Direct and indirect estimates of HIV-1 incidence in a high-prevalence population.

While the worldwide AIDS epidemic continues to expand, directly measured incidence data are difficult to obtain. Methods to reliably estimate human immunodeficiency virus type 1 (HIV-1) incidence from more easily available data are particularly relevant in those parts of the world where prevalence is rising in heterosexually exposed populations. The authors set out to estimate HIV-1 incidence in a population of heterosexual sexually transmitted disease clinic attendees in Trinidad who had a known high prevalence of HIV-1 subtype B. Over the period 1987-1995, HIV-1 incidence estimates from serial cross-sectional studies of HIV-1 prevalence, passive follow-up of clinic recidivists, modeling of early markers of HIV-1 infection (p24 antigen screening), and a cohort study of seronegative genital ulcer disease cases were compared. Measuring incidence density in the genital ulcer disease cases directly gave the highest estimate, 6.9% per annum. Screening for the detection of early HIV-1 markers yielded an incidence of 5.0% per annum, while estimating incidence from serial cross-sectional prevalence data and clinic recidivists gave estimates of 3.5% and 4.5% per annum, respectively. These results were found to be internally consistent. Indirect estimates of incidence based on prevalence data can give accurate surrogates of true incidence. Within limitations, even crude measures of incidence are robust enough for health planning and evaluation purposes. For planning vaccine efficacy trials, consistent conservative estimates may be used to evaluate populations before targeting them for cohort studies.

PIP: HIV incidence data, necessary for the planning and evaluation of national AIDS control programs, are difficult to obtain directly. In this study, HIV-1 incidence in Trinidad was estimated in a population known to be at high risk: heterosexuals attending a sexually transmitted disease clinic in Port of Spain in 1987-95. HIV incidence estimates were obtained from serial cross-sectional studies of HIV-1 prevalence (n = 3625), passive follow-up of clinic recidivists (n = 98), modeling of early markers of HIV-1 infection (p24 antigen screening) (n = 12,154), and a cohort study of seronegative genital ulcer disease cases (n = 196). Measuring incidence density in genital ulcer disease cases directly gave the highest estimate: 6.9% per year. Screening for the detection of early HIV-1 markers yielded an incidence of 5.0% per year, while estimating incidence from serial cross-sectional prevalence data and clinic recidivists provided estimates of 3.5% and 4.5%, respectively. Although these estimates come from groups within the clinic population with differential HIV-1 risk, they were internally consistent. These findings suggest that indirect estimates of incidence based on prevalence data can provide accurate surrogates of true HIV incidence and may be used to target suitable populations for cohort studies.

[Indirect estimation of income and proportion of poor households: a methodological hierarchy for small areas]. / Estimacion indirecta de ingresos y proporcion de hogares pobres: una metodologia para jerarquizar areas menores.

PIP: "The purpose of this paper is to produce indicators of income insufficiency at geographically disaggregated levels by combining information from the Continuous Household Survey (CHS) and the Population and Housing Censuses (PHC) of Uruguay, 1985.... Estimates allowed [us] to construct a hierarchy of the geographical areas according to the proportion of poor households and other income distribution indicators, including measures of distance within the income distribution and of the intensity of poverty...." (EXCERPT)^ieng

Applying the sisterhood method for estimating maternal mortality to a health facility-based sample: a comparison with results from a household-based sample.

BACKGROUND: The sisterhood method is an indirect technique used to estimate maternal mortality in developing countries, where maternal deaths are often poorly registered in official statistics. It has been used successfully in many community-based household surveys. Because such surveys can be costly, this study investigated the suitability of using data collected in outpatient health facilities. METHODS: Adults visiting any one of 91 health centres or posts in a rural region of Nicaragua were randomly sampled and interviewed by health personnel. A sample size, proportional to the population served, was assigned to each facility and 9232 adults were interviewed. Characteristics of health facility users were compared with the general population to identify factors that would allow generalization of results to other settings. RESULTS: Based on these data, the lifetime risk of maternal death was 0.0144 (1 in 69). This estimate is essentially identical to that from a household-based survey in the same region 8 months earlier, which obtained a lifetime risk of 0.0145 (1 in 69). These findings correspond to a maternal mortality ratio of 241 and 243/100000 livebirths, respectively. CONCLUSIONS: This is the first report comparing results of the sisterhood method from household and health facility-based samples. The sisterhood method provided a robust estimate of the magnitude of maternal mortality. Results from the opportunistic health facility-based sample were virtually identical to results from the household-based study. Guidelines need to be developed for applying this low-cost and efficient aproach to estimating maternal mortality in suitable opportunistic settings at subnational levels.

