: during the 1980s attention has focused on the refinement and assessment of existing methods of estimation (Blacker, 1984; Blacker and Mukiza-Gapere, 1988; Hill, 1984; Palloni and Heligman, 1986; Palloni et al., 1984; Timaeus, 1986 Timaeus, , 1987 Timaeus, , 1991a). Techniques based on the survival of relatives can measure only the broad trend in adult mortality and provide no information about the age pattern of mortality within adulthood. ...
... In an extension of methods proposed for analysing data on lifetime orphanhood (Hill and Trussell, 1977; United Nations, 1983; Palloni and Heligman, 1986; Timaeus, 1992), regression models have been estimated for the calculation of conditional survivorship in adulthood from proportions of female respondents with parents surviving to the respondents' first marriage and since their marriage. The models are presented in Table 5.A2. ...
... The Trussell or the Palloni and Heligman variants of the original Brass method provide a series of seven estimates of the probability of dying from birth to age x: x q 0 (x= 1, 2, 3, 5, 10, 15, 20), one for each five-year age group of women in reproductive age (15-19, 20-24, … 45-49 years). The Trussell version makes use of the Coale-Demeny model life table system (UNITED NATION, 1983) and the Palloni-Heligman uses the United Nations model system (PALLONI; HELIGMAN, 1985). ...
The Brass-type indirect methods of early-age mortality estimation have been used for more than four decades, providing very robust estimates for countries without reliable vital registration systems. However, when estimation areas become smaller, the number of dead children could be very small, especially among those born to young women, who provide essential information to estimate recent mortality. In these cases, estimates could be affected by random errors and unexpected annual fluctuations. At the same time, although it is very unlikely that demographic trends in a small area would follow patterns very different from those prevailing in the broader environment they belong to, it is possible that some local events may become relevant to small areas, causing some deviations from the assumptions that may hold true to the larger area. The objective of this paper is to propose an adaptation of the indirect estimation approach, which would allow obtaining infant and child mortality estimates for small areas. As such, this proposal belongs to the realm of indirect estimation methods, sharing the limitations and advantages that characterize this type of estimation procedures. The method is illustrated with data from the 2014 Population and Housing Census of Myanmar. The results indicate that the method proposed here provides reliable and consistent infant mortality estimates, compared to the original Brass’ method, even in very small areas.
... If the vital registration is complete, IMR for each year can be calculated in the conventional manner directly from the system's data. Hill 3 Trussell, 7 Palloni and Helligram 6 have been used for estimating IMR for Nepal using the census or survey data. The National Population Policy, 2000 aims at a reduction of IMR to less than 30 by 2010. ...
... Algumas dessas técnicas são as de Sullivan 6 , Trusell 7 , Preston & Palloni 8 . Adaptações posteriores incluíram situações de mortalidade variável com o tempo e relacionaram probabilidades de sobrevivência dos filhos, categorizadas por grupos de idade da mãe, a tendências temporais da mortalidade infantil em anos anteriores à pesquisa [9][10][11][12] . ...
Resumo
Objetivo: Estimar as coberturas dos sistemas de informações vitais nos municípios brasileiros, com vistas a possibilitar a estimação direta de indicadores de mortalidade por município e por Unidade da Federação.
Metodologia: Foi realizado um procedimento de busca ativa de óbitos e nascidos vivos (NV) em uma amostra de municípios localizados na Amazônia Legal e no Nordeste, estratificada por região, porte populacional e nível de adequação das informações vitais. Nos municípios pesquisados, foram calculados os fatores de correção das informações de óbitos e NV. Para generalizar os resultados para todos os municípios brasileiros, foram utilizados modelos estatísticos multivariados que relacionaram os fatores de correção encontrados na busca ativa a indicadores construídos com base nos dados informados.
