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THF, DETERT\II"TS OF TKE DECREASE
IN INTRA. "TEEINE 1lOR'pALITY AID IKF&T'T MORTALITY _- An example i n Western AÎrica : the Dqyes plateau (South-West Togoland)
Demographer at o.i.S.T.0.~. .
$Y* OY. s'?p O. R. S.T. O. M. Fonds Documenta,irB
lIanila (Philippir,es), 9-1 6 December 1981
- - . .. .. . _ . .P . ..
Abstract
In Africs?, i t seem that there is a large decrease in infant mortality, even i f i t is not observed everywhere. This decrease in the frequency of M a n t mortality can be considered as a phenomenon all the more significant as it is observed in very different physical and human environments as is shown by the various recent studies.
The analysis o f the evolution i n the structures which are considered relevant enough t o define the components of the decrease in infant mortality on the Dayes plateau (South-West Togoland) between 1930 and 1969 made it possible t o better discern the structural changes which appeared along w i t h th is decrease
i n the intensity of infant mortality. Furthermore, the analysis of some independent variables of mortality allowed most decisive social factors concerning this decrease.
t o get a better approach t o the
As lar as the permanent structures o f infant m o r t a l i t y are concerned, the two major data are the absence o f infant excess mortality and the fact that the decrease i n the intensity of mortality is lower in the child period (1-4 yems)
than in the infant period (O year). As f o r the evolution, it can be characterized mainly by the higher decrease i n the endogenous mortality as compared with the l a t e foetal death and the exogenous mortaliQ)by the more significant decrease i n infant mortality than i n child mortality.
a k d .
' C
The most dist inct variation i n mortality as influenced by the human environment l i e s i n the d i s p a r i t y between the Ewe and the Kabye, the l a t t e r being chazacterixed by a higher infant mortality. This distinction which applies only to the exogenous mortali* shows the significance of the variables "school attendance" and "health care and education" which finally refer t o the cultural, social and economic conditions, thus making it easy f o r the Ewe only t o have access t o the health and school infrastructure.
- Items : Western Africa, South-West Togoland, Infant mortality, Intra utérine Mortality, Structures of infant mortality, Social factor of infant
m o r t d i t S r ? childhood mortality
I
I -
l ' THE DETERMINANTS OF THF, DECREASE I N INTRAUTERINE
MORTALITY AND INFANT MORTALITY
An example i n Western Africa : the Dayes p la teau (South-West Togoland).
INTRODUCTION.
In Africa, it seems t h a t there i s a l a rge decrease i n i n f a n t morta-
l i t y , even i f i t i s no t observed everywhere (United Nations, 1978). This de-
crease i n the frequency of i n fan t mor t a l i t y can be considered as a phenome-
non a l l t he more s ign i f i can t as it i s observed i n very d i f f e ren t physical
and human environments as i s shown by the various recent s tud ies . Thus, i t
is poss ib le t o give some examples such as Dakar (Senegal) where a retrospec-
t ive survey shows t h a t the infant mor ta l i ty rate decreased from 143 p e r 1,000
f o r the ch i ldren b o m between 1940 and 1949 t o 57 per 1,000 f o r the chi ldren
born between 1965 and 1969 (FEXEY, 1977) ; Kongoussi-Tikare s i t ua t ed in t h e
Mossi r u r a l zone (Upper Volta) where a survey of complementary sources (BENOIT
e t a l . , 1980) makes i t possible t o evaluate the decrease in the infant morta-
l i t y rate from 359 p e r 1,000 ( f o r ch i ldren b o m between 1953 and 1957) t o
205 per 1,000 ( f o r ch i ldren b o m between 1973 and 1977) ; s imi l a r ly , the d a t a
concerning the Eastern, Western and Northern regions of Nigeria show a de-
cline i n infant mor t a l i t y from 215 t o 160 p e r 1,000 between 1931 and 1971
(OLUSANYA, 1979). This downward t rend i s a l s o observed i n o ther countr ies
such as tIie r u r a l and urban zones i n Algeria (TABUTIN, 1976), Zaïre (TABUTIN,
1979) and the rural region of Sine-Saloum in Senegal (CANTRELLE , 1980).
The ac tua l decl ine i n in fan t mor ta l i ty and i n t r a u t e r i n e mor ta l i ty
(the latter being more d i f f i c u l t t o evaluate) i s observed under d i f f e r e n t
eco logica l cond2tions and affects populations wi th d i s t i n c t cu l tu re and so-
cio-economic structure, thus leading t o raise the question about t he type +
of t h i s decrease and i t s determinants. This text which takes a rural region
i n Western A5ri\ca ca l l ed the Dayes p l a t eau as an example would l ike t o con-
tr2Einte t o the study of tzs decrease. As a matter of f a c t , the evolut ion
i'n tIi2s zone i's in keepi-g w i t h t h i s decrease i n i n f a n t mor ta l i ty . Therefore,
the analysi 's of the determinants of this decrease, although i t i s made on a
. .
- 2 -
t
p a r t i c u l a r region canibe very useful i n i tsel f and through the comparisons
which can be made , f o r , as P. CANTRELLE (1980) wrote ' I . . . given such an
ignoring of the h e a l t h l eve l s i n Africa which r e s u l t i n i n f a n t mor t a l i t y ,
any information even i f i t i s no t representat ive of the whole country must
be consideredjproviding t h a t i t i s r e l i a b l e . Is not it b e t t e r t o g e t some
precise points of reference in d i f f e r e n t ecological environmenCs than t o g e t
evaluations wfiich a re made from l a rge samples i n a discontinuous way, thus
leading t o some vague r e s u l t s ? I t
A. THE BACKGROUND
A. I. The physical and human environment /-
The Dayes p l a t eau whose a rea amourits t o 450 km2 i s s i t u a t e d i r i the
south western pa r r of Togoland on the f r o n t i e r w i t & Ghana (1). It i s p a r t
of the Togo mountahs which represent the souttiem zone of the Atakorian
c h a h of mountdns. Tfie a l t5tude i s r a t h e r high (from 700 t o 950111) with the
exception of two s m a l l va l l eys s i t u a t e d a t 20Om. The climate which i s cha-
r ac t e r i zed By heavy r a i n f a l l s (from 1400 t o 170Om p e r year) and r a t h e r low
mean temperatures for Western + f r i ca (M : 27", m : 17') i s favourable t o
the growth of an abundant vegetat ion and the development of ag r i cu l tu re and
breeding. Therefore, the plateau i s mainly an a g r i c u l t u r a l region.
Tlie development of the coffee cu l t i va t ion a t Dayes from 1945 onwards
caused a considerable numBer of Kaljye t o immigrate and leave the densely po-
pulated zone9 of tFïe Kaza reglon 5n the north of the Togoland i n order t o
go t o tfie p l an ta t lons and work there as unski l led labourers and share-crop-
pers. I n 1970, tlïirs etfinlc group represents 22 % of the t o t a l population (2) ;
tfie etfinlc groups whlcfi can Eie considered as autochthonous, s ince they were
tfie f h s t t o se t t le at Dayes i n the e a r l y XVIIIth century, represent respec-
t i v e l y 69 % of the Ewe and 5 % of the Ahlon ; and the r e s t of the population
(4 %) Is very heterogeneous and is composed of people belonging t o various
etfini'c groups 50th from the Togoland and the neighbouring countries. . . .
TRe di 'fferent d a t a herein r e s u l t from a series of socio-demographic ob- servati'ons made i n 1976 i n collaljoration with A. QUESNEL as p a r t of the researclìes of the ORSTOM Centre a t LomG.. The d a t a from a r e t rospec t ive survey conducted on the evolution of the b i r t h s i n a sample of 1264 women were tfie main source f o r measuring the evolution of i n f a n t mor t a l i t y and i t s d e t e d n a n t s .
l'€¡e t o t a l population w a s evaluated at 27000 persons i n 1976 or a mean po- pulat ion densi'ty of 60 inli./km2. The population growth amounted t o 0,9 % 2n t B e 1970-1976 periad.