PIP: Researchers compared maternal mortality estimates using the sisterhood method in a household survey conducted in November 1991 and in an outpatient health facility survey conducted in July 1992. Both surveys were conducted in Region I, a predominantly rural, mountainous area in northern Nicaragua. They analyzed data from 9232 interviews with adults younger than 49. The estimated lifetime risk of maternal death and the corresponding maternal mortality ratio were essentially identical for both the household and health facility surveys (0.145 and 0.144 [i.e., 1 in 69 of reproductive age died due to pregnancy-related events] and 243 and 241/100,000 live births, respectively). The estimates were similar for both surveys, even when the results were standardized for age, residence, and socioeconomic characteristics. An important limitation to the sisterhood method of estimating maternal mortality is that it estimates maternal mortality for a period about 10-12 years before the study and therefore cannot be used to assess the immediate effect of interventions to reduce maternal mortality. Nevertheless, in areas with poor maternal mortality surveillance or where no alternative exists to collecting population-based data, the sisterhood method can reliably estimate maternal mortality. These findings suggest that health facilities-based studies using the sisterhood method is a feasible, low-cost, and efficient method to estimate maternal mortality in certain settings at subnational levels.

[Infant and child mortality in Mexico, estimated using the 1980 and 1990 censuses and projections to 2000]. / La mortalidad infantil y en los primeros anos de vida en Mexico, estimada en los censos de 1980 y 1990 y su proyeccion al 2000.

PIP: Using indirect methods based on information about live births and surviving children, the author reviews estimates of infant and child mortality in Mexico. Data are from the 1980 and 1990 censuses.^ieng

Extension of the preceding birth technique.

PIP: The Brass-inspired Preceding Birth Technique (PBT), is an indirect estimation technique with low costs of administration. PBT involves asking women at a time close to delivery about the survival of the preceding births. The proportion dead is close to the probability of dying between the birth and the second birthday or an index of early childhood mortality (II or Q). Brass and Macrae have determined that II is an estimate of mortality between birth and an age lower than the birth interval or around 4/5 of the birth interval. Hospital and clinic data are likely to include a concentration of women with lower risks of disease because of higher educational levels and socioeconomic status. A simulation of PBT data from the World Fertility Survey for Mexico and Peru found that the proportions of previously dead children were 0.156 in Peru and 0.092 in Mexican home deliveries. Maternity clinic proportions were 0.088 in Peru and 0.066 in Mexico. Use of clinic and hospital data collection underestimated mortality by 32% in Peru and 15% in Mexico. Another alternative was proposed: interviewing women at some other time than delivery. If the interview was during a child/infant intervention after delivery, the subsample would still be subject to a bias, but this problem could be overcome by computing the weighted average of the actual probability of the older child being dead and the conditional probability of the younger child being dead or both younger and older children being dead. Correction factors could be applied using the general standard of the logit life table system of Brass. Calculation of a simple average of the ages of the younger children could provide enough information to help decide which tables to use. Five surveys were selected for testing the factors of dependence between probabilities of death of successive siblings: Bangladesh, Lesotho, Kenya, Ghana, and Guyana. Higher mortality was related to lower dependency factors between the probabilities of death of successive siblings. Application of the PBT to Mexican data with corrections proved valuable and could be applicable to an immunization campaign or child nutrition program for data collection.^ieng

[Maternal mortality in Argentina]. / La mortalidad materna en la Argentina.

PIP: In Argentina, as in most countries, complications of pregnancy and delivery are important causes of mortality of fertile-age women. At the 1994 International Conference on Population and Development in Cairo, governments agreed on the objective of promoting maternity without risk in order to reduce maternal mortality. Maternal mortality rates in many developing countries are much higher than the 10/100,000 live births in the most developed countries. Deficiencies in reporting due either to failure to report deaths or errors in the cause of death are a major impediment to study of maternal mortality. Two studies were conducted recently to provide more accurate data on maternal mortality in Argentina. A study carried out during 1987-89 was designed to measure underregistration of maternal mortality in the federal capital in 1985. Data from death registers were paired with the corresponding clinical histories. The true maternal mortality rate was found to be 91/100,000 rather than the official 50. 38% of maternal deaths rather than the previously estimated 57% were found to be due to complications of illegal abortion. The degree of underreporting in the federal capital, which has the highest proportion of hospital deliveries and most developed infrastructure, suggests that the maternal mortality rate is also much higher than official estimates in other parts of Argentina. Official estimates for 1993 showed a maternal mortality rate of 46/100,000, with very significant regional differentials. A study using the indirect sister survival method was conducted in a low income neighborhood of Zarate in 1991. 8041 persons in 1679 households were interviewed. The resulting estimate of 140/100,000 corresponded to the early 1980s.^ieng

