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      Demographic, epidemiological, and health transitions: are they relevant to population health patterns in Africa?

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          Abstract

          Background

          Studies of trends in population changes and epidemiological profiles in the developing world have overwhelmingly relied upon the concepts of demographic, epidemiological, and health transitions, even though their usefulness in describing and understanding population and health trends in developing countries has been repeatedly called into question. The issue is particularly relevant for the study of population health patterns in Africa and sub-Saharan Africa, as the history and experience there differs substantially from that of Western Europe and North America, for which these concepts were originally developed.

          Objective

          The aim of this study is two-fold: to review and clarify any distinction between the concepts of demographic transition, epidemiological transition and health transition and to identify summary indicators of population health to test how well these concepts apply in Africa.

          Results

          Notwithstanding the characteristically diverse African context, Africa is a continent of uncertainties and emergencies where discontinuities and interruptions of health, disease, and mortality trends reflect the enduring fragility and instability of countries and the vulnerabilities of individuals and populations in the continent. Africa as a whole remains the furthest behind the world's regions in terms of health improvements and longevity, as do its sub-Saharan African regions and societies specifically. This study documents: 1) theoretically and empirically the similarities and differences between the demographic transition, epidemiological transition, and health transition; 2) simple summary indicators that can be used to evaluate their descriptive and predictive features; 3) marked disparities in the onset and pace of variations and divergent trends in health, disease, and mortality patterns as well as fertility and life expectancy trajectories among African countries and regions over the past 60 years; 4) the rapid decline in infant mortality and gains in life expectancy from the 1950s through the 1990s in a context of preponderant communicable diseases in all African countries; 5) the salient role of adult mortality, mostly ascribed to HIV/AIDS and co-morbidities, since the 1990s in reversing trends in mortality decline, its interruption of life expectancy improvements, and its reversal of gender differences in life expectancies disadvantaging women in several countries with the highest prevalence of HIV/AIDS; 6) the huge impact of wars in reversing the trends in under-five mortality decline in sub-Saharan countries in the 1990s and beyond. These assessments of these transition frameworks and these phenomena were not well documented to date for all five regions and 57 countries of Africa.

          Conclusion

          Prevailing frameworks of demographic, epidemiological, and health transitions as descriptive and predictive models are incomplete or irrelevant for charting the population and health experiences and prospects of national populations in the African context.

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          Most cited references148

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          The nutrition transition: worldwide obesity dynamics and their determinants.

          This paper explores the major changes in diet and physical activity patterns around the world and focuses on shifts in obesity. Review of results focusing on large-scale surveys and nationally representative studies of diet, activity, and obesity among adults and children. Youth and adults from a range of countries around the world. The International Obesity Task Force guidelines for defining overweight and obesity are used for youth and the body mass index > or =25 kg/m(2) and 30 cutoffs are used, respectively, for adults. The nutrition transition patterns are examined from the time period termed the receding famine pattern to one dominated by nutrition-related noncommunicable diseases (NR-NCDs). The speed of dietary and activity pattern shifts is great, particularly in the developing world, resulting in major shifts in obesity on a worldwide basis. Data limitations force us to examine data on obesity trends in adults to provide a broader sense of changes in obesity over time, and then to examine the relatively fewer studies on youth. Specifically, this work provides a sense of change both in the United States, Europe, and the lower- and middle-income countries of Asia, Africa, the Middle East, and Latin America. The paper shows that changes are occurring at great speed and at earlier stages of the economic and social development of each country. The burden of obesity is shifting towards the poor.
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            Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010

            The Lancet, 380(9859), 2144-2162
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              Urbanization, Lifestyle Changes and the Nutrition Transition

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                Author and article information

                Journal
                Glob Health Action
                Glob Health Action
                GHA
                Global Health Action
                Co-Action Publishing
                1654-9716
                1654-9880
                15 May 2014
                2014
                : 7
                : 10.3402/gha.v7.22443
                Affiliations
                Public Health Research Institute and Department of Demography, University of Montreal, Montreal, Quebec, Canada
                Author notes
                [* ]Correspondence to: Barthélémy Kuate Defo, Public Health Research Institute and Department of Demography, University of Montreal, C.P. 6128 Succursale Centre-ville, Montreal, Quebec, Canada H3C 3J7, Email: barthelemy.kuate.defo@ 123456umontreal.ca

                Responsible Editor: Nawi Ng, Umeå University, Sweden.

                Article
                22443
                10.3402/gha.v7.22443
                4028929
                24848648
                01e20a14-ded5-4fc8-9327-5e6979d27416
                © 2014 Barthélémy Kuate Defo

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 July 2013
                : 20 April 2014
                : 20 April 2014
                Categories
                Special Issue: Epidemiological Transitions–Beyond Omran's Theory

                Health & Social care
                systematic review,demographic transition,epidemiological transition,health transition,population health,epidemiology of population change,global health,africa,sub-saharan africa,cross-national comparison,sex differentials

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