- 3 -
In addi t ion t o this sett lement of autochthonous populations , the
development of a p lan ta t ion economy based on the cu l t i va t ion of coffee, and
t o a lesser ex ten t , of cacao, r e su l t ed i n many economic transformations t h e
main of which consis ts i n moving gradually from a l i n e a l mode of production
t y p i c a l of a self-suljsistence economy t o the c a p i t a l i s t mode of production
based on the exchange terms between landowners and share-croppers as w e l l as
the engaging of seasonal workers and maintained by the incomes from cash
crops. This evolution towards a market economy enabled t o c rea t e a aery com-
p l e t e i n f r a s t r u c t u r e ( t a r r e d roads , schools and dispensaries) which brought
some modifications t o the l i v i n g conditions of the population. As a matter
of f a c t , the increasing school attendance by the young generations and the
improvement i n the h e a l t h level are the changes which are the most v i s i b l e
and the most f r u i t f u l of consequences as f a r as the demographic and s o c i a l
evolutions are concemed. The demographic evolution can be characterized
mainly By tbe s l i g h t f e r t i l i t y decl ine, the more s i g n i f i c a n t decrease i n in-
f a n t mor t a l i t y and the emergence of migratory movements among the young school
populati'on i n search of urban jobs and among the "rural" migrants i n search
of new cu l t ivab le lands : these departures reveal the economic d i f f i c u l t i e s
r e l a t e d t o tfie old plantat ions.
After these transformations which have j u s t been b r i e f l y mentioned , the d i s p a r i t y Fetween the e thn ic groups and their d i f f e r e n t react ions t o the
clianges caused by the development of t he p l an ta t ion economy are the major
d a t a wfi~clì can Be oBserved from the demographic and s o c i a l analysis .
So, as e a r l y as 1960 when the p l an ta t ion economy made g rea t s t r i d e s ,
t he s o c i a l s t r u c t u r e of the plateau has been characterized mainly by the dis-
t i n c t i o n between, on the one hand, t he e thn ic groups which were previously
s e t t l e d a t Dayes ( i n the XVIIIth century) such as the Ahlon and the Ewe, and,
on the o the r hand, the Kabye who immigrated from Northern Togoland. This eth-
n i c d i s t i n c t i o n i s based on major s.ocia1 and demographic differences which
o r ig ina t e from the business r e l a t i o n s and the h i s t o r y of the settlementl.
The most v i s iB le demographic difference r e s u l t s from the recent imi- grat ion of the Kabye (a generation t o the maximum) and l i e s i n t h e i r younger
age s t r u c t u r e : f o r instance, i n 1976, there a r e I I % of Ewe over 50 aga ins t
only 5 % of Kabye.
On the o the r hand, the t i m e v a r i a t i o n i n the sett lement of t h e d i f -
f e r en t e thn ic groups and the d i s t i n c t posi t ions held in the mode of produc-
t i o n of cash crops (Autochthonous - landowners h a b y e - share-croppers) condi-
t ioned tEe di-ffezences i n the space d i s t r i b u t i o n of t he populations. The
+ttlement Q$ p l a n t a t h n a on $$tes fzr f ~ o m tBe vi ' l lages , f n f o r e s t s unoccu-
pikd Tp food crops, caused most of tFre KaBye sfrare-croppers t o se t t le in rrfarms"
lb la tea oz gcouped xh an Ramlet: wlfthin tEe zones of plantat ions : thus they
-. .
- I
are l i v i n g i n the very hea r t of the cu l t i vab le lands, while t he autochth0nsr.s
are l i v i n g mainly i n the v i l l a g e s . In 1976, 30 % of the whole population are
l i v i n g i n 'lfarms'l, but the percentages vary with the e thn ic groups amounting
to 94 % f o r the Kabye, 11 % f o r the Ewe and 6 % f o r t h e Ahlon.
In addi t ion t o these b a s i c differences and t o the fundamental cul-
t u r a l d i s p a r i t i e s (mainly the p o l i t i c a l s t r u c t u r e and r e l ig ion ) r e s u l t i n g
from the o r i g i n and the h i s t o r y of the populations under study (CORJEVIN,
1959), there a re some d i s t i n c t i o n s r e l a t e d t o t he pos i t i on held by each eth-
n i c group i n a s o c i a l s t r u c t u r e which has been developing during successive
periods of growth and crisis. It i s possible t o mention from a demographic
point of view the high marital i n s t a b i l i t y which character izes the nup t i a l i -
t y of the autochthonous e thn ic groups, the higher r a t e of b io log ica l repro-
duction i n the Kabye and the more important emigration of the young male Ewe
and Ahlon.
Despite these differences i t remains t h a t the p l an ta t ion economy
caused tfie population t o open up t o the market economy and the ou te r world
(development of the exchange terms , the school attendance, the road in f r a -
s t r u c t u r e and the h e a l t h f a c i l i t i e s ) , which was favourable to the decrease
i n i n f a n t mor t a l i t y . c
A . 1 1 . TIie decrease i n the i n t r a u t e r i n e and i n f a n t mortal i ty .
II. 1.
a) TIie general i n t r a u t e r i n e mor t a l i t y : the general i n t r a u t e r i n e
mor t a l i t y rate (calculated 6p r e l a t i n g the whole i n t r a u t e r i n e deaths t o the
wBole 5359. pregnancies) amaunts t o 9,2 %. According t o the bes t observations, 11 . the fn t r au te r fne mor t a l i t y rare amounts t o about 15 % i n the pregnancies
whkcli can 6e i d e n t i f i e d without any s p e c i f i c means" (LERIDON, 1973). So, we
can cons5der that almost 40 % of tIie i n t r a u t e r i n e deaths which could be ob-
served ih tlie course of a survey were not r eg i s t e red .
Tf the rate observed a t Dayes ( 9 J %) i s compared with the
o t b r evaluatfons made i n Africa in the course of r e t rospec t ive surveys con-
ducted at Dakar (1973) where the rate w a s 8,9 % (FEXStY, 1977) and i n Algeria
wFLere trie Tate was 6,6 % (TABUTIN, 1976) it can be noted t h a t the under-re-
g h t r a t 2 o n i s not higller than those observed i n the course of similar sur-
veys w k n agzeeihg t h a t the i n t r a u t e r i n e mor t a l i t y l e v e l is similar i n these
d5ff e r en t populations.
b) The la te f o e t a l death : since the deaths occurring i n the
f i r s t f i v e months of pregnancy ( ca l l ed abortions or spontaneous abortions)
(3) are more su5ject to omissions, we w i l l focus our analysis on t he evalua-
t i o n of the l a t e f o e t a l death which includes the whole i n t r a u t e r i n e deaths
occurring from
weeks).
the b i r t h year
the s i x t h month of pregnancy (or more p rec i se ly above 26
The evolution of the la te f o e t a l death r a t e s according t o
are as follows :
1930-1949 : 79 p e r 1,000
1950-1964 : 41 per 1,000
1965-1976 : 38 per 1,000
and shows the considerable decrease between the years previous t o 1950 and
the following ones. From the 1950's onwards, the decrease i n the la te f o e t a l
death 4s much lower,
11.2. Infan; mortal i ry .
We w i l l not deal again w i t h the evaluation of the decrease i n
i n f a n t mor t a l i t y which w a s t he subject of a de t a i l ed analysis (VI'MARD, 1981). Tliis decrease Is very high during the period under study and it a f f e c t s as
muclì the in fan t mortali'ty as the chi ld mor t a l i t y ( t a b l e no 1 ) . S t a r t i n g from
a high mor t a l i t y (1930-1949 period) , a r a t h e r l o w l e v e l as f a r as an African
region i s concerned is reached some t h i r t y years l a te r (1965-1974). (IqO decreases from 202 t o 65 p e r 1,000 and 4ql decreases from 127 t o 45 p e r 1,000).