Resultados: Entre os 129 municípios que realizaram a busca ativa, foram encontrados 13.863 óbitos não fetais e 30.208 NV, com 40% dos óbitos já informados ao SIM, 26,3% no município de ocorrência do óbito; 42% dos NV já informados ao Sinasc, 29,3% no município de ocorrência de nascimento. Mais de 35% dos óbitos e NV foram encontrados em serviços de saúde. Para o Brasil, a cobertura do SIM foi estimada em 93% enquanto
a do Sinasc ultrapassou 95%. Entretanto, entre os municípios pequenos e informações de mortalidade inadequadas localizados no Nordeste e Amazônia Legal, apenas metade dos óbitos foi informada ao SIM.
Discussão: O estudo de busca ativa possibilitou identificar irregularidades locais no fluxo das informações vitais, levando a concluir que esse tipo de estudo é fundamental para propor intervenções frente aos problemas observados.
... Para el calculo de la probabilidad de muerte infantil y de niñez se emplearon dos técnicas de estimación llamadas a menudo como " Método de Brass", en honor a William Brass 1 que originalmente desarrolló la técnica en 1964 [6]; y posteriormente fue mejorada con el apoyo de sus asociados -Sullivan en 1972 y Trussell en 1975. Las versiones del método de Brass empleadas en este estudio son la versión Trussell [6] y la versión Palloni-Heligman [7]. ...
A pesar de las importantes mejoras en los resultados de salud infantil y de niñez durante el Siglo XXI en América Latina, las tasas de mortalidad infantil y de niñez permanecen inaceptablemente altas en Bolivia encontrándose entre las más elevadas la región, solo por debajo de Haití, dirigiéndose a una deficiente salud infantil y de niñez. Estos resultados requieren de evidencia científica sobre la mejor manera de hacer frente a sus determinantes. Este estudio aproxima, teóricamente, mediante el marco teórico propuesto por Mosley-Chen y Sastry, los determinantes de la mortalidad infantil y de niñez en Bolivia enfocados en características individuales, del hogar y contextual. Además se examina de manera preliminar los niveles y magnitudes de la mortalidad mediante el uso de métodos directos e indirectos de estimación mediante la técnica propuesta por la versión Trussel y la versión Palloni-Heligman del Método de Brass y se realiza un análisis bivariado que da cuenta de relaciones existentes entre la mortalidad infantil y de niñez y las variables a nivel del
hogar, individual y contextual relacionado con las políticas públicas.
... Adaptações posteriores incluíram situações de mortalidade variável com o tempo e relacionaram probabilidades de sobrevivência dos filhos, categorizadas por grupos de idade da mãe, a tendências temporais da mortalidade infantil em anos anteriores à pesquisa, solucionando o problema de corresponder um ponto do tempo à estimativa da mortalidade infantil. [23][24][25] Atualmente, as estimativas da mortalidade infantil fornecidas pelo IBGE, são realizadas pelo método demográfico indireto, a partir das informações coletadas nos censos e nas Pesquisas Nacionais de Amostra por Domicílio (PNAD). Este método tem sido utilizado em publicações acadêmicas, 15 como também por organismos oficiais para substituir a técnica de mensuração direta. ...
The article discusses strategies for estimating infant mortality in the decentralized Brazilian National Health System. It presents direct and indirect techniques for measuring infant mortality, the ways these can be applied and the methodological problems that arise. It further discusses the Ministry of Health's permanent life events information systems and the strategies for evaluating the adequacy of information for the calculation of infant mortality. These issues are set in the context of the new needs that have emerged from the decentralization of the Brazilian health system. Finally, it remarks on the challenge of direct estimation of infant mortality using Ministry of Health information systems in small-scale municipalities and the shortcomings of the data available.
... In the maternal orphanhood method, for example, the proportion with mothers who are alive is closely related to the life table probability of surviving for a number of years equal to the age of the respondent and starting from the mean age at childbearing at the time of the respondent's birth. Because these estimates pertain to a mortality regime of the past, part of the difficulty consisted of developing schemes for dating those estimates (e.g., Brass and Bamgboye 1981;Palloni and Heligman 1985;Zlotnik and Hill 1981). ...
