African Studies: Health 281
information and were often the sites for intervention
projects. They included largely demographic projects such
as the Sine-Saloum (1962–6) and later studies in Senegal,
and those with greater attempts to investigate health: Pare-
Taveta, Kenya and Tanzania (1954–6), Keneba, Gambia
(1956 onward), Danfa, Ghana (1969–74), Malumfashi,
northern Nigeria (1974–9), Machakos, Kenya (1974–81),
Kilombera, Tanzania (1982–8) and Navrongo, Ghana
(1993 onward). All programs measured health, mostly by
mortality or survival measures, and all involved collabora-
tion between African and outside institutions. African
demographic estimation was the most challenging in the
world, and the new techniques developed to meet that
challenge were employed subsequently in other parts of the
developing world and by historical demographers.
The data released from these investigations were employed
by a succession of research programs:
1. The African project of Princeton’s Office of Population
Research analyzed the results from predominantly franco-
phone African demographic surveys and anglophone
African censuses from 1961, and published The Demography
of Tropical Africa in 1968. Its major contribution was its
fertility estimates, and those on mortality were largely
confined to infancy.
2. The International Union for the Scientific Study of Pop-
ulation (IUSSP) in the mid-1980s commissioned papers on
African mortality change for a 1987 conference and pub-
lished Mortality and Society in Sub-Saharan Africa in 1992.
3. The American National Research Council’s Committee on
Population established a program on the population
dynamics of sub-Saharan Africa in 1989 and published
Demographic Change in Sub-Saharan Africa and five other
volumes in 1993.
4. From the late 1980s the World Bank commissioned studies
of the health of sub-Saharan Africa and in 1991 published
Disease and Mortality in Sub Saharan Africa. The first part of
the book was constituted by studies of child and adult
mortality and child malnutrition drawn from WFS and DHS
data, the second part by studies of specific ailments from
miscellaneous sources, and the third part by reports on
morbidity and mortality from the various surveillance
projects.
5. A collaborative analytical program of persons working in
African universities and institutions on West and Middle
Africa resulted in 1975 in the publication of Population
Growth and Socioeconomic Change in West Africa. In it, Can-
trelle developed his thesis on tropical mortality (discussed
below).
Some African research themes have a strong behavioral
component. Studies of the impact of parental education,
especially maternal education on child survival began in the
region (Orubuloye and Caldwell, 1975; Caldwell, 1979; Farah
and Preston, 1982), and have since become numerous else-
where. The AIDS epidemic has brought demographers and
other social scientists to the study both of AIDS mortality and
of sexual relations and other aspects of HIV transmission
(Cleland and Way, 1994; Awusabo-Asare et al., 1997).
Health in sub-Saharan Africa has not been a major
feature of social science literature, probably because the data
have been elusive and difficult to interpret. It has consti-
tuted 7.8% of all articles in Social Science and Medicine,
2.5% in Population and Development Review and, except for
anthropological accounts of traditional healing practices,
none in Africa. The latter point underscores the fact that the
major social science input into African health research has
been by demographers. Biomedical researchers have under-
taken research on specific diseases. The balance of this
article summarizes what the research reveals about African
health.
The Health Situation
The first reliable estimates of sub-Saharan mortality were for
the late 1940s and early 1950s, and were for infants, and then
young children, made by adjusting mothers’ reports of their
children’s deaths. These revealed infant mortality rates (deaths
per 1000 births during the first year of life) ranging in most
of francophone Africa between 200 and 275 (and probably
equivalent to life expectancies ranging from 25 to 35 years). At
the district level, Mopti in Mali and Luanda in Angola recorded
infant mortality rates of 350 and 329, respectively, showing
that one-third of all births resulted in deaths during the first
year of life. In contrast, Kenya recorded an infant mortality
rate of only 132 (a life expectancy around 45 years) and two
of its districts, Central and Rift Valley Provinces, registered
rates under 100. Subsequent studies increasingly involving life
histories, many summarized by Althea Hill, showed infant and
child survival improving nearly everywhere until at least the
1980s. West African mortality was higher than that of East and
Southern Africa, but convergence was taking place. As appro-
priate questions were added to surveys, advances were also
made in the study of adult mortality, which fell consistently
until the 1980s. Thereafter, the decline became much slower in
West Africa, and halted or reversed in East and Southern Africa
(Timaeus, 1999).
At the end of the twentieth century (1999) sub-Saharan
Africa’s life expectancy was 49 years, with male expectancy
around 48 years and female 50 years. This compared with 61
years in South Asia, 64 years in North Africa, 65 years in
Southeast Asia, 69 years in Latin America, 72 years in East Asia,
73 years in Southwest Asia, and 75 years in industrialized
countries. With 9% of sub-Saharan African babies dying
in the first year of life, and 15% in the first five years, the
region’s infant and child mortality was also the world’s highest.
Sub-Saharan Africa’s life expectancy compares with that in
Western Europe at the beginning of the twentieth century,
suggesting a health lag of about 100 years. Within sub-Saharan
Africa, Southern Africa recorded a life expectancy of 56 years,
West Africa 52 years, Central Africa 49 years, and East Africa 44
years, the latter’s poor performance being a recent product of
the AIDS epidemic. National levels ranged from 55 or more
years in Ghana, Liberia, South Africa, and Cameroon to 42
years or less in Malawi, Swaziland, Botswana, Zimbabwe,
Niger, and Ethiopia. Such low levels as those for the last-
mentioned countries are no longer found anywhere else in the
world.