B. TEE E'VOLTITION'IN T H E ' D 1 " R E N T STRUCTUlU3S OF INFANT MORTALITY.
After g i v h g a general d e f i n i t i o n of the decrease i n in fan t morta-
l k t y and i ' n t r au tedne mor t a l i t y , i t i s necessary t o study the evolution of
tlìe i ' n t e n a l s t ruc tu res WWCS are considered as the most re levant i n order
t o d e t e d n e tEe foundations of t h i s decrease.
E. I. Evolutlon of tIie endogenous and exogenoue causes of '1hE-t 'deaths
I. I . e n e r a l evoluti'on,.
The biometri'c analysi 's which evaluates the xespecti'e , ra tes of
(3) The ra te of spontaneous aliortions o6served (expressed by the r a t i o of tEle numlier of spontaneous aFortions t o the numEer of t o t a l pregnancies) amounts t o 5,4 % a t Dayes against 6,7 % a t Dakar and 4,5 % i n Algeria.
. . . .. . . . . . . . .
the endogenous mort a l i t y and the exogenous mort a l i t y (4) spec i f ies the
s t ruc tu re of i n fan t mor ta l i ty according t o the d i f f e ren t causes. Given
the absence of a r e l i a b l e da ta gathering about the exact causes of death,
the J. BOURGEOIS-PLCHAT l a w (1946, 1951) makes i t possible through a gra-
phic method t o evaluate the r a t e of each type of mortal i ty thus leading t o
the f o l l o w k g ï e s u l r s ( r e s u l t s which are corroborated by the measurements
conducted from the d i f f e ren t ana ly t i ca l methods put forward by R. PRGSSAT,
1969).
Endogenous mor ta l i ty :
1930-1949 : 90 pe r 1,000
1950-.1964 : 50 per 1,000
1965-7974 : 22 per 1,000
Exogenous mor ta l i ty :
1930-1949 : 112 p e r 1,000
1950-1964 : 56 p e r 1,000
1965-1974 : 43 p e r 1,000
9
Given the whole 1930-1974 period, the decrease i n the endogenous
mor ta l l ty Is equal t o rIie decrease i n the exogenous mor ta l i ty as expressed
i n aFsolute value, but it i s considerably higher as expressed i n r a t i o .
T a s d i spa r i ty Between the two pa t te rns of decrease i s pa r t i cu la r ly obvious
from 1950 onwards.
I 2 . T h e - E , a ~ t e ~ , ~ f _ d e c r ~ ~ ~ ~ The d i f f e ren t s tages i n the evolution of t he i n t e n s i t y of t h e two
great causes of i n fan t mor ta l i ty can be spec i f ied by observing the respec-
tive r a t e s calculated through the ana ly t i ca l method no 1 over shor t e r pe-
r iods of t i m e (exogenous mor ta l i ty = deaths 31 - 365 days x 1,25).
The exogenous mor ta l i ty i s always higher than the endogenous morta-
l i t y , except i n the 1960-1964 years ( tab le no 2 ) . As f a r as the comparative
evolution i s concerned, it i s necessary t o observe a decrease i n the exoge-
nous mor ta l i ty which is very rap id from 1930 t o 1965 and diminishes from
1965 onwards. On the contrary, the decrease i n the endogenous mor ta l i ty i s regular w i t h th ree levels of d i f f e ren t i n t e n s i t y and i s consis tent with the
p a t t e r n of the decrease i n infan t mortal i ty .
- 1930-1949 : 91 per 1,000
- 1950-1964 : about 50 per 1,000
- 1965-1974 : 22-23 p e r 1,000
( 4 ) It w f l l Be reca l led that the endogenous mor ta l i ty i s caused by congeni- t a l mal torqat ibns and tmamuat5sm.s i'n tFre m o c e s e of TYi?rtB and t B a t tlire exogenous mmtali'ty 2% caused by environmental f a c t m a (i'nfecti!on, df- sease acci%ent) .
- 7 -
There are, indeed, two d i f f e ren t s tages i n the evolution of i n f a n t
mor ta l i ty : i n the f i r s t s tage (1930-1964), the decrease i n the exogenous
and endogenous components i s high (especial ly as f a r as the exogenous causes
are concerned) ; i n the second s tage (1965-1974), the decrease i n the exoge-
nous mor ta l i ty i s abating, while the decrease i n the endogenous mortal i ty
continues and i s gaining momentum.
So, the decrease i n in fan t mortal i ty a t Dayes s ince 1930 went along . ~
f i r s t with an increase i n the endogenous mor ta l i ty r a t e as compared with the
t o t a l mor ta l i ty rate from 45 (1930-1949) t o 48 (1950-1964) and with a consi-
derable decrease in the same endogenous mor ta l i ty r a t e which amounts to 35 %
a t the end of the period under study (1965-1974).
A comparison between the s t ruc tu re of the deaths a t Dayes and t h i s
prevai l ing i n s imi l a r countries or regions s i t ua t ed mainly i n Africa (VIMARD,
1980) makes it possible t o define more prec ise ly the character of the evolu-
t i o n i n the s t ruc tu re of the infan t mor ta l i ty on the plateau and t o reveal ~
th ree main cha rac t e r i s t i c s " ( t a b l e no 3) :
.
- the absence of exoggsous excewg-mortality a t Day25 whatever the
rnfant mor ta l i ty l eve l may be. This information seems t o be qui te t yp ica l of
the Dayes p la teau Because a high in fan t mor ta l i ty most of ten goes along with
an exogenous excess mor ta l i ty from the t h i r d or s i x t h month, as i s the case
espec ia l ly a t N?akliar and PaosS-Koto i n Senegal (CANTRELLE, 1969) and i n
Algeri'a CTABlJTIX, 1976) ; only the Adamaoua region i n the Cameroons shows
t h b same clïazacterEst2c (PODLEWSKI, 1970) . - A 1 . w e r , e . a R e n . U s - ~ ~ ~ t ~ ~ ~ ~ ~ - ~ ~ ~ ~ - ~ ~ ~ - ~ ~ ~ ~ ~ ~ ~ ~ Y - ~ ~ ~ ~ ~ - ~ ~ - ~ ~ ~ ~ -
--- lar . Tus charac te r5s t ic does not r e s u l t only from the absence of excess
mortali'ty ; as a m a t t e r of €act, the exogenous mor ta l i ty and t o t a l i n fan t
mortality r a t e s can Be evaluated i n the absence of excess mor ta l i ty respec-
t i v e l y a t :
75 pe r 1,000 and 104 per 17,000 f o r Algeria (1966-68)
46: per 2,000 and 11.1 per 7,000 f o r Niäkhar (1963-65)
65- p e r 1,000 and 98 per 1,000 f o r Paos-Koto (1963-65)
Gi?yen h f a n t mor ta l i ty r a t e s similar t o those prevai l ing i n t b 1104%96:4 p e r h d a t Dayes, a MgFier exogenous mor ta l i ty is observed.
TEerefore, tlie low exogenous mor ta l i ty seems t o be a bas ic struc-
tural element of tFie in fan t mor ta l i ty on the Dayes plateau, whatever the
- . _ _
- 8 -
period under study and the i n t e n s i t y of t h i s mor t a l i t y may be. This s t ruc-
t u r a l information must be r e l a t e d t o the f a c t t h a t t he climate a t Dayes i s ,
as compared with those of o the r African regions, r a t h e r favourable t o a
more l imited exogenous mor t a l i t y r e s u l t i n g from the r a t h e r minor environmen-
t a l cons t r a in t s ( c l ima t i c conditions a re not very severe and the maximum
temperatures or r a i n f a l l s are less pronounced than i n other zones).
