Date of Award


Degree Type


Degree Name

Doctor of Philosophy


The dissertation aims to tie together the empirical, theoretical and policy oriented aspects dealing with the dynamics of morbidity and mortality in Africa. On the theoretical aspect, scholars are arguing that the epidemiologic transition theory which provided the framework for understanding African mortality in the past, is actually part of a broader health transition theory which also includes a health care transition. In this theory, the overemphasis on biomedical interventions is down-played. To understand African mortality, it is argued, we have to consider the social and cultural determinants. Also we have to consider morbidity and its relationship to mortality. This thesis is only considering two aspects of these concerns of health transition theory, namely health care planning and the dynamic relationship between morbidity and mortality.;In order to study the dynamics of morbidity and mortality, a multistate demographic model is used. As data availability in Africa is poor, a straight-forward application of the model is not possible because of its high data requirements. The adopted solution is to construct separate submodels for the indirect estimation of morbidity and of mortality. In the mortality submodel, the relevant age-cause-specific death rates are obtained by synthesizing Preston's cause of death model and an extension of the Brass logit model. In the morbidity submodel, the relevant morbidity rates are obtained by modifying Klementiev's degenerative model to handle lethal infectious disease for which limited recovery is possible.;With the data obtained from these submodels, the multistate (dynamic) model is used to investigate the mechanism of the health transition; that is, the effect of changes in risk factors (affecting incidence rates) and that of health care technology (affecting case fatality rates). With changes in the incidence rates, case fatality rates or recovery rates, the model can then be used to obtain estimates of life expectancies in either the illness states or the well state.;A specific application of the dynamic model is in health care planning. In two hypothetical examples given in the thesis, scenarios are constructed and the application of the dynamic model in aiding in decision making is outlined.



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