This study presents a reconstruction of under-five mortality trends derived from data provided by the Demographic and Health Surveys (DHS) and World Fertility Surveys (WFS) in sub-Saharan Africa from 1950 to 2000. Death rates were first calculated by single years for each of the 64 surveys available. When several surveys were available for the same country, they were combined for each of the overlapping years. Then the series was analyzed to identify periods of monotonic trends, whether they were declining, steady, or increasing. Changes in trends were tested using a linear logistic model. All calculations were done at the national level and by urban-rural residence. Among the 33 countries studied, which account for some 80 percent of the sub-Saharan population, only eight had monotonic or quasi-monotonic mortality trends, which indicate a smooth health transition. Another eight countries had periods when mortality rose significantly for a variety of reasons. In at least eight other countries mortality increased through 1985-90the most recent period covered in the studyas a result of increasing levels of AIDS mortality. Reconstructed levels and trends are compared with other estimates made by international organizations. These estimates are usually based on indirect methods.
Results indicate that in sub-Saharan Africa, progress was made in the health transition during the second half of the twentieth century. However, improvement was slower than expected, with an average decline in mortality of -1.7 percent per year. The transition was not smooth in more than half of the countries, and cases of reversals in mortality trends occur that appear to be linked to political, economic, and epidemiological crises, particularly the HIV/AIDS pandemic.