- A - ~ _ e _ r - ~ ~ g k e ~ ~ ~ g ~ n _ o _ u - m o r r a ~ ~ ~ ~ - ~ ~ ~ ~ - ~ ~ ~ a n y - ~ ~ ~ ~ a l ~ ~ ~ , i s _ h _ ~ g h :
i f a comparison i s made between the r a t e s p reva i l i ng a t Dayes up t o 1964 and
those prevai l ing i n regions where they a r e of the same magnitude (more than
I00 p e r 1,000 as f a r as IqO i s concerned), it i s observed t h a t , given the
same i n f a n t mor t a l i t y level, the endogenous mor t a l i t y r a t e s are considerably
higher at Dayes. When the i n f a n t mor t a l i t y i s decreasing on the plateau, t h i s
trend i s reversed and given the same mor ta l i t y level, t he endogenous mortali-
ty rate Gecomes sindlar a t Dayes t o those p reva i l i ng in the other regions.
It is oBserved through these comparisons t h a t the rapid and
continuous decrease i n the endogenous mor t a l i t y seems t o r e s u l t from i t s
p a r t i c u l a r l y high i n t e n s i t y a t t he beginning of the period under study. This
decrease i s only a r e c t i f i c a t i o n of the unusual s t r u c t u r e of the i n f a n t mor- *
t a l i t y a t Dayes from 1930 t o 1964 when the endogenous mor t a l i t y i s almost
as si’gnif i c a n t as tFLe exogenous mortal i ty .
A s a conclusion t o t h i s chapter about t he biometric analysis
of the i h f a n t mortality, i‘t must be observed that the death d i s t r i b u t i o n
va r i e s l a rge ly with the regions, Within a group with a similar mor t a l i t y
level, the percentage of tFLe endogenous mor t a l i t y varies s i g n i f i c a n t l y :
from 17 t o 61 % fn gToup A (low i n f a n t mortadzty)
from 17’ t o 48 Z ih group E (mean l’nfant mortal i ty)
from 1 4 t o 4 5 % 2n group C (MgE infant mor t a l i t y )
Despite tus heterogeneity within each group, i t i s ohserved
tEat tEe lower the infant mor t a l i t y level, tfie higher the endogenous morta-
li‘ty r a t e ; t’de m e a n percentages mount respect ively t o 25,4 f o r group C
t o 30,7 f o r group B t o 37,7 f o r gToup A.
TBese d a t a c o m o b r a t e the already establ ished f a c t about the
Fi5,gh’e.r inf luence exerted E2y t f re Piealth pcrogress on the exogenous mor t a l i t y
(P%E”A’II, :193B$. TEe medFcizle and the Kealth s i tmcture are more s u i t e d t o
Trave an ihf luence on tEe external causes of deatfi. Howeve.r, the s p e c i f i c
case of tEe Bayes p l a t eau undeni’ab’ly shows that t h e i r h f l u e n c e s on the
endogenous causes a r e r e a l and tBat the general improvement i n the h e a l t h
. .. - . . . . - .. . . . -. . . . . . . .. . -
- 9 -
l eve l of the population a t Dayes which allows t o make progress i n the endogenous
mortali ty. i s p a r t i c u l a r l y pronounced.
B. II. Pe r ina t a l mortal i ty .
Among the d i f f e r e n t de f in i t i ons of the p e r i n a t a l mor t a l i t y which can
be put forward (CANTRELLE, 1969) , we w i l l consider t he most usual one which
defines the p e r i n a t a l mortal i ty as the t o t a l of the l a te f o e t a l death and the
endogenous mor t a l i t y ; t h i s formula seems t o be the most l o g i c a l i n s o f a r as the
causes of the l a t e f o e t a l death can be r e l a t e d t o those which cause the endoge-
nous mortal i ty .
S t a r t i ng from the respect ive l a t e f o e t a l death r a t e s (§ A.II.1) and
endogenous mor t a l i t y rates ( t a b l e no Z), i t i s possible t o determine l a t e foe-
t a l death t ab le s f o r each period under study and t o analyse t h e i r evolution sin-
ce 1930. The parameters used i n the t a b l e a r e the r a t e s (qx p e r 1,000) which
a re applied successively t o 1000 pregnancies a t t h e i r s i x t h month of ges t a t ion
These t ab le s ( t ab le no 4) a l l o w us t o get f o r each period the number
of chi ldren surviving the p e r i n a t a l mortal i ty and the p e r i n a t a l mor t a l i t y r a t e
which represents the r i s k of "death" (through t h e l a t e f o e t a l death o r the en-
dogenous mor t a l i t y ) . The r e s u l t s are as follows :
1930-1949 : surviving chi ldren (pe r I,OOO) : 837 ; r a t e (per 1,000) : 163
1950-1964 :
1965-1974 :
,
I 1 I l I I 11 : 910 ; I' : 90 I I I I : 940 ; I r : 60 I t II
say a decrease by 102 pe r 7,000 over the whole per iod, which represents 63 % of
the ea r ly p e r i n a t a l mor t a l i t y : with a decrease of the l a t e f o e t a l death by
52 % and of the endogenous mor t a l i t y by 75 2. Apar t from t h i s v a r i a t i o n i n
the i n t e n s i t y of tlie decrease, i t i s possible t o add the difference i n the du-
r a t i o n of the decrease of these two components : the l a t e f o e t a l death reaches
a bottom l i n e as f a r back as the 1950-1959 period, and it i s necessary t o w a i t
f o r 1965 i n order t o oljseme a s t a b i l i t y in the endogenous mor t a l i t y . This d i f -
ference shows t h a t t he progress i n the p e r i n a t a l mor t a l i t y concern more the
deatlis occurring a f t e r the b i r t h than those occurring between the s i x t h and
tfie n in th month of ges t a t ion (up t o 1964, the endogenous mor t a l i t y i s higher
tfian mor t a l i t y , t h i s trend i s reversed from 1965 onwards.)
TFiis d l f ference r e s u l t s from the f a c t t h a t t he hea l th e f f o r t s which
are made i n the dlspensar ies i n order t o Improve che conditions of confinement
and decrease tlie number of deaths from tramatisms i n the process of b i r t h a r e
a complement t o the decrease i n the s t r i c t l y endogenous deaths (which a re due
t o a malformatlon of tlie foetus l i k e l y t o cause death before or a f t e r the con-
.- .
- 10 -
finement). These progress r e s u l t mainly from a general improvement i n the
hea l th of t he f e r t i l e population.
Supposing a decrease i n the " s t r i c t l y endogenous mortali ty" which
w i l l be equal on both s ides of the b i r t h , i t is possible t o evaluate the
influence of the progress i n confinements. The decrease i n the l a t e f o e t a l
death a f f e c t s only the deaths from malformations : i t i s equal eo q (1930-
1949) - q, (1965-1974), say 41 pe r 1,000, while t he decrease i n the endoge-
nous mor t a l i t y which i s calculated i n the same way amounts t o 68 p e r 1,000.
The decrease i n the deaths which r e s u l t s from t h e improvement i n the con-
d i t i o n s of confinement would be equal t o the d i f f e rence between the decrease
i n the t o t a l endogenous mor t a l i t y and the decrease i n the l a t e f o e t a l death,
say 27 pe r 1,000. It represents more than 25 % (26,5 % exactly) of the ge-
neTa1 decrease i n the p e r i n a t a l mor t a l i t y .
X
I f the same method Is used i n order t o evaluate the improvement
i n tۓe conditions of confinement from one period t o the o the r , it can be
oljserved t h a t it i s maximum i n the 1960's when the late foe ta f death i s s t a t iona ry , which shows the d i f f e r e n t character of these two causes of
death i n the p e r i n a t a l period.