[Maternal mortality in Peru]. / La mortalidad materna en el Peru.

The author investigates maternal mortality in Peru using data from the second Demographic and Family Health Survey (ENDES-II) carried out in 1991-1992. "The inclusion of a module about adult mortality in the questionnaire of the ENDES II [made it possible] to estimate maternal mortality using a set of questions about the sisters of the women interviewed. The study highlights the inverse relation between levels of maternal mortality and education, [especially] the relevance of formal education for decreasing the incidence of maternal mortality." (SUMMARY IN ENG)

[Infant mortality in the indigenous population: backwardness and contrasts]. / La mortalidad infantil en la poblacion indigena: atraso y contrastes.

PIP: Some 6.4 million speakers of indigenous languages were enumerated in the 1990 Mexican census. The same census provided the basis for an indirect estimate of infant mortality using data on the numbers of live born and surviving children. Municipios with 40% or more of the population speaking an indigenous language were studied. The overall estimated infant mortality rate for indigenous municipios was 55.1/1000 live births, the equivalent of the Mexican infant mortality rate around 1982. Mexico's national infant mortality rate in 1990 was 34.8/1000. Great contrasts were found in indigenous infant mortality rates. Campeche, Quintana Roo, and Yucatan, the states of the Mayan region, had a low rate of 35.09/1000, very close to the national average. Infant mortality levels were relatively low in the indigenous populations of Hidalgo, the state of Mexico, and Michoacan, with rates of 44 to 48. Chiapas, Oaxaca, Puebla, Durango, Guerrero, and San Luis Potosi had rates of 55 to 65. The highest rates were in states with few indigenous municipios, including Chihuahua, Jalisco, and Nayarit. The Huichol of Jalisco had the highest rate at 100.01/1000. Infant mortality levels were found to be correlated in different degrees with socioeconomic indicators. The highest infant mortality rates were in the indigenous regions with the poorest socioeconomic conditions.^ieng

[Fertility at the state level in 1990]. / La fecundidad en el ambito estatal en 1990.

PIP: Specialized surveys, vital statistics, and census data have made evident the decline of Mexican fertility beginning in the late 1970s and the transformation of the reproductive patterns of Mexican women. Fertility levels were analyzed for each Mexican state for the years between 1980 and 1990 using vital statistics and census data. Estimated total fertility rates for each state and federal entity for 1990 were indirectly generated with information on live born children from the 1980 and 1990 censuses. The problems inherent in this type of data, including significant rates of nonresponse, are well known and may result in underestimation. Estimated total fertility rates for 1990 ranged from 2.0 in the Federal District and 2.1 in Tamaulipas to 4.5 in Oaxaca and 4.7 in Chiapas. In general, the lowest fertility was in the northern states. The fertility estimates, which were obtained using the model developed by Arriaga, are probably close to the true level. A comparison of estimates from the census with estimates from the vital statistics adjusted to eliminate the effects of late registration shows that both estimates maintain the same profile. It is possible to assume that the states with higher levels of fertility have lower prevalence of contraception, lower levels of female education, and large population sectors in a condition of marginalization. It is evident that not all population sectors have been integrated into the new reproductive patterns, which should prompt a redefinition of population policies to focus on reduction of the social imbalances that are reflected in fertility differences.^ieng

[Africa: land of innovation and imagination in demography]. / L'Afrique: terre d'innovation et d'imagination en demographie.