Following an overview of the data and approaches for mortality estimation in African countries, we compare trends in estimates of 45q15 produced by the UN agencies with those derived from reports of sibling survival in the Demographic and Health Surveys. A short discussion of the distribution of causes of death is based on verbal autopsy data coming from a handful of Demographic Surveillance Sites. Despite the sometimes intriguing differences between estimates from different sources, a few general patterns of adult mortality trends are common to most sources. With the exception of northern Africa, declines in adult mortality during the last few decades have been modest, and in some populations drastic mortality reversals have been recorded. These are primarily driven by the HIV/AIDS epidemic, but the extremely high adult mortality rates in some southeastern African countries are due to the triple burden of infectious and chronic diseases and the relatively high level of deaths due to external injuries. In some countries severely affected by the HIV/AIDS epidemic, adult mortality started to decline again, and that occurred well before the large scale availability of antiretroviral therapy.
... A simple and robust way of analyzing data on the survival of mothers and fathers was proposed by Brass and Hill in 1973. Further estimation procedures based on regression models have been developed since (United Nations, 1983;Palloni and Heligman, 1986;Timaeus, 1990). To improve upon the results, Chackiel and Orellana (1985) propose supplementary questions about the dates when parents died. ...
... The difficulty in obtaining accurate estimates of the IMR has encouraged the methodological development of demographic procedures for its estimation. 1 The indirect estimation techniques were originally proposed by Brass 2 and then adapted throughout the years. [3][4][5][6] These methods are based on the conversion of the proportions of children dead, classified by the mother's 5-year age-groups, into probabilities of dying between childbirth and different ages of childhood. 7 Since the 1970s, the inclusion of specific questions for the indirect measuring of mortality in censuses and household surveys in many Latin American countries have become standard procedure. ...
In view of the limitations of survey-based demographic techniques for infant mortality estimation, the current strategy of some developing countries is to improve vital information. This article presents recent progress in the improvement of national databases in Brazil.
For the vital information analysis, the data sources are the Mortality Information System and the Live Birth Information System. The adequacy analysis is based on five indicators calculated at the municipality level per 3-year period. Adequacy criteria are established by means of the indicator percentile distributions among Brazilian municipalities. To complement the vital data analysis, in 2001, a proactive search of infant deaths was carried out in selected areas of the North and North-east with very deficient information.
Temporal trends of the adequacy indicators indicate advances in both information systems. In 2003-05, 80.3% of municipalities (87.3% population) have adequate live birth data and 63.6% of municipalities (77.9% population) have a satisfactory level of mortality information. The most important problem refers to deaths with undetermined causes, mainly in the North-east. The proactive search of infant deaths showed large deficiencies of vital information in areas of extreme poverty: from 520 infant deaths found in the study, only 175 (33.7%) were reported to the Mortality Information System.
The monitoring of vital events is an essential step in the process of reducing infant mortality. The analysis of local irregularities not only improves the quality of vital data registration, making possible to estimate the infant mortality rate, but also identifies priority areas for intervention.
... The technique for calculating the indirect estimates of mortality used are as described in Brass and Coale (1968), and also in other studies (Brass, 1975;Coale and Trussell, 1978;Feeny, 1980;Palloni and Heligman, 1985;Shryock and Siegel, 1976;Sullivan, 1972;Trussell, 1975;United Nations, 1983). As is also widely-used in these studies, the mortality ratio is calculated as a ratio of the difference between children ever born and children surviving: ...
This study investigated the importance of socioeconomic factors such as education, income, religion, family structure and residence in explaining the increased risk of mortality among vulnerable populations aged less than 20 years in Rio de Janeiro, Brazil. Data used were from the 1991 Brazilian Demographic Census and comprised 121,060 women aged 15-49 residing in Rio de Janeiro. Two alternative statistical methods were used to calculate the risk of death: the widely used Brass method (an indirect estimate which assesses population risks) and a case-control study (which assesses individual risks). The study also focused on the importance of indicators of human and social capital, the lack of which may explain the higher risk of death among children and adolescents. Lack of education was found to be a major determinant of mortality at young ages. Residence in a favela (shantytown), families in which mothers were the head of the family, and a lower median level of income were found to be significant determinants of mortality among vulnerable populations in Brazil. However, religion was not found to be as important a predictor of high mortality.
