African Population Studies
Union for African Population Studies
ISSN: 0850-5780
Vol. 10, Num. 1, 1995
African Population Studies/Etude de la Population Africaine, Vol. 10,
November/novembre
1995
The Mortality Situation in Cameroun
Bangha Martin Wultoff
Code Number: ep95006
Abstract
In this article, we examine the mortality situation in Cameroon in relation
to other countries of the sub continent. Evidence for the overall childhood
mortality rate suggests that 13 percent of the newborn babies are expected
to die before their fifth birthday, a decline of 6 percent points from the
1978 value. This, compared to other Sub-Saharan African countries, appears
to be moderate but is very high by other developing countries' or world's standard.
In fact, the decline has not yet reached a reasonable minimum that could suggest
noticeable improvement in the health status of the population at both macro
and micro levels.
The adult mortality situation on the other hand is very high even by Sub-Saharan
African standards. About 35 percent of those who survive childhood hazards
up to age 15 are not expected to celebrate their 60th anniversary compared
to barely 20 percent for some other countries of the sub continent. Even when
compared to the childhood mortality situation, Cameroon is a country with very
poor health for adults. It appears that children in Cameroon have benefitted
more than adults from the reduction of overall mortality to a "moderate" level.
Consequently, as year 2000 approaches it is clear that Cameroon is still
far from attaining the goal of "Health for All" and it is becoming very uncertain
whether the target will be attained. As the results suggest, not only is there
need for greater efforts to improve the survival of children in the country,
but in addition, it is also necessary to institute strategies to maintain their
health when they survive childhood.
Résumé
Dans cet exposé, nous examinons la situation de la mortalité au
Cameroun en la comparant à celle qui prévaut dans d'autres
pays du sous-continent. Les données disponibles sur le taux global
de la mortalité infantile suggèrent que 13 % des nouveaux-nés
meurent avant la célébration de leur cinquième anniversaire,
ce qui constitue une baisse de 6 % par rapport à la situation de 1978.
Ceci, si on le compare à d'autres pays d'Afrique au Sud du Sahara,
apparaît comme un taux très modéré mais suffisamment élevé par
rapport à la situation qui prévaut dans d'autres pays en développement
et même par rapport à la situation mondiale. En effet, la baisse
n'a pas encore atteint un niveau minimum raisonnable qui pourrait suggérer
que la situation sanitaire de la population est devenue un poids moins lourd à supporter
par les familles prises séparément et par le développement
du pays dans son ensemble.
D'autre part, la situation de la mortalité chez les adultes est
très préoccupante, même si l'on en juge par ce qui se
passe généralement en Afrique, même si l'on en juge par
ce qui se passe généralement en Afrique sub-saharienne. Environ
35 % de ceux qui arrivent à survivre au risque de l'enfance jusqu'à l'âge
de 15 ans ont une espérance de vie n'atteignant pas les 60 ans à côté de
ceux, qui dans d'autres pays du sous-continent, font à peine 20 %.
Même si on la compare à la situation de la mortalité infantile,
la situation de la santé des adultes au Cameroun est très préoccupante.
Il semble que les enfants aient bénéficié plus que les
adultes de la baisse de la mortalité globale de manière tout
de même "modérée".
En conséquence, à mesure que l'an 2000 approche, il apparaît
nettement que le Cameroun est loin d'atteindre son objectif déclaré de "La
santé pour tous avant l'an 2000" et, il est devenu très incertain
si l'objectif sera jamais atteint. Comme le suggèrent les résultats,
non seulement il existe un réel besoin de multiplier les efforts pour
améliorer la survie de l'enfant dans le pays, mais en plus, il est
tout aussi important, et/ou nécessaire, de développer des stratégies
aptes à maintenir leur santé à un bon niveau même
s'ils réussissent à survivre à l'enfance.
