Explaining the divergent trends and differentials in morbidity and mortality: an African example.

Here we look at recent attempts to measure simultaneously trends in mortality and morbidity in African populations. We begin with the measures of health which are currently available for African populations including partially complete incidence data and survey data which include both self-report and objectively measured aspect of health. The relationships between different measures of health are discussed in some detail, making the point that standard measures of health status developed in high income populations seem to produce reliable and consistent results in Africa as well. The issues of selection which arise when we study the health of the elderly in relatively high mortality populations are reviewed.

Using the short form 36 as measures of self-reported health, we examined the levels and differentials of the norm-based scores in adult women in Accra Ghana. From their birth histories, we can discern strong differentials in under five mortality that are associated with education and a number of other socio-economic indices in the expected direction. Turning to the women's current health status, we find much narrower differentials in the indices of their self-reported health and indeed in several objective measures of health including height, weight, blood pressure and histories of recent hospitalization.