B.111. TBe, cAiId excess mortaIì ty8
According t o the J. BOURGEOIS-PICHAT s c a l e , the death d i s t r i -
k t i ' o n r evea l s a clìild excess mortality (f igure no I ) which concerns the
25-60 aonths f n t e r v a l f o r the 1930-1949 years and the whole ch i ld period
(23-60 months i 'n tewal) f o r tlìe following years.
A grapfiic adjustment makes i t possible t o measure the impact
of tWs chi'ld excess mor t a l i t y : By extending the alignment of points 1 and
12, we g e t the in fan t mor t a l i t y Tate a t 60 months without any ch i ld excess
mortali ' ty, and tlie comparison w2th tlie i n f a n t mor t a l i t y observed ( f igu res
in lìrackets) gives us tlie ch i ld excess mor t a l i t y l e v e l of each period f o r
7000 live Eìirtfis.
ls13O-Is149 : 278 (303) cli2ld excess mor t a l i t y : 25
1950-19S9 : -153 (387) chi'ld excess mor t a l i t y : 34
: 25 19-60-3964 : 128 (153) I'
: 20 1%5~3!XQ : 93 (1733 "
: 14 1930-:1a74 : 88 (-1023 "
19 Il
11 u
u 11
TBe cYdld excese mortali'ty f k r s t i 'ncreases , t k n i t decreases considerably
from tRe 746-0's. TB2S decli'ne o c c w s only i n the second s t age of t he de-
I-.... . -
.. . . .
- 11 -
crease i n the in fan t mortal i ty .
This decrease i n the chi ld excess mor t a l i t y r a t e i n terms of
absolute value does not go along with a decrease of i t s s ignif icance as p a r t
of the in fan t and ch i ld mortal i ty . The d i f f e r e n t r a t i o s of the ch i ld excess
mor t a l i t y r a t e t o the in fan t mor t a l i t y rate and the ch i ld excess mor t a l i t y
r a t e to the ch i ld excess mor t a l i t y r a t e give the following respect ive per-
centages :
1930-3949 : 8 and 25 %
1950-1959 : 18 and 40 %
1960-1964 : 16 and 42 %
1965-1969 : 18 and 41 2 3970-1974 : 14 and 33 %
The evolution of these r a t i o s which evaluate the percentage of
t’rie cliild excess mortal i ty i n the general i n f a n t and ch i ld mor t a l i t y i s d i f -
f e r e n t fTom t h i s of tHe i n t e n s i t i e s , but the general trends a re i d e n t i c a l .
F i r s t of a l l , wlien the mor t a l i t y i s high (1930-1949), t he chi ld excess mor-
t a l i t y i s lower. From the moment when the general mortal i ty decreases, the
percentage of the excess mortal i ty increases and becomes s t a b l e i n a f i r s t
period (1950-7969) and the percentage of the ch i ld excess mortal i ty decrea-
ses only i n a second period clìaracterized by the decrease i n the general
mor t a l i t y wtthout, however, reaching the lower l e v e l prevai l ing a t the be-
ginning of the observation ; as f a r as the l as t period (1970-74) i s concer-
ned, the excess mor t a l i t y level is s t i l l high, thus representing 1/3 of
tfie general cMld mortal i ty .
111.2. Cfiazacter of the chi ld excess mor t a l i t y
TKe previous developments which emphasized t h e chi ld excess
..
molrtal i ’ tymst lie speci‘fred 6y two major c h a r a c t e r i s t i c s which define the
real csazacter of t’iii’s excess mortal i ty .
a) A r e l a t i v e excess mor t a l i t y . During the whole period under
study, the ch i ld mor t a l i t y r a t e i s lower than the in fan t mor t a l i t y r a t e and
the deaths occurring between 1 and 4 years represent only 55 t o 70 % of the
deatfis ia the f i r s t year of l i f e . In terms of absolute value, the c h i l d ex-
cess mor t a l i t y does not e x i s t , it appears only i f the J. Bourgeois Pichat
s c a l e based on the hypothesis of a continuous and s t a b l e decrease i n the in-
t e n s i t y of mortal i ty i s used. ‘Moreover, a s e r i e s of da t a had allowed t o
transform t h i s hypothesis i n t o a l a w as f a r as in fan t mor t a l i t y i s concer-
ned.
d
- 12 -
Fina l ly , ch i ld mor t a l i t y i s not higher, than i n f a n t mortal i ty
(unlike what could be observed i n some African countries : CANTRELLE, 1980)
Eut the decl ine i n the i n t e n s i t y of mortal i ty i s lower i n the ch i ld period
and t h e excess. mor t a l i t y between I and 4 years can be revealed only by
comparing the decreasing funct ion of ch i ld deaths with t h i s of i n f a n t
deaths o
b) A continuous excess mor t a l i t y . A second notion corrobora- ............................ tes t h i s t h e s i s : "the ch i ld excess mortali ty" concerns the whole period
from 1 t o 4 years and the functions of the s t r a i g h t l i n e s of ch i ld morta-
l i t y which a re defined by the J. Bourgeois-Pichat s ca l e are constant. The
excess mor t a l i t y i s not t y p i c a l of a p a r t i c u l a r moment i n the ch i ld period
and does not seem t o be caused by s p e c i f i c events occurring i n a w e l l def i -
ned period, but i t i s considered more as a permanent element.
Once c e r t a i n s t r u c t u r e s i n i n f a n t mor t a l i t y a r e defined and
the d is t r i l iu t ion of the g rea t causes of death i s spec i f i ed , i t is possible
to begin analysing the independent determinants of t h i s mortal i ty .
C. THE INDEPENDENT DETERMINANTS OF INFANT MORTALITY.
I f the mor t a l i t y Is determined d i r e c t l y by the pathological fac-
t o r s (heal th of the i n f a n t , causes of death) which represent tlìe so-called
intermediate va r i ab le s , other f a c t o r s have a l e s s d i r e c t influence. They
are ca l l ed "independent var iables" i n t h a t they do not inf luence mor t a l i t y
by themselves But ratlier through lJ intemediate" va r i ab le s .
mese lndependent determinants a r e :
- on the one Band, tEe physical environment along w i t h i t s e f f e c t s on
d b e a s e s
- on tlie o the r hand, the human environment and i t s socio-cultural and econo-
mic f ac to r s .
C. I. TEe physica1 environment.
7Eie climate i s the physical element: which has the g rea t e s t e f f e c t s
on mor t a l i t y : it i s determined by the major geographical da t a (longitude,
lati ' tude and a l t i t u d e ) and s u f f e r s long t e m modiEications through the hu-
m a n tntervent ion. It is no t a matter of dealing w i t h t he ac t ion of t he phy-
&cal environment on the evolution of the in fan t mor t a l i t y ; since the re-
gron d?d no t s u f f e r any Basic and sudden c l ima t i c change (such as was t h e
case for tEe S a h e l as a r e s u l t of the drought). The c l ima t i c act ion i s By
na tu re a permanent element whose consequences only can change with the evo-
. . . .
- 13 -
l u t i o n of some intermediate var iables such as the feeding of the mother
and the i n f a n t , the hea l th follow up and s a n i t a t i o n . It i s only possible
t o sum up the main conclusions about the study of the seasonal va r i a t ions
i n the in fan t mor t a l i t y (VIMARD, 1980) ; with respect t o the neonatal mor-
t a l i t y where the endogenous causes of death a r e predominant, the climate i s
not a d i r e c t determinant of mor t a l i t y , but r a t h e r an element which can s t a r t
or increase the act ion of a f i r s t and most o f t en endogenous f a c t o r . Once
these differences a r e mentioned, i t i s possible t o observe the s l i g h t excess
neonatal mor t a l i t y i n the w a r m season, while the months with low temperatu-
res are characterized by a l e s s e r mor t a l i t y .