Introduction
Developing countries in general and Africa in particular have for long being
experiencing very high mortality rates. This persistent high mortality has
been a subject of concern to social scientists, policy makers, the public at
large and especially the governments who have been striving to allocate their
meagre resources towards the reduction of mortality to acceptable levels. Available
evidence shows that over the last three decades, appreciable declines in mortality
rates have occurred in almost all developing countries. For instance, among
the developing countries with adequate information in 1960, the median probability
of dying before age 5q0 was 200 per 1000 live births.
Childhood mortality was lowest at a median value of 145 per 1000 in Latin America,
somewhat higher (170) in Asia and Oceania and clearly highest in Africa with
a median value of 228 per 1000 (UN, 1992a). Current estimates for 1985-90 indicate
that childhood mortality has fallen sharply in all regions though they still
remain very high in Africa. The median probability of dying before age 5 was,
globally, 80 per 1000 live births but ranged regionally from a low 47 for Latin
America through 50 for Asia and Oceania to a high 155 per 1000 for Africa.
Thus, the childhood mortality level for Africa is clearly three times higher
than for the other developing regions. That is, a child born in Africa is at
least three times more likely to die during childhood than if he/she were born
in the other developing regions.
This article examines the mortality situation in Cameroon with particular
attention to infant and child mortality and their major causes. The results
presented are mainly from two surveys, the Cameroon fertility survey (CFS)
of 1978 and the Demographic and health survey of Cameroon (CDHS) of 1991. The
results are compared to those of other countries of the sub continent that
also took part in the DHS programme.
General Mortality Level and Trends for Cameroon
For the early 1960s, rough estimates for Cameroon indicate that the crude
death rate (CDR) was about 23 per thousand population (Cameroun, 1978 ; UN,
1993). Estimates for the northern part of the country made by the Princeton
group (Coale, 1968 ; Brass, 1968) showed that the CDR was at least 31 per 1000.
But based on the second census results of 1987, the CDR was estimated at 13.7
per 1000 population, down from the 1976 value of 20.4 per 1000 - a decline
of about 32.8 percent.
Table 1 presents estimates of the principal indicators of general mortality
and its evolution. The life expectancy at birth (e0) which provides
a better estimate of mortality than CDR indicates that an average Cameroonian
born currently will expect to live for 53 years.
There is some slight indication of male excess mortality in relation to that
of females evident in the e0. For instance, the CDR for males in
1987 was estimated at 15.4 against 12.7 for females or 13.7 for the entire
population. The difference between life expectancies of males and females which
was about 2.4 years in 1976 had increased to about 3.8 years in 1987 suggesting
a further deterioration of male health relative to that of females.
Infant and Child Mortality
Most often, infant and child mortality rate is considered as one of the best
indicators of the level of development, health and standard of life of a population
given that it is a very sensitive index of the socio-economic status of the
population. At the time of independence some three decades ago, childhood hazards
were much greater than now. For instance, rough estimates show that around
1960 in Cameroon, the probability of dying before age 5 was 29.1 percent ,
declining to about 18.9 percent by the early 1970s (Hill, 1990). Within the
country some regions experienced death rates of above 35 percent (see also
Coale, 1968).
Estimates from the CFS which collected more detailed information on mortality
from a sample of 8219 women show just a slight difference from these rough
estimates for the rates pertaining to about the same periods. For the period
1973-78, the estimates show that two newborns (19.5 percent) out of every ten
died before the age of 5 with at least one (10.5 percent) of them dying during
their first year of life, in which case infant mortality (1q0)
was just as high as child mortality (4q1).
