# 1. INTRODUCTION

Much attention in recent years has been given to the determination of levels and causes of mortality among childrel **i** n developing countries. By contrast, relatively little attention has bean paid to the problem of adult mortality, despite the potentially severe economic and social consequences of the premature death of adults, both for the immediate family and for the local and national economy. This lack of attention is reflected in a marked lack of information on the levels and causes of adult mortality in developing countries. -In a companion paper (Timaeus and Graham, 1988), methods for measuring the levels of adult mortality in such countries are reviewed and assessed. In the present paper, the focus is on the determination of cause-specific adult mortality. Knowledge of the causes of adult' mortality adds considerably to the value of data on overall levels of mortality. It assists with the formulation of intervention strategies designed to reduce mortality in adults, and with the rational allocation of resources between such interventions. Although the health sector is the major beneficiary of such information, it also has consequences for other sectors. For example, data showing high rates of death from road accidents could have implications for transport policy, while a high rate of lung carter deaths might suggest changes in taxation on tobacco, or other measures designed to reduce levels of smoking.

This paper begins, in Section 2, with a review of the limited infcrmation already available concerning causes of death in ad-Its in developing countries. Some information is available from national vital registration data, mainly in countries in Latin America and the Middle East with relatively well developed systems of civil registration. In other countries, and.particularly in Sub-Saharan Africa and South Asia, the incompleteness and unreliability of vital registration data mean that existing data on cause-specific mortality come mostly from specially conducted surveys.

Sections 3 and 4 review and discuss methodologies that could be used in countries or areas without reliable registration data to obtain useful data on the causes of adult mortality. Section 3 discusses alternative approaches to collecting such information. These include community-based reporting systems, as well as specially conducted surveys, either single round, multiple round, or involving continuous follow-up of selected communities. Special attention is given to single-round surveys, as it is argued that in the short-term these may provide the most cost-effective approach to obtaining useful data on adult mortality, and that it is likely to be feasible for such surveys to be conducted in a range of developing countries. Consideration is given to aspects of survey methodology, including sampling methods, sample size, choice of respondents and recall periods. Possible biases resulting from the survey methods are also discussed.

In the countries or areas of conceril in this paper, the prorortions of people that die while under medical care are likely to be lo>k. Ascertainment of causes of death therefore depends mainly on recrospective data obtained by questioning relatives or associates of the deceased. There is some experience of the use of such retrospective questioning with respect to childhood deaths, but less experience for 2