La nécessité de rapprocher l’action publique des besoins de la population exige que l’analyse des phénomènes démographiques prenne en compte les différences géographiques. À partir des données des recensements du Burkina Faso (1996 et 2006),
nous étudions les disparités entre les provinces du Burkina Faso en ce qui a trait à la mortalité des enfants de moins de 5 ans au milieu des années 1990 et 2000, et analysons l’évolution de ces disparités. Nous estimons les quotients de mortalité selon
une méthode indirecte en raison des limites inhérentes aux déclarations des décès des douze derniers mois.
Il ressort de notre étude que la mortalité infanto-juvénile varie considérablement selon les provinces (de 136 ‰ à 293 ‰ au milieu des années 1990 et de 93 ‰ à 297 ‰ au milieu des années 2000). L’examen cartographique montre deux pôles majeurs de mortalité, beaucoup plus perceptibles au début des années 2000. Les provinces périphériques du pays présentent un niveau de mortalité relativement plus élevé que celles proches de la province centrale du Kadiogo, qui abrite Ouagadougou, capitale politique du pays. Une telle caractéristique n’est pas observée pour l’ensemble des provinces proches du Houet, province où se trouve Bobo-Dioulasso, capitale économique.
Despite significant improvements in child and childhood health outcomes during the XXI Century in Latin America, rates of infant and childhood mortality remain unacceptably high in Bolivia being among the highest in the region, only after Haiti, regarding poor child and childhood health. These results require scientific evidence on the best way to address its determinants. This study approaches theoretically the determinants of infant and childhood mortality in Bolivia focused on individual, household and contextual characteristics using the theoretical framework proposed by Mosley-Chen and Sastry. Furthermore, levels and magnitudes of mortality are preliminarily examined by using direct and indirect methods of estimation using the technique proposed by the Trussell version and Palloni-Heligman version of the method of Brass. Alsoa bivariate analysis is performed, which shows the relationships between infant and childhood mortality and variables at the household level, individual and contextual related to public policy.
The present work performs an analysis of the educational situation and its relation with the differenced mortality of the province of Cordoba, Argentina. The distribution of adult population is studied by literacy, age and sex; later, the same analysis is carried out for the highest schooling level attained, being found that young generations have better schooling level than the previous. In a second phase, we carried out a longitudinal analysis of the 50-60 years of age cohort from the 1980 census by instruction level, and tracing it through the 1991 and 2001 censuses. It is detected that the proportion of adults with higher schooling increases, while the proportion of less instructed decreases; this indicates a differential mortality by educational level. This is verified when calculating life expectancy at the 25 differential years by instruction and sex, using information from vital statistics.
The present work performs an analysis of the educational situation and its relation with the differenced mortality of the province of Cordoba, Argentina. The distribution of adult population is studied by literacy, age and sex; later, the same analysis is carried out for the highest schooling level attained, being found that young generations have better schooling level than the previous. In a second phase, we carried out a longitudinal analysis of the 50-60 years of age cohort from the 1980 census by instruction level, and tracing it through the 1991 and 2001 censuses. It is detected that the proportion of adults with higher schooling increases, while the proportion of less instructed decreases; this indicates a differential mortality by educational level. This is verified when calculating life expectancy at the 25 differential years by instruction and sex, using information from vital statistics.