Table 2 presents the estimates of infant and child mortality rates from results
of the CFS and CDHS for certain periods before the survey. The results however,
do not seem to agree perfectly as to the rate of decline or levels for certain
periods, probably due to differences in the conduct of the two surveys as well
as sampling differences. The CDHS 1991 conducted some 13 years after the CFS
was somewhat poorly executed and the sample size was less than half of the
CFS sample. But despite the erratic nature of the estimates, there is every
indication of a slow and steady decline in the level of infant and child mortality
(see Fig. 1). In the period 10-14 years prior to the CFS corresponding approximately
to 1963-68, the probability of a child dying before the 5th birthday
was about 24 percent. By 1973-78, it had declined to 20 percent. The recent
results of the CDHS show that childhood mortality further declined to about
13 percent in the late 1980s.
The fluctuations in mortality at the young ages suggest that during the first
year of life, neonatal mortality is becoming relatively more important than
post-neonatal mortality, a reverse of what prevailed around the 1970s. The
relationship of infant mortality (1q0) is a bit erratic.
For the current period, it is of the same order of magnitude though infant
mortality appears to have been heavier in the past. It is also clear from the
table that the decline has been contributed by all the ages with a slightly
greater decline at the level of infant rates if we take the figures at face
value. For instance, infant mortality fell from 135 per 1000 live births in
the early 1960s to about 65 in the recent period while child mortality fell
from 126 to 66 during the same period.
For all the developing countries with available information (see UN, 1992a),
the average childhood mortality rate ((5q0) stands at
about 80 per 1000 live births but as high as 155 for Africa as a whole. The
mortality rates for selected Sub-Saharan African countries participating in
the DHS programme are presented in Table 3. These countries have been ordered
downward by their magnitude of under 5 or childhood mortality in the DHS.
The table shows that the chances of early death for today's newborn babies
varies greatly within the sub continent from a low 53 per 1000 births in Botswana
to a high 249 in Mali. The observed size and pace of decline in death rates
between the 1970s and the late 1980s also varied greatly among the countries;
some countries have experienced dramatic declines in childhood deaths while
at the other end of the spectrum, there are few others with increasing childhood
deaths.
The highest reductions in childhood mortality of more than half (55 percent)
is observed for Botswana, and above 40 percent for Zimbabwe and Kenya whereas
countries like Liberia, Nigeria, Ghana and Uganda appeared to have experienced
a deterioration of their childhood mortality situation. The worst deterioration
both in absolute and in relative terms for Liberia is understandable given
the persistent civil strife. The case of Uganda that has been virtually stagnant
since the late 1960s may also be explained by the alarming incidence of AIDS
and the civil war of the 1980s. But the cases of Nigeria and Ghana with increasing
infant deaths are somewhat puzzling.
For Cameroon, the evidence is that childhood mortality is quite high compared
to the average for all developing countries but the table places the country
in a moderate position by Sub-Saharan African standards. It is also worthy
of note here that the percentage decline in 5q0 for Cameroon
(35 percent) is comparable to that for Africa as a whole (32 percent) over
the last three decades.
Grouping the countries into three categories, Cameroon falls in the middle
range worse than the "best performers" such as Kenya, Botswana and Zimbabwe
(where childhood mortality has been brought to below 100 per 1000 births) but
better than Mali, Liberia, Uganda, Burundi and Nigeria. In any case, the level
of childhood mortality is generally high even for the standard (Sub-Saharan
Africa) and we are nowhere close to the reasonable minimum of 50 per 1000 births
that was proposed way back in the early 1980s except the case of Botswana with
about 53 per 1000 lives births. Thus, in spite of the progress made over the
last decades, many children are still dying before age 5.
Causes of Death during Childhood
Knowledge of the specific causes of death is essential in defining the relative
order of importance of the various causes but not the main solution to problems
of controlling infant and child mortality (because of the issue of competing
risks or death from multiple causes). Often times, the main causes of death
are classified as endogenous or exogenous. The former which usually occur soon
after birth are related to the birth process itself and include immaturity,
obstetrical problems, congenital malformation, neonatal tetanus, etc. Exogenous
causes that usually come into play after the first month of life are more environmentally
determined. These include parasitic and infectious diseases, other medical
and non-medical causes.
