Impact on mortality of the AIDS epidemic in northern Namibia assessed using parish registers.

OBJECTIVES: HIV spread rapidly in Namibia in the 1990s. As in most of Africa, however, few data exist to document the impact on mortality of AIDS. Such data can contribute to knowledge of the epidemiology of HIV infection and inform the development of programmes to mitigate the impact of the AIDS epidemic. DESIGN: This study analyses death records from the registers of eight Evangelical Lutheran parishes in northern Namibia. The dataset covers the experience between 1980 and January 2001 of 4680 couples who married between 1956 and 2000 and their children. METHODS: We examine trends in post-neonatal and 1-4-years mortality, and the age-standardized death rates at age 20-64 years of both men and women. Poisson regression for rates is used to smooth the data and test for statistically significant discontinuities in the trend. RESULTS: Post-neonatal mortality increased more than sixfold and 1-4-years mortality more than threefold between 1991 and 2000. By 2000 adult mortality for women was 3.5 times, and for men 2.5 times its 1993 level. The increase in adult mortality was concentrated at ages 30-54 years for men and 25-49 years for women. CONCLUSIONS: The pattern of mortality increase by age is consistent with the hypothesis that it is entirely due to AIDS. While not widely available, parish registers exist elsewhere in Africa and are potentially a low-cost source of data for study of the impact of AIDS on mortality and demographic trends more generally.