Delayed birth registration (DBR) in Sao Paulo State: an attempt at correcting underregistration.

"The aim of this paper is to analyze the pattern of delayed birth registration [in Brazil] and to establish a relationship with the total and registered births in order to estimate a mathematical function that quantifies birth underregistration."

[Correction of underregistration of general mortality]. / Correccion del subregistro de mortalidad general.

PIP: The authors evaluate the underregistration of mortality in Latin America, using the example of Ecuador. Underregistration by province, age groups, sex, and cause of death is investigated.^ieng

Analysis of maternal mortality in Nicaragua.

PIP: The Women's Collective in Matagalpa, Nicaragua, Sanitaria VI region estimated maternal mortality rates for 1989 and 1990 to be 309 and 239/100,000 live births, respectively. The majority of births took place at home, assisted by untrained midwives, and in 68% of cases the place and attendant(s) were not listed. National figures for maternal mortality are 49.4 and 159/per 100,000 in 1989. Thus the proportion of unreported maternal mortality is probably high in Nicaragua. The Collective believers that health workers give substandard prenatal care and fail to refer high risk cases to higher levels of care. They recommend that women mount a permanent campaign, insist on training programs for health workers that focus on women's situation, that more data be collected, and that women themselves take action.^ieng

The problem of under-registration of infant deaths in Jamaica.

PIP: Infant mortality rate (IMR) is an important indicator of a country's socioeconomic development. While IMR has declined among most developing countries over the past 3 decades, under-registration of infant deaths remains a serious problem. In the case of Jamaica, IMR declined from 102/1000 in 1945 to 32/1000 in 1970 to 13/1000 by 1984. This 1984 rate is comparable to those enjoyed in the US, Austria, UK, Spain, and Australia. Significant under-registration of infant births and deaths, however, render suspect the validity of Jamaica's IMR of 13/1000. One study found 34% of infant deaths to be unregistered, while another found 9.0% of 10,249 live births to be also be unregistered. Under-registration of this magnitude is the result of faulty hospital procedures and recording systems, a lack of standardization of related terminology, and the under-registration of live births. Inaccurate IMR adversely affects development and health planning. Efforts should therefore be made with the active support of the Ministry of Health to strengthen the registration system by increasing the numbers of registrars of births and deaths and training all personnel involved in registration.^ieng

Jamaican measles surveillance system.

PIP: In 1991, the Ministry of Health and technical consultants from PAHO evaluated the measles surveillance system in Jamaica. This system consisted of the notification system, the sentinel sites system, active hospital surveillance, laboratory reporting, and special surveys. The team concentrated their efforts on the system's ability to detect and investigate suspected cases of measles. The team visited sentinel sites including health centers, hospitals, or a physician in all 13 parishes. 44 sites operated at the time. It spoke with medical Officers and Senior Public Health Nurses and evaluated written records. The notification system had recently classified measles as a Class I disease to encourage a rapid public health response and to secure investigation records. The major weakness of the notification system was case investigation. In 1991, health workers investigated only 6 (3%) of 208 suspected cases within 48 hours and eventually investigated only 76 (36.5%). 23 cases were confirmed as measles. Serology tests revealed that most suspected cases were actually rubella. This indicated a need to include serological testing for confirmation. The team found that the notification system underreported cases. Each sentinel site was required to collect each week a count of the number of cases of measles and other conditions to monitor trends. 87% reported the counts weekly. The sites consistently reported measles bas ed on clinical suspicion. Public health staff visited hospitals weekly to review cases of target disease including measles. They visited at least 1 hospital regularly in each parish. Hospital records did not contain consistent measles data. For example, only 10 of 13 visit reports included patient's name, age, sex, and address and only 7 included outcome. Detailed information was only available on 13 of the 208 suspected cases so the team was only able to evaluate them.^ieng

[Maternal death: an avoidable tragedy]. / Morte materna: uma tragedia evitavel.