The inability to smooth consumption in developing countries is thought to make health vulnerable to sudden economic downturns. However, studies suggesting this relationship often examine events that influence health independently of household income. We address this difficulty by investigating how world coffee price shocks influence child survival in Colombia's coffee-growing regions, highlighting two important facts: (1) The most important determinants of child health are inexpensive but require large amounts of time, and (2) As the value of time declines with adverse economic shocks, so does the relative price of health. We find that changes in the opportunity cost of time dominate changes in transitory income in child health production: important time-intensive health investments are countercyclical, and mortality at young ages is procyclical. These findings are consistent with growing evidence that the relative price of health is a more powerful determinant of mortality than income.
Recent studies demonstrate procyclical mortality in wealthy countries, but there are reasons to expect a countercyclical relationship in developing nations. We investigate how child survival in Colombia responds to fluctuations in world Arabica coffee prices - and document starkly procyclical child deaths. In studying this result's behavioral underpinnings, we highlight that: (1) The leading determinants of child health are inexpensive but require considerable time, and (2) As the value of time declines with falling coffee prices, so does the relative price of health. We find a variety of direct evidence consistent with the primacy of time in child health production.
This paper extends earlier research into methods for estimating adult mortality from information on the recent incidence of orphanhood. It presents a series of regression coefficients for estimating female and male mortality from synthetic cohort data on the subsequent orphanhood of those who had a living mother or father at exact age 20. Such information can be obtained either where questions about parental survival have been asked in two inquiries or by asking retrospectively about dates of orphanhood in a single survey. Although the method is somewhat sensitive to errors in the reporting of ages and dates, it is a promising source of up-to-date estimates of adult mortality that are free from bias due to the underreporting of the orphanhood of young children ("the adoption effect").
Since the 1920s Mongolia has developed an extensive and well-staffed health care system that has made modern health technologies accessible to most of its population. In addition, the country experienced rapid economic and social development whose benefits were equitably distributed among the population. In spite of this progress, infant and child mortality levels are high by contemporary standards and during the past 20 years these rates have remained virtually constant. The modern health care delivery system, externally imposed, failed to take into account the specific characteristics of the Mongolian culture; this fact is identified as one of the major determinants of the unexpected levels of early-age mortality. The excessive orientation toward curative medicine, the lack of health prevention and promotion activities and the lack of community participation have resulted in the people continuing to believe in traditional therapeutic patterns and self-care. They perceive the modern system exclusively in curative terms and not with regard to health preservation and disease prevention. Most Mongolians do not fully understand the health care system, and use its services mainly because they have no alternative, or because of coercion rather than conviction based on the learning and internalization of its basic principles. In practices and ideas of child care, preservation of health and disease prevention, people seem to identify more with the traditional health care system. Like other former socialist countries, Mongolia is experiencing deep economic and social transformations, whose implications for the health care system are discussed. An economic crisis whose end is nowhere in sight, emergent social inequalities, a vague health insurance model with unclear financing sources, and lack of concern by most policy-makers in strengthening the preventive component of the health system, are not positive factors for substantial infant and child mortality decline in the near future. A clear advantage is, however, the fact that there is a wide space for major improvements with existing internal and external resources.
"Because the Government of Myanmar (formerly known as Burma) considers the country under-populated, it has not adopted a family planning programme. However, recent data show that, while fertility remains high, there has been some decline since the mid-1970s. Since the mid-1950s, mortality has gradually declined, but the decline seems to have slowed down in recent years. This article concludes that it is necessary to slow population growth by controlling fertility in order to achieve economic and social development."
"This paper compares the direct and indirect methods used to measure adult mortality in the developing world. No other approach can substitute fully for accurate and complete vital registration, but in many countries it is unrealistic to expect the registration system to cover the majority of the population in the foreseeable future.... The difficulties involved in measuring adult mortality using surveys and other ad hoc inquiries are discussed.... While the choice of methods must depend on each country's situation, direct questions require very large samples and are unreliable in single-round inquiries. On the other hand, although indirect methods provide less detailed and up-to-date information than is ideal, they are adequate for many practical purposes. In particular, the experience of the 1980s suggests that questions about orphanhood perform better than earlier assessments indicated, and recent methodological developments have circumvented some of the limitations of the indirect approach."
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