title: Determinants of epidemiologic transition in rural Africa: the role of socioeconomic status and drinking water source.
abstract: BACKGROUND
  Many African countries experience a protracted epidemiologic transition, different from the classical transition in western societies. The factors driving this protracted transition are largely unknown. In northeast Ghana, we studied an ongoing epidemiologic transition and investigated the effects of socioeconomic status and drinking water source on the transition.
  
  
  METHODS
  During a 9-year period, we followed a cohort of almost 30 000 individuals and collected information on mortality and fertility rates. In addition, using the standards set out by the WHO, we obtained the causes of death by verbal autopsy. Individuals were stratified according to their socioeconomic status and the households' use of an improved or unimproved drinking water source.
  
  
  RESULTS
  Mortality rates decreased by -5.0% annually (p<0.001) and the main cause of death shifted from infectious to non-infectious diseases (p=0.014). General fertility rates and child-women ratios decreased annually by -12.7% (p<0.001) and -11.9% (p<0.001), respectively. There was no difference in the decline of mortality and fertility depending on socioeconomic status or drinking water source.
  
  
  CONCLUSIONS
  Factors other than socioeconomic status and drinking water source are responsible for the observed declines in mortality and fertility observed during the protracted epidemiologic transition. Identifying the specific determinants of the ongoing transition is of importance, as they could be targeted in order to further improve public health in rural African countries.
authors.affiliation: Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Center, Post Box 9600, 2300 RC, Leiden, The Netherlands engelaer@leydenacademy.nl.
authors.forename: Frouke M
authors.initials: FM
authors.lastname: Engelaer
authors.affiliation: Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Center, Post Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Jacob J E
authors.initials: JJ
authors.lastname: Koopman
authors.affiliation: Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Center, Post Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: David
authors.initials: D
authors.lastname: van Bodegom
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, Post Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Ulrika K
authors.initials: UK
authors.lastname: Eriksson
authors.affiliation: Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Center, Post Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D060766:Drinking Water / Q000592:standards*; D005260:Female; D005298:Fertility; D005869:Ghana / Q000453:epidemiology; D019456:Health Transition; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011634:Public Health / Q000706:statistics & numerical data; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D060766:Drinking Water
keywords: Drinking water; Epidemiologic transition; Fertility; Ghana; Mortality; Socioeconomic status