PIP: Although statistics show that maternal mortality has declined during this century, high levels persist in the developing world. There are 100 to 1000 maternal deaths per 100,000 live births in developing countries, compared to 7 to 15 deaths per 100,000 live births in developed countries. Most of these deaths in developing countries are avoidable by effective maternal care interventions. A book edited by Unicamp on maternal mortality has made an important contribution to the debate that has been going on in scientific circles and among planners and health professionals. The quality of data for analysis of maternal mortality is implicated also because of erroneous classification of maternal deaths as nonmaternal, imprecision in the death certification, and omission of the status of pregnancy associated with illegal abortion. The identification of these errors means that medical files, hospital registers, family interviews, and autopsies have to be consulted. Research carried out in Sao Paulo demonstrated that at the end of the 1980s the maternal mortality rate was in fact 99.5/100,000 live births, whereas original records showed only 44.5/100,000 live births. Even in the United States during 1980-85, 33% of maternal deaths were underreported. In England the level of underreporting amounted to 41% during 1970-72. The World Health Organization has encouraged the formation of committees to study the prevention of maternal mortality. Two such committees were started in the state of Sao Paulo with the objectives of making professionals aware of the importance of accurate death records; immediate notification of maternal deaths to the regional committee; means from the proper authorities for the correction of deficiencies detected; and continuous evaluation of maternal mortality rates. The committee of Marilia, in the interior of the state of Sao Paulo, demonstrated that 72% of maternal deaths during 1986-88 were avoidable by medical-obstetrical means, prenatal care, or social assistance. 61% of deaths were attributed to cesarean section, which indicates the major risk of surgical complications.^ieng

[The reliability of reliability]. / Confiabilidad de la confiabilidad.

PIP: The author critically analyzes an article by Rodolfo Corona Vazquez that questions the reliability of the preliminary results of the Eleventh Census of Population and Housing, conducted in Mexico in March 1990. The need to define what constitutes "reliability" for preliminary results is stressed.^ieng

[Reliability of the preliminary results of the Eleventh Census of Population and Housing of 1990]. / Confiabilidad de los resultados preliminares del XI Censo General de Poblacion y Vivienda de 1990.

PIP: The author assesses the reliability of the eleventh general population and housing census conducted in Mexico in March 1990. An undercount of as many as two million persons is estimated. (SUMMARY IN ENG)^ieng

Neonatal tetanus: countdown to 1995.

Progress in the campaign against neonatal tetanus in South and Central America and the Caribbean is reviewed. The main emphasis is on immunizing women of childbearing age who live in high-risk areas, although importance also attaches to routine tetanus toxoid treatment, adequate care during the prenatal period and delivery, and epidemiological surveillance.

PIP: In 1990, the Pan American Health Organization (PAHO) announced its strategy to reduce neonatal tetanus: immunize all 12-44 year old women in high risk areas with the tetanus toxoid. As of mid-1991, health workers in Bolivia, Colombia, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Peru, and Venezuela systematically reported neonatal tetanus cases. Only Guatemala had not yet began case investigations. Workers in Argentina, Brazil, Haiti, and Paraguay did not report neonatal tetanus cases. In fact, hospital searches were the only means to detect tetanus cases in Haiti. The number of reported cases/year fluctuated between 1300-1500 between 1985-90. PAHO defined a high risk area as an area that has a neonatal tetanus morbidity or mortality rate higher than the national average for the last 3-5 years. PAHO found 50% of all cases occurred in 5% of municipios. El Salvador, however, case occurrence did not differ from 1 region to another, PAHO proposed training traditional midwives how to vaccinate women with the tetanus toxoid and children with other vaccines as has been done in Bolivia's Department of Santa Cruz. They can also report tetanus cases and refer women to health facilities if they cannot vaccinate the women themselves. Before 1990, 78% of recorded neonatal tetanus cases occurred to women with at least 2 other children. This represented at least 2 missed opportunities for vaccination/woman. In 1990, only 17 of the 212 reported tetanus cases in the Americas were born in a hospital. In 1988, the incidence rate for deliveries in hygienic conditions averaged .11/1000 compared with .5 for all deliveries. 90% of mothers who had infants with tetanus in 1990 had not received any tetanus toxoid vaccinations, and only 22% of all mothers had received the 2nd dose. In addition to prenatal and delivery care, PAHO promoted effective epidemiological surveillance systems.