PIP: This edition of Cahiers Quebecois de Demographie is dedicated to the important evolution in the demographic production in French speaking Africa, with the exception of one article on fertility trends in Haiti. Between the 1960s until about the 1980s, African demography settled down to the heavy task of filling the void in demographic data. Data collection and development of new analysis techniques characterize the type of training received by demographers and their scientific production, most often realized in the teaching of national statistics. During this period, African demography contributed much to the advancement of demography, especially certain concepts and tools for collection and analysis. It faced declared limits in classical definitions of household, migration, and forms of union. It yearned to forge definitions which better fit the African context. It uses historical calendars to collect data on age in populations which do not always know their birth year. It developed the technique of observation to collect data on nomads. Africa had been the place entitled to the development of indirect estimation methods. Demographic works in Africa have participated in the restatement of the demographic transition theory and the reversal of intergenerational transfers theory. Since the end of the 1980s, African demography has moved in a social and explicative direction. One article in this edition concerns a new proposed method to comprehend the notion of family ties in demographic surveys, especially those examining migrants to Dakar and Bamako. Another article explores the implications of a very young age structure in Africa. Another article analyzes the differential factors of intergenerational intervals while considering all at once demographic variables and socioeconomic variables. Another articles addresses excess female mortality, especially after three months, in Mali. Two articles examine female migration towards Lome, Togo, and in Burkina Faso.^ieng

The synthesis economic fertility model: a latent variable investigation of some critical attributes.

"This study uses Nicaraguan data to estimate a latent variable system of reduced-form demands for births, infant mortality, contraception, nutrition and breastfeeding. The estimates support some of the synthesis extensions to the standard fertility model, such as the concurrent increase of contraception, health, nutrition and fertility and decline in breastfeeding with income increases from initial low levels.... The initial stages of development may experience an increase in family size despite an increase in contraceptive use...as well as a profertility impact of reduced breastfeeding." Data are from a survey of women aged 15-45 that was conducted in Nicaragua from 1977 to 1978.

[Estimation of infant mortality using perinatal clinical history]. / Estimacion de la mortalidad infantil a partir de la historia clinica perinatal.

PIP: This work explains a classic indirect method for estimating infant mortality and its retrospective tendencies based on census data, and demonstrates an adaptation of the procedure for data taken from Perinatal Clinical History forms. The new procedure is illustrated using data from the Cauca River Valley in Colombia and from Uruguay. The Perinatal Clinical History forms were introduced in 1983 by the Latin American Center for Perinatology as a simple and inexpensive record containing the minimum information needed for adequate prenatal care. Indirect estimates of the type developed by Brass and others based on a census or survey require data on the mother's age, previous live births and surviving and decreased children. The data are 1st divided into 7 5-year cohorts by maternal age and the numbers of mothers, previous births, and surviving and decreased children are calculated for each group. The proportion of children deceased is calculated for each maternal cohort. Although this proportion constitutes a form of mortality measure in itself, it has the limitation of not being a conventional indicator and it also refers to the ages of the mothers rather than of the children. Brass demonstrated that a relationship exists between the proportion of deceased children and the probabilities of dying from birth through an exact age X. An appendix to this work presents the Brass method for estimating with greater precision the probabilities of dying before an exact age based on the proportions of children dying, mean parities, and the West model life table. The Perinatal Clinical History furnishes information on women who constitute not a random sample, but a sample of women who have just given birth and who therefore have not given birth and who therefore have not given birth for approximately the past 30 months (the average birth interval). The procedure proposed by Brass and Macrae allows a progression from infant mortality estimates based on the experience of women who have just given birth to unconditional estimates that would apply to the entire population. An estimate of unconditional mean parity is obtained by adding to the average previous parity of the sample women (not counting the current birth) 1/2 the number of women in the sample. An additional adjustment is necessary to reflect inclusion of all women, and not just mothers, in the estimate. Information on the total number of women of each age group should be obtained from a source external to the Perinatal Clinical History. The mortality of the additional infants is assumed to be identical to that of infants already included. Once these adjustments are made, the estimation procedure is identical to that using census data. Estimates obtained from census data and from the Perinatal Clinical History cards in the Cauca River Valley and in Uruguay were reasonably close, suggesting that the technique would be useful for assessing and monitoring infant mortality trends in countries lacking reliable vital statistics.^ieng

[Fertility levels, trends, and differentials in Brazil since the 1930s]. / Neveis, tendencias e diferenciais de fecundidade no Brasil a partir da decada de 30.