TJitli respect t o i n fan t mortal i ty which i s mainly exogenous a f t e r
the f i r s t month of l i f e , the impact of the external cons t r a in t s which a re
represented by tIie c l imat ic var iables i s more pronounced. An excess morta-
l i t y wfiich i s r e l a t e d t o tIie increase i n the r a i n f a l l s and the decrease i n
temperatures i s observed (tempeTatures which, given the high a l t i tude, can
Be p a r t i c u l a r l y low ; the lowest mean i n August amounts t o 21'6 with tempe-
r a tu re s l i k e l y t o reach 16" a t night .
c.11. 1:
accordi'ng t o tfie et'finic group and t h e l o c a l i z a t i o n of the place of
residence.
The lnfluence o€ the human environment i s characterized by the
emergence of a dìfferent i 'a l mor t a l i t y r e l a t e d t o the d i f f e r e n t characte-
cr is t ic vaT2aEle.s of tes envi'ronment ; whether they a re s o c i a l (e thnic
gToup, educati") o r economic ( a c t i v i t y , s t a t u s ) ; i n f a c t , these varia-
Eles aTe o f t en correlated.
In tRe e s s e n t l a l l y r u r a l population of the Dayes plateau, the
f a c t o m wfii.ch seem t o Be ttìe most re levant ?n order t o determine the d i f -
f e r e n t types o€ tlie Iìman environment a r e represented by the "ethnic group"
and tRe " local izat ion of t he place of residence" va r i ab le s . While both va-
r5aBles aTe closely r e l a t e d , i t i s advisable not t o separate them and t o
s tudy tBem j o i n t l y .
Tfie t h e e f o l l o w h g groups are numerous enough t o be analysed :
- tlìe Ewe wlio aTe l h i ' n g i'n the v i l l a g e
- tlìe Ewe WBO acre local ized i'n tfie farms - and tFie &Eye wBo a r e s i t u a t e d i n tlie farms.
They allow t o make a double compari'son :
- Getween two types of residence occupied by the same e thn ic group ( the Ewe)
- Between two etlini'c groups l i v ing i n the same type of residence ( the farms).
.. . - . . . . . _ _ " " - . . . . - _ .. J
- 14 -
They are a l l the more v a l i d f o r the analysis as they include, i n addi t ion
t o t h e i r own c r i t e r i o n of d i s t i n c t i o n , o the r differences i n :
- the o r i g i n : autochthonous/allochthonous ( d i s t i n c t i o n between the Ewe
and the Kabye) ;
- the economic s t a t u s : landowner/sharecropper ( d i s t i n c t i o n between the
v i l l a g e s and the f a m s ) ;
- tlie education : high school attendance/low school attendance ( d i s t i n c t i o n
Between the Ewe and tlie KaGye).
The in fan t mor t a l i t y and the ch i ld mortal i ty which reveal d i f f e r e n t
l eve l s of d i s t i n c t i o n between the groups w i l l be s tudied successively i n
order t o measure the differences . 11.1. (tab1e.n' 5)
a) Tlie difference between the two Ewe groups i s low and i s li- mi'ted t o the mor t a l i t y of the f i r s t qua r t e r , while i t i s higher i n the Ewe
WRO are liv-lng In tlìe farms.
b) The difference between the Ewe and the Kabye groups who are
l i v i n g i n the farms i s more important ; but it occurs only from the second
month of l i f e , -wh ibe the neonatal mor t a l i t y i s similar. The difference bet-
ween both groups i s m a x i m - i n t he case of the mor t a l i t y between 1 and 5 months
- and e spec ia l ly i n the case of t he mortal i ty
occurring i n the f o u r t h qua r t e r when the mortal i ty r a t e ia the Kabye i s
higher than t h i s of the t h i r d qua r t e r , unlike the s i t u a t i o n prevai l ing i n
tlìe whole population.
The infant mor t a l i t y which i s higher i n the Kabye goes along
with an excess mor t a l i t y i n t h e second half-year. This excess mortal i ty
corroborates what can be observed i n a biometric analysis conducted accor-
ding t o tlie groups. me endogenous and exogenous r a t e s (pe r 1,000) amount
respect ively t o :
33 and 28 f o r the Ewe i n the v i l l a g e
36 and 37 f o r the Ewe i n the farm
27 and 81 f o r the Kabye i n the farm.
11.2. TEie d i f f e ren t i a l - sg i ld mor t a l i t y ( t a b l e no 6)
The differences wlìich were observed i n the i n f a n t mortal i ty a re
found i'n the c h i l d mortall ' ty i'n a less pronounced form'.
TTie clìild mor t a l i t y (4ql) which does not g e t the same value cor-
responds t o differences wlìich vary with the r a t i o selected:
- lql i s characterized by an opposition between the Ewe and the Kabye which
extends i n t o the 9-11 months qua r t e r ly r a t i o ,
- on the contrary, 2q2 and 1q4 are characterized by a d i s t i n c t i o n between
the v i l l a g e and the farm.
The Ewe who are l i v ing i n the farms g e t an in fan t mor t a l i t y c lose
t o t h i s of the Ewe who are l i v ing i n the v i l l a g e up t o the 24th month ( i t
i s the e thn ic element which prevai ls) ; from the second birthday, the "loca-
l i za t ion" element p reva i l s and the mor t a l i t y of the Ewe i n the farms can be
r e l a t ed t o t h i s of the Kabye.
This modification concerning the Ewe who are l i v i n g i n the
farms can be accounted f o r by a decrease i n the care given t o the o lde r
children (two years and more) which i s no longer the same from a therapeu-
t i c a l point of view f o r they are considered off the danger l i s t . This hy-
pothesis which must be checked could be the reason f o r the r a t h e r higher
mor t a l i t y from the second birthday as compared with the r a t e s prevai l ing
In the previous ages.
11.3. Variations i n the in fan t mor t a l i i y l eve l s .
The va r i a t ions i n the i n f a n t mor t a l i t y i n the group under study
show the existence o f three periods :
- the neonatal period ( f i r s t month) whenc mortal i ty i s highly influenced by
the endogenous f a c t o r s and the l eve l s are similar.
- t he period from 2 t o 24 months when mor ta l i t y i s lower i n the Ewe.
- t he period f r o m the 25th month wben mor ta l i t y is lower i n the v i l l a g e than
i n the farms.
A t the end of the period, a t t he 5 th birthday, the in fan t morta-
l i t y l e v e l i s diffeTent from one group t o the other : the respect ive values
f o r 5qO ( f o r the 1961-1970 period) are respect ively 99 p e r 1,000 f o r t he
Ewe i n the v i l l a g e , 123 p e r 1,000 f o r the Ewe i n the farm and 176 p e r 1,000
f o r the KaEye i n the farm.
The e thn ic group/localization va r i ab le s which i n f a c t include
some socio-economic f ac to r s prove t o be closely r e l a t e d t o the mor t a l i t y
l e v e l .
n a n t s of m o r t a l h p and tEat i\t i's ikdependent of tFte endogenous causes of
deatfi.
). . - I 6 -
Since the groups are s i t u a t e d i n the same physical environment,
i t i s possible t o suppose t h a t they s u f f e r s i m i l a r external cons t r a in t s
and must withstand the same kinds of disease. So the difference i n mortali-
t y would r e s u l t more from the d i f f e r e n t conditions of r e s i s t ance t o disease
than t o morbidity i t s e l f .
Apart from the endogenous f a c t o r s which do not have any influen-
ce here , the r e s i s t i n g a b i l i t y of t h e groups seems t o be defined by fou r
major data :
- the n u t r i t i o n
- the environment (place of residence, clothing)
- the h e a l t h conditions
- the c u l t u r a l environment.
a) Tfie n u t r i t i o n : i n their na t ive region-, the Kabye got a Su-
danese d i e t which was i n s u f f i c l e n t and caused a deficiency i n c a l o r i e s and
p ro t ides , while t he Ewe got a Guinean d i e t which was characterized by a sa-
t i 'sfactory c a l o r i e intake and an unquestionable deficiency i n prot ides . Sin-
ce the emigration of the Kafiye, t h e d i e t s of the two e thn ic groups a t Dayes
a r e less d i f f e r e n t and are now based on an almost equal supply of s tarchy
food (yam, manioc) and cereals ( r i c e , maize) (PERISSE, s .d . ) .