[The estimation of Chilean mortality (1860-1940): limits and possibilities]. / La estimacion de la mortalidad chilena (1865-1940): limites y posibilidades.

PIP: The limitations and errors in data sources, primarily censuses and vital statistics, concerning mortality in Chile from 1865 to 1940 are examined. Solutions are offered to adjust the sources' underestimations, particularly with regard to infant mortality.^ieng

[Coverage and quality of the registration of perinatal deaths occurring in health institutions in the Federal District]. / Cobertura y calidad del registro de defunciones perinatales ocurridas en instituciones de salud del Distrito Federal.

"This paper presents the results of the first direct attempt at evaluating the coverage of the perinatal death registration in the Distrito Federal [of Mexico]; this study is based on the information gathered from 574 deaths which took place in 23 hospitals in the Distrito Federal during a three month period in 1984. Both the causes of the failure to register many of these deaths and the quality of the information presented in perinatal death certificates are pointed out and discussed here. According to the evidence analyzed, it is clear that underregistration in the Distrito Federal is extremely marked.... The paper suggests the possibility of establishing a hospital registration system which would keep a record of both deaths and births. It also stresses the need for establishing rules to detect fetal deaths plus the need for unifying criteria regarding the definition of 'live birth'." (SUMMARY IN ENG)

[Some problems related to the collection of demographic data in the population censuses taken in Latin America during the 1980s]. / Algunos problemas relativos a la recoleccion de datos demograficos en los censos de poblacion de America Latina en la decada de 1980.

PIP: Questions permitting indirect estimates of population movement have become more common in Latin America censuses because they are the most timely and reliable basis for estimates when good vital statistics are lacking. A question on the Survival of the last child or of children born in the last year (unlike the more common questions on total number of live births, survival of all children born, or date of the last live birth or the number born in the last year) has not yet provided good results and is not recommended by the Latin American Demographic Center (CELADE) except in experimental censuses and demographic surveys. All countries should include a question on the "year of arrival" for foreign-born persons so that migration trends over time can be assessed. Some countries with incomplete vital statistics have omitted a question on whether the mother of each person in the household is living or not; this question has been very useful in estimating adult mortality. Although there has been great progress in including questions allowing study of population dynamics, there are disquieting indications of decline in the quality of data in some of the Latin American censuses taken in the 1980s. The content of questions in the census form or the order or manner in which they are included may lead to errors. Data users should participate in formulation of questions to ensure that the desired information is sought, and persons intimately familiar with local usage should participate to ensure that questions will be understood. An example of a poorly framed question occurred in the fertility section of the Argentinian census, where the 8th and subsequent births were lumped together in a precoded question, greatly limiting the usefulness of the data. The user should not have to skip from 1 place to another on the form; the inconvenience may lead to error or omission. The best order for questions is still a matter of study. In general questions pertaining to the entire universe should be followed by questions directed to specific subgroups, with clear instructions provided. The number of questions should be limited. Most countries include about 20. Precoding should be carefully planned to avoid loss of needed detail. All aspects of the census form should be subjected to careful evaluation in pilot and experimental censuses. There are indications that omission rates increased in the most recent census for 5 of the 9 countries whose 1970 and 1980 decade censuses were evaluated by CELADE. When nonresponse rates for particular questions become too high, the temptation to fill in the information using special problems should be avoided because of the danger of biasing the results. The original data should be preserved if assignments are made, and the criteria for assignment should be clear to the reader. The major risk of having a sample of households complete a more detailed census form is that the sample will not be representative. CELADE does not recommend post-census surveys because the amount of information they can impart does not justify their significant diversion of economic and manpower resources.^ieng

[A brief analysis of mortality data from the 1980 population census]. / Breve analise sobre os obitos informados pelo censo demografico de 1980.

PIP: The quality of mortality data from the 1980 census of Brazil is compared with that of vital statistics data. The results suggest that census figures are lower as a result of under-enumeration and that the vital statistics data present a more accurate picture of the age structure of deaths. (summary in ENG)^ieng