PIP: The total fertility rate (TFR) estimated for the period of 1930-35 was 6.22 children per mother, which declined to 5.80 during 1940-45, increased slightly to 5.86 during 1950-55, and to 6.0 during 1960-65, to drop to 4.97 during 1970-75. The decline was 17.2% between 1963 and 1973, 14.3% between 1943-1973, and 20.1% between 1933 and 1973 (or an average decline by 1.26 children per woman in 40 years). The evolution of the national and regional levels of fertility was estimated by a unique methodology that utilized the average births per woman with data extracted from censuses and research samples. In particular, the technique of Brass was used with correction for P2/F2 as valid data 5 years prior to taking the information. In this manner the TFR was estimated at 3.5142 based on the 1984 national household survey and specific rates for age groups encompassed the period of 1979-84. In this case it was estimated that 3,311,000 births must have occurred on the average annually during this period. It was only in 1980 that the Civil Register recorded 3,860,000 births. During this same period the hypothesis of constancy, utilizing current fertility rates corrected for P2/F2, yielded 2,745,000 births in the course of 5 years. In recent times fertility in Brazil has been on a declining trend, starting in the 1960s. The intensity of this decline varied according to the sources of information: the Civil Register and the national survey of households. Prior to the 1960s the less developed regions of the north experienced pronounced increases, while the southeastern and southern regions showed declines. From the mid-1960s all regions experienced a forceful decline in fertiltiy levels. The results indicate the convincing nature of the proposed model for estimating the levels and patterns of fertility, and it is particularly useful for other levels of disaggregation.^ieng

[Estimations of maternal mortality using the sisterhood survival method: Latin American experience]. / Estimaciones de mortalidad materna a partir del metodo de sobrevivencia de hermanas: experiencias en America Latina.

PIP: The method of surviving sisters for indirectly estimating maternal mortality is still under development but shows promise for countries lacking alternative sources of data and good statistics. This work uses census or survey data to apply the method to rural villages in Gambia; Mapuche settlements in Cautin, Chile; marginal populations on the outskirts of Lima, Peru; and rural villages of Avaroa, Bolivia. The method is explained in detail following presentation of the results. The necessary basic information is outlined, and the particularities of its application to each Latin American case are discussed. The surviving sisters method was developed by Graham and Brass to derive indicators of maternal mortality based on the proportion of sisters who arrive at fertile age and die during pregnancy, delivery, or the postpartum period. The method transforms the proportions of sisters who died of maternal causes obtained from a census or survey into conventional probabilities of death. The basic information required concerns the numbers of sisters entering the reproductive period (excluding the respondent is she is a woman), the number surviving and decreased at the survey data, and the number who died during pregnancy, delivery, or the postpartum period. The probabilities of dying from a maternal cause were estimated on the basis of the sister survival method at 1/98 in Lima, 1/53 in Cautin, 1/17 in Gambia, and 1/10 in Bolivia. These probabilities correspond to ratios of maternal mortality per 100,000 live births of 286 in Lima, 414 in Cautin, 1005 in Gambia, and 1379 in Bolivia. The results demonstrate great variability in maternal mortality rates. In the cases of Lima and Cautin there were significant differences between estimates derived from the sister survival method and those derived from vital statistics. The 4 cases demonstrated the familiar association between maternal and infant mortality, fertility, and overall female mortality expressed in life expectancy at birth. The more detailed presentation of the 3 Latin American cases stresses the need to formulate survey questions that will enable the population at risk to be correctly identified in each case. A minimum of 3 questions is usually required, and their formulation may vary depending in part on the importance of extramarital fertility.^ieng

[Data, methods, and indirect techniques of estimating mortality]. / Dados, medidas e tecnicas indiretas de estimacao de mortalidade.

PIP: The author compares alternative methods for estimating infant and adult mortality using data from various Brazilian sources. Methods of estimating child mortality considered include those of Brass, Feeney, and Preston and Palloni. The focus is on the selection of the most appropriate method for estimating mortality in Brazil. The importance of information on deaths in the previous year for the accurate estimation of current mortality is stressed. (SUMMARY IN ENG)^ieng

[The previous birth technique: the Latin American experience]. / El procedimiento del hijo previo: la experiencia latinoamericana.

PIP: The author describes the use of the previous birth technique, developed by Brass and Macrae, in Latin American countries. The technique involves the estimation of infant and child mortality using data on the survivorship of previous children. The focus is on the experiences of CELADE in collecting data in maternity hospitals in Argentina, Bolivia, the Dominican Republic, and Honduras. The inclusion of survey questions related to dates of birth and death of the previous child is evaluated. (SUMMARY IN ENG)^ieng

[Estimating child mortality using the previous child technique, with data from health centers and household surveys: methodological aspects]. / Estimacion de la mortalidad de la ninez mediante la tecnica del hijo previo con datos provenientes de centros de salud o de encuestas de hogares: aspectos metodologicos.

