Mortality trends in Sub-Saharan Africa: Evidence from survey data on the survival of siblings and children

We provide a joint overview of trends in mortality under age 5 and between ages 15 and 60 in Sub-Saharan Africa using data on the survival of children and siblings collected in Demographic and Health Surveys. Disregarding conspicuous stalls in the 1990s, child mortality levels mostly declined and converged over the last 30–40 years. By contrast, many Eastern and Southern African countries have witnessed an enormous surge in adult mortality that echoed earlier increases in HIV incidence. In Eastern Africa, adult mortality levels have begun to decline again, in some instances before the large-scale expansion of antiretroviral therapy programs. More surprising is the lack of sustained improvements in adult survival in some countries without severe HIV epidemics. Because trends in child and adult mortality do not always evolve in concert, model-based estimates that are inferred from matching indices of child survival onto standard mortality schedules can be very misleading.