INDEPTH Network Understanding the Demographic and Health Transitions in Developing Countries using Health, Health System and Demographic Surveillance Data Participating sites Agincourt and Navrongo (Africa); Matlab and Filabavi (Asia) Prepared for presentation at the 9 th INDEPTH AGM, Pune, India, Oct 26-29, 2009

Background/motivation The shift from high to low levels of mortality and fertility now famously called the demographic transition occurred over a century ago in the developed world. The transition, it is argued, starts with a drop in mortality followed by fertility Decline attributed to several factors

Although the demographic transition is underway in a number of countries, it has been argued that the pattern and structure of the current transition is substantially different from what occurred in historical Europe. Fertility decline stalled mid-stream (in Africa) Mortality decline also stalled or reversed in a number of African countries “Double burden” of infectious and degenerative and non- communicable diseases.

Strategic role of INDEPTH Longitudinal data on fertility, mortality (including causes of death) Characterize changing age-structural patterns of mortality associated with increasing prevalence of non- communicable diseases How different is the transition in developing countries from what happened in the current developed world.

Objectives: Explore demographic and health transitions at selected INDEPTH sites Document changes in health and demographic transitions using data from the participating sites Compare transitions between the African and Asian sites and between different sub-regions in Africa. Compare the experience in the developing country-settings to what happened in the developed countries. Examine the implications of the transitions on the health care systems (to consider the possible cost implications: infrastructure – human and physical; health financing; education awareness and promotion implications)

Proposed analyses Analyze trends in fertility, mortality and diseases patterns in the initial sites. The aim shall be to describe changes in fertility, mortality and disease pattern in these sites Analyse fertility and mortality trends over time as birth interval analysis to determine the pace and speed of fertility decline For mortality, we shall examine trends in both childhood and adult mortality as well as the age-patterns of mortality. INDEPTH Network

Verbal autopsy (VA) data shall be used to describe the major causes of death over time. Examine the relative contributions of communicable vrs non- communicable causes, and external (injury) causes over time. We shall examine age, sex and socio-economic differences in disease distributions and how these change over time INDEPTH Network

The First Meeting at Accra on September 17-18, 2009 Discussed detailed data requirements and major roles Specified analysis plan and major outcomes Discussed data structure and started with the creation of data files All sites have made data available for the project We bought software each site Meeting scheduled for further discussions. INDEPTH Network

Acknowledgement Funded provided by International Development Research Centre (IDRC), Canada. INDEPTH Network