Below-repiacement fertility in Tropical Africa? Some evidence from Addis Ababa

DO THE SEX COMPOSITION OF LIVING CHILDREN AND THE DESIRE FOR ADDITIONAL CHILDREN AFFECT FUTURE INTENTION TO USE CONTRACEPTION IN ETHIOPIA?

Information on future intention to use contraceptives is a potential programme indicator for family planning services. Using three consecutive rounds of Ethiopian Demographic and Health Survey (EDHS) data collected in 2000, 2005 and 2011, this study examined whether the sex composition of living children and future desire for additional children were associated with the intention to use contraceptives among Ethiopian women aged 15-49 years who were not using any method of contraception at the time of the survey. The pooled multivariate binary logistic regression analysis indicated that between 2000 and 2011, the intentions of non-users to use contraceptives in the future increased significantly. Women who had at least one child (with an equal number of boys and girls, more boys than girls or more girls than boys) who did not want any more children, and those who were unsure about their desire for additional children, showed an increased intention to use contraceptives in the future, compared with those with an equal number of boys and girls who expressed a desire for additional children. Women with no children and who did not want children, or those who were unclear about their future desire, showed a lower intention to use contraceptives, compared with women with an equal number of boys and girls who wanted a child in the future.

Steep declines in population-level AIDS mortality following the introduction of antiretroviral therapy in Addis Ababa, Ethiopia

OBJECTIVES

Assessments of population-level effects of antiretroviral therapy (ART) programmes in Africa are rare. We use data from burial sites to estimate trends in adult AIDS mortality and the mitigating effects of ART in Addis Ababa. ART has been available since 2003, and for free since 2005.

METHODS

To substitute for deficient vital registration, we use surveillance of burials at all cemeteries. We present trends in all-cause mortality, and estimate AIDS mortality (ages 20-64 years) from lay reports of causes of death. These lay reports are first used as a diagnostic test for the true cause of death. As reference standard, we use the cause of death established via verbal autopsy interviews conducted in 2004. The positive predictive value and sensitivity are subsequently used as anchors to estimate the number of AIDS deaths for the period 2001-2007. Estimates are compared with Spectrum projections.

RESULTS

Between 2001 and 2005, the number of AIDS deaths declined by 21.9 and 9.3% for men and women, respectively. Between 2005 and 2007, the number of AIDS deaths declined by 38.2 for men and 42.9% for women. Compared with the expected number in the absence of ART, the reduction in AIDS deaths in 2007 is estimated to be between 56.8 and 63.3%, depending on the coverage of the burial surveillance.

CONCLUSION

Five years into the ART programme, adult AIDS mortality has been reduced by more than half. Following the free provision of ART in 2005, the decline accelerated and became more sex balanced. Substantial AIDS mortality, however, persists.

Mortality impact of AIDS in Addis Ababa, Ethiopia

OBJECTIVE

To measure the impact of HIV on mortality in Addis Ababa, Ethiopia.

DESIGN

A retrospective review of burials at three cemeteries, 1987-2001 and a prospective surveillance of burials at all (n = 70) cemeteries, February-May, 2001.

METHODS

The age, sex, and date of burial were recorded; in the absence of denominators, we compared the ratio of deaths of persons 25-49 versus 5-14 years of age per calendar year, using logistic regression, adjusting for sex and site. The age- and sex- specific mortality were calculated and compared with pre-HIV mortality in 1984.

RESULTS

Of 17,519 deaths, retrospectively reviewed, complete data were available for 6342 (47%) females and 7269 (53%) males. During 1987-2001, the '25-49' versus '5-14' group all-cause mortality ratio increased by 8.5% per calendar year (P < 0.05). A total of 5101 deaths were recorded in the prospective surveillance. Crude mortality rates were 9.5/1000 per year (men) and 7.1/1000 per year (women). In comparison with 1984, 5.0-times as many men and 5.3-times as many women died in the age group 35-39 years. Attributing the increase in mortality in ages 15-60 to HIV in the period 1984-2001, Ethiopian men and women have a probability of 18.8 and 17.8%, respectively, of dying of HIV before age 60.

CONCLUSION

Burials increased significantly among the '25-49', versus the '5-14' group, during the period 1987-2001. This trend, and a five-times higher mortality in 2001 than in 1984 in those aged 35-39 years demonstrate a severe impact of HIV on mortality. Continuing surveillance of burials is recommended.

The proximate determinants of the decline to below-replacement fertility in Addis Ababa, Ethiopia

Between 1990 and 2000, the total fertility rate (TFR) in Ethiopia declined moderately from 6.4 to 5.9 children per woman of reproductive age. During the same period, the TFR in the capital city of Addis Ababa declined from 3.1 to 1.9 children per woman. Even more striking than the magnitude of this decline is that it occurred in the absence of a strong and effective national family planning program. In this study, the components of this fertility decline are identified using the Bongaarts framework of the proximate determinants of fertility. The results of a decomposition analysis indicate that a decrease in the age-specific proportions of women who are married, followed by an increase in contraceptive use are the most important mechanisms by which fertility has declined in Addis Ababa. Poor employment prospects and relatively high housing costs are likely factors that encourage couples to delay marriage and reduce marital fertility.