The CDHS 1991 collected some information on causes of children deaths. The
main reported causes of death among infants that died within their first month
of life were respiratory infections which accounted for 13.6 percent of the
deaths. This was closely followed by immaturity with 11.6 percent, then tetanus
and other obstetrical problems. Malaria accounted for 8.8 percent of the deaths.
However, it is worth noting that for at least one out of every four (29.4 percent)
infant deaths during the first month of life, the mother could neither determine
nor tell the cause (Direction du 2ème RGPH, 1992).
For those who survived the first month of life and died before their fifth
anniversary, the major cause is measles which took care of 18.9 percent of
the deaths. This appears to be in line with some studies that suggest measles
are commonly responsible for about 20 percent of the annual childhood deaths
in Africa (see Dackam, 1989). Diarrhea comes second position with 17.4 percent
and malaria third (15.7 percent). However, if malaria were to be combined with
other fever or taking all the children together, malaria singles out itself
as the principal cause of death during childhood. Besides, this is actually
the case when the causes of death are deduced from symptoms. Indeed, as Boerma
et al (1991) rightly indicates, recurrent attacks of malaria often results
in severe anemia and most likely affects the child's nutritional status and
subsequent resistance to other infections. This implies that further efforts
to combat malaria will offer many children the chances to survive. On the whole,
malaria, measles, respiratory infections and diarrhea took care of the lives
of half of the children that died before they could ever celebrate their fifth
birthday if the figures are taken at face value.
Adult Mortality
As studies on mortality are most often concerned with infant and child deaths,
the available information on adult mortality in Africa south of the Sahara
is limited, unreliable and even far more scanty than that of infant and child
mortality. The levels have been little investigate and so it is difficult to
make any firm statements for Cameroon. Nevertheless, it has been estimated
that the probability of dying between ages 15 and 60 (measure of adult mortality)
in Sub-Saharan Africa is broadly similar to the probability of dying in childhood
(Timaeus, 1989 ; cited in Hill, 1990).
A general review of this topic has been presented by Timaeus (1993) for a
range of countries for which information is available. These estimates which
are the most recent for a selected countries are presented in Table 4. Here
again we have ordered the countries by descending order of magnitude of survivorship
ratio (45p15) to show the position of Cameroon.
The results again reveal that the average level of adult mortality in Sub-Saharan
African though variable is very high compared to the rest of the world or other
developing countries. For instance, estimates of life expectancy at exact age
15 where available (see UN, 1992b) for Sub-Saharan Africa, rarely exceed 50
years compared to that of the other developing countries that in most cases
is within the neighborhood of 60 years. Also, there are apparently wide differences
(though not as large as in the case of childhood mortality) in adult mortality
levels between the countries in the sub continent. Comparing this table with
Table 3, the balance between childhood and adult mortality is also found to
vary across countries with some countries having relatively low adult compared
to childhood mortality and others the reverse like Botswana with very low childhood
mortality that exhibit very high adult mortality. However, there are some countries
that we could term "best performers" such as Kenya and Zimbabwe where both
adult and childhood mortality are quite low2 and some few at the
other end of the spectrum like Mali where both levels are high. The progress
over the last three decades and the knowledge of health and medical technology
notwithstanding, the results generally suggest that many adults continue to
die before their 60th birthday or before the "conventional" end
of activity.
For Cameroon, the results indicate that adult mortality is very high even
when compared to other countries of the sub continent. The estimates show that
an average Cameroonian who managed to overcome childhood hazards and attain
age 15 has slightly above 6 chances in 10 to ever celebrate this 60th anniversary
compared to about 8 chances for say a Zimbabwean, Gambian, Ghanaian or Mauritanian.
That is, in Cameroon as many as 35 percent of those who survive to age 15 would
die before the celebration of their 60th birthday (against 17 percent
for Mauritania and Zimbabwe, 20 percent for Ghana, 24 percent for Benin, etc.)
at the levels of mortality prevailing in the 1980s.