This absence of d h t i n c t i o n i n the food d i e t Js combined with
an equivalent food equiliErium. In t h i s respect , point observations which
cannot be calculated would give the impression of a g r e a t e r a v a i l a b i l i t y
of food products in the groups l i v i n g i n the farms, whether they are Kabye
o r Ewe (:tYie percentage o f tۓe laEiour fo rce i s higher there and the food
p l o t a acre morre numerous.).
A s far as tke chi'ldcren's d i e t i s concerned, i t i s necessary t o
cons$deT tFte dmati'ons of Breastfeeding and the conditions of weaning. The
average age a t tRe Geginnihg of the weaning ( t h a t i s t o say a t t he moment
wkkn a supplemental food, pap andlor s o l i d food is combined with breast-
feedihg) vari'es accordi'ng t o t H e groups amounting t o 6,5 months f o r t he
Ewe id tEe vi'llage, 4,7 montlìs f o r the Ewe i n the farm and 5,6 months f o r
tF& Rawe i!n th'e farm. ?!Fie weanihg begins e a r l i e r i n the farms, which can
?Ye t b expresslton of a Ge t t e r way of feeding ; t he d i s t i n c t i o n i s particu-
l a r l y oE'vi'ous ia tfie Ewe, wFdle the KaEye ge t an i n t e m e d i a t e behaviour.
As. f o r tFre t o t a l d-uratlton of Breastfeeding, i t i s almost s i m i l a r f o r t he
Ewe id t R e vi 'llage (11$,4 mont%) and tlïe Ewe i n the fanu (19,6 months)
and Ft 2s. 1onge.r f o r t R e KaBye i n the farm (22,8 months).
rn tFie ligfit of the r e l a t i o n s e x i s t i n g between the in fan t mor-
tali ' ty and tl3a weaning p a t t e m s (-, 1980), it seems t h a t t he d i f f e -
I ' - 17 -
rences i n the age at the beginning of the mixed d i e t and i n the t o t a l dura-
t i o n of breastfeeding cannot account f o r t he va r i a t ions in the i n f a n t mor-
t a l i t y of t he d i f f e r e n t groups, as a matter of f a c t , the only s i t u a t i o n
which can be revealed shows an in fan t death occurring i n the months fo l lo -
wing an e a r l y weaning ( a t 4 months or before) ; which a f f e c t s more the
Ewe i n the farm than the Kabye, while t h e i r i n fan t mor t a l i t y i s lower.
These whole da t a about the d i e t show t h a t t he important varia- t i o n i n the i n f a n t mor t a l i t y cannot be accounted f o r by the "nutr i t ion"
va r i ab le .
b) The immediate envirorgszt : no bas i c d i s t i n c t i o n can be ob-
served the re ; only the place of residence can be considered more impoveris-
hed i n the farms without, however, causing differences i n the f i g h t against
disease.
c) The h e a l t h conditigzg : the Dayes plateau g e t s seven dispen-
saries (set up from 7942 t o 1970) which operate with a t l e a s t one male nur-
se and a t r a ined mldwife and three pharmaceutic storages created from 1968
t o 1970. Moreover, a male nurse or a midwife are avai lable i n some v i l l a -
ges. There a r e 1 dispensary f o r 4000 persons and 1 pharmaceutic s torage
f o r 9000
zone. With respect t o the hea l th i n f r a s t r u c t u r e , the main c h a r a c t e r i s t i c
seems t o be the more regular use of t he dispensaries by the Ewe. The d i f f e -
rence i n behaviour i s obvious as f a r as the place of confinement i s concer-
ned (wbicEi deterrm'nes By i ts nature the a s s i s t ance t o the child-birth) :
f o r tke most Tecent peTi'od, the frequency of confinements i n the dispensa-
ri'es (wMch leads to tےe ass2stance of a t r a ined midwife) amounts t o 95 %
for tfie Ewe 2n tke v l l l a g e , 6 4 - % f o r the Ewe i n the farm and only 8 % f o r t he
Kafiye l n tFLe f a m ; moTeoveT, the e thn ic c r i t e r i o n proves t o
.mihant of tRe spTead of the p rac t i ce of the confinements i n the dispensary
wl35cR s t a r t e d before 1960 and became usual i n the autochthonous e thn ic
gToups ih the 19.60's, tFLe f a c t of l i v i n g i n the v i l l a g e contributes t o the
persons, which seems t o be q u i t e remarkable f o r an African r u r a l
be the deter-
spread of tfii's
In
w5tEil a gTeater
tihe vi'si'ts t o
l'ri tFie medi'cal
d) concerned , tlie
- .
type of confinement.
tlie Ewe, tbese Getter conditions of confinement a r e combined
Realtlì follow-up i n the infancy which r e s u l t s both i n rou-
tlìe dispensazy i n the f i r s t months of the in fan t l i f e and
attendance i n case of disease.
TRe. "ggltural" en,ironment. As f a r as school attendance i s
d?spar?ty Getween the autochthonous e thn ic groups and the
KaBye 2s. parti 'cularly Bigli (QUESNEL e t VLMARD, 1481). A considerably high
,
" 1 . - 18 -
percentage of i l l i t e r a t e can be observed i n the Kabye population over 6
years amounting t o 59 % aga ins t only 10 % i n the Ahlon and 17 % i n the Ewe ;
the d i s p a r i t y i s similar i n the female group (81 % f o r the Kabye, 47 % f o r
the Ewe and 32 % f o r the Ahlon). If w e consider the child-be'aring women inII
t he groups mentioned i n t h i s chapter, the percentages of i l l i t e r a t e women
are respect ively 50 % f o r the Ewe i n the v i l l a g e , 60 % f o r t he Ewe i n the
farm and 93 % f o r t he Kabye i n the farm. The higher education i n the Ewe
r e s u l t s i n a b e t t e r knowledge of the hea l th p r inc ip l e s and a g rea t e r aware-
ness of the problems about the hea l th of the mother and the in fan t which
are the subject of campaigns conducted on the r ad io , i n t he newspapers and
i n the hea l th centres.
e) These f a c t s show t h a t t he Ewe can f i g h t aga ins t t h e patho- gens more e f f i c i e n t l y than the KaGye. These differences which can favour
a l e s s e r mor t a l i t y , depend d i r e c t l y on t he s o c i a l d i s t i n c t i o n between the
groups : tfie e thn ic group i d g r a a - f r o m a region d e f i c i e n t i n the school
and hea l th i n f r a s t r u c t u r e gets a lower education and i s not accustomed to
going t o the dispensar ies . This las t c h a r a c t e r i s t i c i s increased by the
dis tance of the place of residence which r e s u l t s d i r e c t l y from t h e i r s o c i a l
s t a t u s of sharecropper ; moreover, t h i s dis tance, without being a deciding
f a c t o r , Is a complement t o an already unfavourable s i t u a t i o n .
CONCLJJS TON
T k a n a l y s h of tke evolution i n the s t ruc tu res which are consi-
dered relevant enougR t o defi'ne tEie components of the decrease i n in fan t
mortali ' tymade i't poss?Ele t o Ge t t e r discern the structural changes which
appeared along wi'th tlds decrease i n the intensl ' ty of i n f a n t mor t a l i t y .
YurtBennore, tlie analysis of some Independent va r i ab le s of mor t a l i t y a l lo -
wed t o get a b-etter approach t o the most decis ive s o c i a l f a c t o r s concerning
tR2s decrease.