PIP: 2 trials of the previous child or preceding birth technique in Bamako, Mali, and Lima, Peru, gave very promising results for measurement of infant and early child mortality using data on survivorship of the 2 most recent births. In the Peruvian study, another technique was tested in which each woman was asked about her last 3 births. The preceding birth technique described by Brass and Macrae has rapidly been adopted as a simple means of estimating recent trends in early childhood mortality. The questions formulated and the analysis of results are direct when the mothers are visited at the time of birth or soon after. Several technical aspects of the method believed to introduce unforeseen biases have now been studied and found to be relatively unimportant. But the problems arising when the data come from a nonrepresentative fraction of the total fertile-aged population have not been resolved. The analysis based on data from 5 maternity centers including 1 hospital in Bamako, Mali, indicated some practical problems and the information obtained showed the kinds of subtle biases that can result from the effects of selection. The study in Lima tested 2 abbreviated methods for obtaining recent early childhood mortality estimates in countries with deficient vital registration. The basic idea was that a few simple questions added to household surveys on immunization or diarrheal disease control for example could produce improved child mortality estimates. The mortality estimates in Peru were based on 2 distinct sources of information in the questionnaire. All women were asked their total number of live born children and the number still alive at the time of the interview. The proportion of deaths was converted into a measure of child survival using a life table. Then each woman was asked for a brief history of the 3 most recent live births. Dates of birth and death were noted in month and year of occurrence. The interviews took only slightly longer than the basic survey of coverage for the expanded program of immunization to which the questions were added. Information from the trial clarified some important problems that should be taken into account in future surveys to measure recent early mortality trends in countries with incomplete registration. Collection of data on early childhood mortality in brief household interviews has been proven feasible . All women able to bear children should be interviewed if possible. The minimum questions on child mortality include the Brass questions on live born and surviving children and dates of birth and death of the 2 most recent births. The data should be analyzed based on each birth rather than each women. Use of the previous child method applied to regularly collected data offers a potentially rewarding method of discovering recent mortality trends.^ieng

[Field performance of the sisterhood method for measuring maternal mortality]. / Evaluacion del trabajo de campo del metodo de la sobrevivencia de hermanas para medir la mortalitdad materna.

PIP: Reducing maternal mortality has now been declared a health priority in many developing countries. Translating rhetoric into action requires inputs of scarce resources. Information plays an essential role in the planning, management and evaluation of action. In many developing countries, reliable and timely information is also a scarce resource and the short term prospects for significant improvement of the conventional sources of data on maternal mortality are not encouraging. Alternative and complementary methods for generating information are required which recognize the needs and constraints of developing countries. Indirect techniques for demographic estimation have made a considerable contribution to our knowledge of child and adult mortality in these circumstances. This paper describes a new indirect technique, the sisterhood method, for estimating maternal mortality and the results of the first 2 field trials in Gambia and Peru. (Author's).^ieng

[The registration of deaths in Venezuela: an evaluation of coverage]. / El registro de defunciones en Venezuela: evolucion de su cabalidad.

"This paper presents six indirect techniques for estimating the degree of death coverage as applied to vital statistics information in Venezuela between 1960 and 1982, collected by two public institutions, namely, the 'Oficina Central de Estadistica e Informatica' (OCEI) and the Ministry of Health and Social Assistance (MSAS).... The results show remarkable improvements in the death registry coverage for both institutions, that amount to 97 or 98 per cent at the beginning of the 80's. Nevertheless, great differences can be observed between them regarding both structure and volume of deaths by sex and age." Among the problems discussed are the impact of immigration and errors in age reporting. (SUMMARY IN ENG)

[General methodological guidelines for the study of the different mortality components of a population]. / Orientaciones metodologicas generales para el estudio de los distintos componentes de la mortalidad de la poblacion.

PIP: Methodological aspects of the analysis of mortality using data from death registers are described. Consideration is also given to indirect methods of estimating mortality from inadequate data. Procedures to estimate infant, child, and adult mortality are mentioned, as well as procedures to calculate crude death rates and to evaluate the quality of available data sources. (SUMMARY IN ENG AND FRE)^ieng