Besides, compared to the childhood mortality levels where Cameroon's position
is somewhat "moderate", adult mortality is clearly very high. Gender disparities
in adult mortality are somehow small but despite the usual indication of high
maternal mortality, female survivorship in adulthood is slightly higher than
for males. As such the high adult mortality cannot be attributed to the prevailing
high incidence of maternal mortality in the country.
These results suggest that for adults relative to children, Cameroon is a
country with very poor health status. As such sustained efforts are required
not only in the domain of child health but also that of adult health to improve
the survival of the children and also maintain their health after they survive
childhood. However, little is known about the causes of prevailing high adult
mortality because of lack of information on adult health problems in the country.
Future Levels of Mortality
The health situation of the population has deteriorated in recent years resulting
from civil and/or political struggles which have both provoked heavy death
tolls and rendered many people homeless. There is widespread and aggravated
malnutrition, lack of basic needs of water and shelter, etc. The advancement
of the desert is also taking its toll while other forms of environmental degradation
(severe and prolonged droughts and floods among others) have all been, and
still are, detrimental to health. Coupled with these, is the advent of epidemics
that take away many lives. A case in point is that of cholera, meningitis and
yellow fever in the northern parts of Cameroon3.
Another major issue affecting health is the current economic crises with all
its deleterious effects. As indicated earlier, infant mortality in particular
and mortality in general, is very sensitive to changes in the socio-economic
status. The "imposed" poverty associated with the crises may likely increase
the level of mortality because of the inability of the people to bear the cost
of health care. Many people have given up on relatives and watch them die because
they have no money to buy drugs. Others have had to choose between sick relatives
for treatment only those they will very much want alive4. The level
of malnutrition on the other hand is increasing as a result of the constant
deterioration in standards of living of the population. Famine is becoming
rampant as many areas of the country face disastrous food shortages and the
skyrocketing prices.
The part of the national budget allotted to health which defines the health
policy has also been handicapped by the crises and the heavy debt burden. Worst
still, some of the policies adopted to overcome the crises (so they say) have
rather led to widespread health problems. Furthermore, the crises adversely
affect female education, which is an important factor that may lower infant
and child mortality. The AIDS epidemics compounds all these poor conditions.
Predicting future levels of mortality or health is at best speculative. Nevertheless,
there is every likelihood that the above mentioned unfavorable factors may
tend not only to counter the slight achievements of lower childhood mortality
but may also outweigh the favorable factors and worsen adult mortality to a
point where death rates may rise.
Conclusions
In this article, we have examined the mortality situation in Cameroon compared
to that of other Sub-Saharan African countries. Evidence presented show appreciable
declines in infant and child mortality over the past three decades with the
decline in infant mortality virtually the same as that of child mortality.
The overall childhood mortality rate as assessed in 1991, suggests that around
13 percent of the newborn babies would expect to die before their fifth anniversary
down from 19 percent in 1978. Compared to other Sub-Saharan African countries,
this rate appears moderate. But it is evident that the population is experiencing
very high mortality rates when compared to other developing countries, or world's
standard. Besides, the expectation of life at birth is below the conventional
stop of activity and equally below the reasonable minimum proposed by WHO (WHO,
1981) way back in 1981 for mortality to be a lesser burden on the individual
families and on the country's development.
Also, in spite of this apparent moderate childhood mortality situation in
Cameroon by African standards, the adult mortality level on the other hand
is very high even by Sub-Saharan African standards. Barely 65 percent of those
who survive childhood hazards up to 15 years of age would expect to celebrate
their 60th anniversary compared to other countries of the sub continent
with about 80 percent. Even when compared to the childhood mortality situation,
Cameroon is a country with very poor health for adults. It seems children have
benefitted more than adults from the reduction of overall mortality to a "moderate" level.
The results suggest that, in addition to making more efforts to improve the
survival of children in the country, it is necessary to institute strategies
to maintain their health when they survive childhood".
