The absence of adult mortality data for sub-Saharan Africa: a practical solution

Information on cause of death among adults in sub-Saharan Africa is essentially nonexistent. Published sources provide statistics on both cause-specific and overall rates of mortality, but closer examination reveals that these data consist mostly of extrapolations and outright guesses. In the absence of accurate and comprehensive registries of vital events for the majority of the region's inhabitants, longitudinal studies of defined population-based cohorts represent the only realistic strategy to fill this void in basic public health information. The advantage of longitudinal studies is particularly clear for chronic diseases, the category for which the least is known. Noncommunicable diseases account for a significant portion of adult deaths in sub-Saharan Africa, yet the empirical bases for public health policies and interventions are essentially absent. Verbal autopsy has great potential to contribute to understanding about the cause of death among African adults. This method is discussed in the present article, and practical considerations for longitudinal studies using this methodology are reviewed.