Estimating adult mortality based on maternal orphanhood in populations with HIV/AIDS

In countries without adequate death registration systems, adult mortality is often estimated using orphanhood-based methods. The HIV pandemic breaches several assumptions of these methods, for example, by increasing the correlation between maternal and child survival. Using microsimulations we generated 1,152 populations facing HIV epidemics and evaluated different orphanhood-based estimates against the underlying mortality rates. We regressed survivorship probabilities on proportions of respondents with surviving mothers, adjusting for trends in seroprevalence and coverage of antiretroviral therapy, to obtain new coefficients. We tested the different methods on survey and census data from 16 African countries with high HIV prevalence. We found that the original orphanhood method underestimates mortality during an AIDS epidemic, but better estimates can be obtained using new coefficients applied to synthetic measures of maternal survival. The resulting estimates agree well with those of the United Nations Population Division. Orphanhood-based estimates can fill data gaps in adult mortality, including in countries with high HIV prevalence.