In order to maintain a steady decline in infant and child mortality, basic
facilities such as access to safe drinking water and sanitation are required
in addition to the provision of adequate health care facilities. Health care
facilities at present are grossly insufficient and poor where available and
inexistent some localities. These should be made available and accessible.
The health care must of necessity start with prenatal care. Besides, it will
also be essential to impress on pregnant women or potential users not only
on the need to use them but also to do so early in pregnancy in order to permit
the detection and easy handling of complications.
The aforementioned financial accessibility requires strategies to alleviate
the current widespread poverty because it tends to increase the mortality risks
of the population. As a matter of fact, it will be difficult to talk of health
if a great majority of the people are unable to assure subsistence. Just the
inability to afford subsistence implies health is endangered. As a matter of
fact, the rises in prices of basic commodities have demoted health in the list
of individuals' essential needs.
Education (of women especially) is associated with lower risks of mortality
for children (see for instance Bicego and Boerma, 1991; Cleland et al, 1991;
on Cameroon data see also Cameroon, 1983; Direction du 2ème RGPH, 1992;
Tamen, 1992) even when the woman has not completed primary level. For instance,
the CDHS results for Cameroon show that the risk of dying before the fifth
birthday is about twice as high for children of uneducated mothers than it
is for children of mothers with some minimum level of education. Education
creates the basic awareness of sanitation, nutrition and health issues. Thus,
policies aimed at the expansion of educational opportunities particularly for
women will give them greater access to information and improve their ability
to make use of such information in order to live healthily.
If these and other appropriate and realistic measures are not undertaken,
we will surely approach the year 2000 with the package "Health for All" remaining
not only a slogan but worse off than where we started.
Table 1 :Principal indicators of General Mortality for Cameroon
Indicator
1960-65
1970-75
1980-85
1990-95
1976
1987
CDR'000'
23.4
19.5
15.6
12.2
20.4
13.7
e0 Both sexes
40.5
45.8
51.0
56.0
44.4
53.4
Males
39.0
44.3
49.5
54.5
43.2
52.4
Females
42.0
47.3
52.5
57.5
45.6
56.2
Note :e0 Life expectancy at birth.
CDR crude death rate per 1000
population Sources :Except for 1976 and 1987 (respective census estimates), all
are medium variant estimates from UN (1993).
Table 2 :Childhood mortality rates for certain periods before the surveys
: CFS 1978 and CDHS 1991
Years to survey
NN
P-NN
Infant
1q0
Child
4q1
Childhood
5q0
197810-14
61.2
73.6
134.7
124.6
242.5
5-9
47.1
55.8
102.8
101.4
193.8
0-4
47.3
58.3
105.6
100.0
195.0
199110-14
55.4
52.7
108.1
100.6
197.9
5-9
52.4
44.9
97.3
73.8
164.0
0-4
33.1
31.9
65.0
65.6
126.3
Note :NN Neonatal P-NN Post-neonatal Sources :For CFS 1978, Rutstein (1994).
For CDHS 1991, Direction du 2ème
RGPH (1992).
Table 3 :Current levels of mortality for selected countries DHS and WFS
Country
DHS Date
5q0
WFS Date
5q0
Change
% Change
Mali
1987
249
1961@
348
- 99
- 28.4
Liberia
1986
220
1974*
178
+ 42
+ 23.6
Nigeria
1990
192
1981-82
165
+ 27
+ 16.4
Senegal
1986
190
1978
262
- 72
- 27.5
Uganda
1988-89
190
1969*
194
- 4
- 2.1
Togo
1988
158
1971*
219
- 61
- 27.9
Ghana
1988
155
1979
127
+ 28
+ 22.0
Burundi
1987
152
1979*
229
- 77
- 33.6
Cameroon
1991
126
1978
191
- 69
- 35.4
Sudan !