A s f a r as tBe permanent s t r u c t u r e s of i n f a n t mor t a l i t y a re concer-
ned, tBe two m a j o r da t a a r e tlìe absence of i n f a n t excess mor t a l i t y and the
f a c t tBat tBe decrease l'n t R e Entensity of mor t a l i t y is lower in the ch i ld
peTi'od (1-4 years) tt'ian i'n the i n f a n t period (O y e a r ) * As f o r the evolution,
i't can '$e c b r a c t e r k z e d mainly %y the higher decrease i n the endogenous mor-
tali'ty a s compared w i t h t he l a t e f o e t a l death and the 'exogenous mor t a l i t y
on tEe one Fiand and on the otlìez: ha&, By the more s i g n i f i c a n t decrease i n i n f a n t moTtali'ty tlîan ih c-ld mortality.
L
P - - -u
- 19 -
The most d i s t i n c t v a r i a t i o n i n mortal i ty as influenced by the hu-
man environment l i e s i n the d i s p a r i t y between the Ewe and the Kabye, t he
l a t t e r being characterized by a hcgher i n f a n t mor t a l i t y . This d i s t i n c t i o n
which applies only t o the exogenous mortal i ty shows the s ignif icance of
the var iables "school attendance" and "health care and education" which
f i n a l l y r e f e r t o the c u l t u r a l , s o c i a l and economic conditions , thus making
i t easy f o r t he Ewe only t o have access t o the hea l th and school i n f r a s t ruc -
t u r e .
On the whole, the decrease i n the in fan t mortal i ty shows the grea-
t e r care given t o chi ldren i n a society where they a re no longer only a
p o t e n t i a l labour fo rce i n the a g r i c u l t u r a l f i e l d but a l so , and e spec ia l ly
i n t h e case of the autochthonous e thn ic groups , t he fu tu re agents of a fa-
mily r ise i n the s o c i a l scale through educational f a c i l i t i e s which w i l l
make it possible f o r them t o e n t e r the bureaucracy whether i t i s publ ic or
pr iva t e . The synergy i n the hea l th and school progress and i n the change
of tBe s o c i a l Gelìaviour of the ch i ld i s fundamental t o the decrease i n in-
f a n t mortal i ty .
- 20 -
Table no 1 : Evolution of infant mortal i ty
' Table no 2 : Evolution of the endogenous and exogenous mortal i ty
- 21 - Table no 3 Comparative data. about the biometric structure o f infant mortality
[ Zone and date of observation :Nortality: Type o f : Rate per 1 .O00 : $ of the :level : excess :- - : -- : - : endogenous )
:mortality: endogenous: exogenous: $otal:mortality ) : in the ) :genera ) : mortdLity ) : rate
I
[
I
( ( (
1 1 i
1 1
I
1 i
-'---I-----------: ---: ----: :----:-----:---
---I---: -- : ----: ----: -1-_1_- : _I_: -1-w
-----------I----: ----: -:--u:--:-:---
-------_I__----_.---: ---: ----: - -:---:--:---I---
Dayes : 1965-74 : A : O : 23 : 42 : 6 5 : 35
Dakar (Sé&gal): 1960-64. (1) : A : ? : 10 : 50 : 60 : 17
Dakar (Sénégal): 1965-69 (1) : A : ? : 14 : 43 : 57 : 25
a-----
1 1 (---------u----- -: ---- :----:---. *--:---:--
(
(--- -----:- ':I---:---:---:--:--
(--
(1__-1---- --: :--o-:- :---.--:--cl-:
(2): A : O : 13 : 23 : 3 6 : 36 )
I ( France : 1953-55 .
( Quebec (Canada) : 1960 (3) : A : O : 17 : 16 : 33 : 52
[ Toscane (Italie): 1951-53 (3) : A : O : 25 : 16 : 41 : 61
( Dayes : 195044 : B : O : 51 : 55 :lo6 : 48 )
( Algérie : 1968 ( 4 ) : B : I : 29 : 98 :lr/ : 23
---I__ :u--: ----: --I---: c-:
-u__----- -: : --- : ---I_ : - : --- : -I )
* c ----Y---.--: :--I : ----- : _I_ : -----
Cameroun occidental:1965 ( 5 ) : B : I : 45 : 93 :138 : 33 )
( Ui : 1960-61 (5) : B : II : 52 : 89 :141 : 37 ) 1 )
------I- -: :- :----:---u---:-: ---- :--I-: --: -: PI_
I
[---- Paos-Koto (S&&al):1963-65(6) : B : I : 33 : 96 :129 : 26
Ipogo 196041 (5) : B : I : 22 : 105 :127 : 17 : --I : e--- -: -: --
-: :----.o:--:--
--u: -: :---u:-
i--- I
: c : o : 91 : 111 :202 : 45 1 )
1
: --: [-i=: 1930-1949
( Adamaoua (Caa"):1966 (7) : C : O : 37 : 124 :161 : 23 )
(4) : C : I : 36 : 127 :163 : 22 ) ( Algérie : 1960
(- -:--y:-
( :---: :--:---
~ . - ~~ . ~ --- . --
( Cameroun Bamileke: 196 t (5) : C : I : 28 : 131 :159 : 18 )
( Haute Volta : 196061 ( 5 ) : C : II : 60 : 122 :182 : 33
( Ni.akhar(Sénbgal):1963-65 (6) : C : I : 23 : 147 :I70 : 14
) :-: (- -:
(-
(
I :--:-:
i ;---: :--:-I--
Tchad : 1964 . (5) : c : II : 3a : 127 :i65 : 23-
Source : (1) Ferry, 1977 Mortali* level A : Low 2 Pressat, 1969 --- B : Nean
4 Tabutin, 5 BlWo, 1967 -- - I : exogenonB excess
II : excess mortality
3 Taltisperger, 1976 . C : H i g h 1976 Type of excess mortality : O : no excess m o r t a l i t y
- I1 u C a b e l l e , 1969 mortality f rom the 3 rd or 6 th month Podlewski; 1970
in %he first six mon-ths
I ... I- . . . . - . . . . . . . . . . . . . . . . . . . ............ --
-3 5 ~ . . . . . . . . - -. I . . - ..
- 2 2 -
1
1 I
1930-1 949 1950-1 964 1965-1 976 :-:-e .-• *-:--:--:---:--:--y
:-' .--:-...:--' *-:-:--:--:-- : g x : d x : q x . : g x : d x : q x : g x : k : qx
1 Late f o e z a death : 1000 : 79 : 79 : 1000 : 41 : 41 : 1000 38 : 38
Endogenous 1 22 i 23 1 morta3,ity : 921 : 84 : 91 : 959 : 49 : 51 : 962
Infants 1 surviving the : 837 : : 910 : : 940 : ) perinatal mortality
Table no 5 : Infant mortality ra t e according td the ethnic ~ O U D a d the localization o f the ulace of residence ( l o r the b i r t h s Îrom. 1961 t o 1974) (2)
7 1 RA^ (per 1.000) )
) : O m, I - I I ~ . 0-2 m. 3-5 m. 6-8 m, 9-111~ O an )
) )
) Ewe in the Îarm : 43 31 : 56 10 4 o : 7 3 I
1
1
:- -- Ewe in the v i l l a g e : 39 23 : 43 8 6 4 : 6 1 )
J: -- :-
---: Kabye in the f aw : 44 67 : 66 19 7 28 : 108 )
x) One selected 8 period when the aanuab snuctme or" births d id not sxîfer any variation fzom one ethnicgroup t o the other i n order t o avoid the influence of correlation b i r t h year/mortality level
Table no 6 : Child mortal i* r a t e according t o the ethnic group and '&e localization of the place of residence ( f o r births Îrom 1961 t o m)
\
i (per 1.000)
Ewe in the vil lage : 16 24 2 41 )
( ~ ~ e i n t h e ~ a n r n : 20 31 10 60 1 -1
----:-----p - ---:- ---
i Kabye in the fm : 33 71 7 73
.- I
f. SO
1 ' k
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/
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~, - 25 -
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