Mortality levels, patterns and differentials and their correlates in the pre-development context : the case of Lao PDR

Until recently Lao PDR (Laos) has lacked mortality data for use in planning and social analysis. Mortality estimates came mostly from indirect estimation techniques and were mainly confined to infant mortality rates. Adult mortality was largely neglected. Although it was estimated that mortality in Laos is among the highest in the world, no comprehensive study of mortality and its correlates has been undertaken for Laos. This study made use of newly available data from nationally representative surveys on adult, infant and child mortality to investigate the patterns and differentials in adult mortality, and to examine the levels, differentials and determinants of infant and child mortality. This allowed the calculation of first national life tables by sex. The 1989-91 Multi-round Vital Statistics Survey (MVSS) is used for the adult mortality estimation while the 1994 Fertility and Birth Spacing Survey is the basis of infant and child mortality estimates. This study first assesses the quality of the MVSS to determine errors in coverage of the population and deaths and identify data inconsistencies and other non-sampling errors. It then evaluates age-sex reporting of the population, and derives age-specific death rates by sex for national population and subgroups using direct methods of estimation. It is found that young adult male mortality is very high, and this is probably linked to high incidence of work-related hazards and accidents. At the same time, mortality among adult females is high during reproductive ages reflecting high maternal mortality due to the general lack of maternity clinics. Laos has high fertility and close birth intervals and about 90 per cent of Lao women give birth at home. Adult mortality differentials across population subgroups can be clearly identified only from ages 5 to 39. At ages 40 and above, differential mortality is less clear. Mortality is higher among people living at high altitudes and practicing slash-and-burn cultivation, among populations in regions other than the central region of the country, among rural populations and among people belonging to ethnic minorities. This clearly indicates that mortality is linked to level of development, elevation, food security and cultural factors such as health beliefs and health seeking behaviour, access to health care and sanitation, housing and food habits. Life table survival analysis is employed to estimate infant and child mortality levels and differentials, while Cox regression is used for study of determinants of infant and child mortality. Infant and child mortality has declined over time, especially during the period from 1975-89, but is still very high. Mother's age at childbirth and birth order are strongly correlated with infant and child mortality. Among socio-economic covariates, maternal education is the strongest determinant of mortality followed by urban or rural residence, paternal education and father's occupation. Multivariate analysis indicates that occupation of mothers and regions of residence are not statistically significant determinants of infant and child mortality. Overall, morality is higher for males than for females. This study analyzed the context of such mortality findings and suggests the most likely reasons for the prevailing high mortality regime is the underdevelopment of economic and transport infrastructure, food insecurity, the lack of preventive health care and of access to health care for the general population. If Laos improves health care services for all segments of the population mortality can be expected to fall. This is a challenge that has eluded governments in the past, but it must be met if Lao children are to have a better future.