1989-90
123
1979-80
151
- 28
- 18.5
Kenya
1989
89
1977-78
149
- 60
- 40.3
Zimbabwe
1988
75
1982*
134
- 59
- 44.0
Botswana
1988
53
1981*
118
- 65
- 55.1
Notes:! Mostly refers to Northern Sudan.
@ National Demographic Survey.
* Census estimates North Model Life Table.
Countries have been ordered here by
magnitude of childhood mortality rate in the DHS. Sources:Compiled from Hill (1993) except for Cameroon.
For WFS, see Rutstein
(1984).
Table 4 :Estimates of adult mortality : life expectancy at age 15 (e15)
and survivorship from age 15 to 60 (45q15), selected countries 1970-80
Country
Life Expectancy at 15
Survivorship Ratios
Date
Male
Female
Both
Date
Male
Female
Both
Zimbabwe
1975
52.3
57.0
54.6
1978
.801
.863
.833
Ghana
1968
45.5
47.5
46.5
1982
.778
.880
.830
Benin
1970
46.2
48.3
47.3
1978
.749
.779
.764
Kenya
1974
49.5
55.9
52.7
1974
.714
.769
.742
Togo
--
--
--
--
1981
.704
.760
.733
Sudan*
1975
55.9
55.6
55.7
1975
.695
.768
.732
Côte d'Ivoire
1978
46.8
46.5
46.7
1978
.646
.741
.694
Senegal
1978
48.9
51.5
50.0
1978
.652
.710
.682
Congo
1967
52.4
55.6
54.0
1984
.656
.703
.680
Tanzania
1965
52.8
54.4
53.6
1988
.656
.675
.666
Burundi
1970
43.1
46.2
44.6
1981
.622
.699
.661
Cameroon
1975
50.5
54.2
52.4
1976
.644
.666
.654
Botswana
1965
50.3
54.6
52.5
1980
.555
.732
.646
Lesotho
1976
42.3
52.4
47.4
1976
.503
.749
.627
Mali
--
--
--
--
1986
.579
.541
.560
Notes :-- Not available.
* Northern Sudan. Sources :Timaeus (1987 ; reproduced in Hill, 1990) for life expectancy
; Timaeus (1993) for survivorship.
Notes
1.A report by the World Health Organization (WHO, 1981), indicates that each
country can decide on its own norms, but suggests a minimum life expectancy
of at least 60 years at birth and a maximum infant mortality of 50 per 1000
live births to imply that the health status of the population is becoming a
decreasing burden on individual families and community development.
2.Such interpretations need to be taken with some caution because, the estimates
as clearly indicated in the table refer to different dates and also there is
the likelihood that causes of death may differ greatly between the countries.
3.In the specific case of meningitis, a major outbreak occurred in the Far
North Province in 1992 with about 7782 cases recorded in health facilities
and 705 deaths : representing a case fatality rate of 9.1 percent. In 1993,
though the reported cases in health facilities fell to 3134, there were 412
deaths raising the case fatality to 13.2 percent. These figures are however,
gross underestimates because they are based only on patients that visited health
facilities.
4.We encountered some of these cases in some interviews conducted in the Northern
part of the country, most of which occurred during epidemic outbreaks. It was
noted that some families have had to choose between sick members who could
not all be taken to at the same time health facilities at the same time because
of inaccessibility (both financial and geographical). It is worthy of note
that in some areas where private missions facilities existed, this eventuality
was eliminated by the fact that these facilities could offer treatment on a
deferred payment basis.
5.Another implication of this study though it was not our initial aim, is
on the use of infant and/or childhood mortality level as an indicator of the
general health status of the population. As we have seen, it may be useful
in some populations where adult mortality is of about the same magnitude as
that of children but is quite misleading for some other populations. For instance,
the case of Cameroon where childhood mortality may be termed moderate but there
is little health assurance after the children survive childhood.
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Copyright 1995 - Union for African Population Studies