Análise de casos e óbitos relacionados à esquistossomose no Brasil: padrões epidemiológicos e distribuição espaçotemporal, 2010-2022 / Analysis of schistosomiasis cases and deaths in Brazil: epidemiologic patterns and spatio-temporal distribution, 2010-2022 / Análisis de los casos y muertes relacionados con la esquistosomiasis en Brasil: patrones epidemiológión espaciotemporal, 2010-2022cos y distribuci

A esquistossomose é uma infecção parasitária causada por um grupo de vermes chatos chamados Schistosoma. A doença encontra-se, sobretudo, nos países em desenvolvimento, especialmente nas zonas rurais com más condições de saneamento e acesso limitado à água potável. A esquistossomose é transmitida através do contato com água doce contaminada, como de rios, lagos e lagoas em que vivem as larvas dos parasitas. O objetivo deste artigo foi analisar as variáveis epidemiológicas dos casos (2010-2022) e dos óbitos (2010-2020) por esquistossomose no Brasil. Trata-se de um estudo epidemiológico transversal, descritivo e quantitativo. A estratégia metodológica envolveu análise dos boletins epidemiológicos disponibilizados pelo Sistema de Informação de Agravos de Notificação (Sinan) e pelo Sistema de Informação sobre Mortalidade (SIM) no período de 2010 a 2022. Foram notificados 93.521 casos de esquistossomose e 5.495 óbitos devido a complicações dessa infecção. A forma intestinal foi a mais identificada. Minas Gerais, São Paulo, Bahia e Espírito Santo foram os estados com maior prevalência da doença. Constatou-se que homens pardos com idade entre 20 e 39 anos e com baixo nível de escolaridade são os mais afetados. Identificaram-se 732 casos da infecção em gestantes. Ademais, 62,56% dos casos evoluíram para cura e 5,88% para óbito pelo agravo notificado. Em conclusão, é crucial adotar medidas de prevenção e acesso à educação para combater efetivamente a esquistossomose.

Schistosomiasis is a parasitic infection caused by a group of flatworms called Schistosoma. The disease is primarily found in developing countries, especially in rural areas with poor sanitation and limited access to clean water. Schistosomiasis is transmitted by contact with contaminated freshwater, such as rivers, lakes, and ponds, where the parasites' larvae live. The aim of this article was to analyze the epidemiological variables of schistosomiasis cases (2010-2022) and deaths (2010-2020) in Brazil. This is a cross-sectional, descriptive, and quantitative epidemiologic study. The methodological strategy involved the analysis of epidemiological bulletins provided by the Sistema de Informação de Agravos de Notificação (SINAN) and the Sistema de Informação sobre Mortalidade (SIM) from 2010 to 2022. There were 93.521 reported cases of schistosomiasis and 5.495 deaths due to complications of this infection. The intestinal form was the most identified. Minas Gerais, São Paulo, Bahia, and Espírito Santo were the states with the highest prevalence of the disease. Males, of mixed race, aged between 20 and 39 years, and with a low level of education were the most affected. There were 732 cases of infection in pregnant women. Furthermore, 62.56% of the cases evolved to cure and 5.88% evolved to death by the notified disease. In conclusion, it is crucial to adopt prevention measures and access to education to effectively combat schistosomiasis.

La esquistosomiasis es una enfermedad parasitaria causada por un grupo de platelmintos conocidos como Schistosoma. La enfermedad es más frecuente sobre todo en países en desarrollo, especialmente en zonas rurales con saneamiento deficiente y acceso limitado al agua potable. La transmisión de la esquistosomiasis se da por el contacto con agua dulce contaminada, como ríos, lagos y lagunas donde viven las larvas de los parásitos. El objetivo de este artículo fue analizar las variables epidemiológicas de los casos (2010-2022) y muertes (2010-2020) por esquistosomiasis en Brasil. Se trata de un estudio epidemiológico transversal, descriptivo y cuantitativo. La estrategia metodológica contó con el análisis de los informes epidemiológicos que pone a disposición el Sistema de Información de Enfermedades de Declaración Obligatoria (Sinan) y el Sistema de Información sobre Mortalidad (SIM) en el período de 2010 a 2022. Se notificaron 93.521 casos de esquistosomiasis y 5.495 muertes por complicaciones de esta infección. La forma intestinal fue la más identificada. Minas Gerais, São Paulo, Bahia y Espírito Santo fueron los estados con mayor prevalencia de la enfermedad. Se constató que hombres pardos, de edad entre 20 y 39 años, y bajo nivel de escolaridad son los más afectados. Se identificaron 732 casos de infección en mujeres embarazadas. El 62,56% de los casos evolucionaron a cura; y el 5,88% tuvieron muerte confirmada por el agravio notificado. Se concluye con la necesidad de adoptar medidas de prevención y acceso a la educación para combatir eficazmente la esquistosomiasis.

Excessive alcohol use and drug overdose deaths, New Mexico, 2015-2016.

BACKGROUND: Excessive alcohol use is an important component of a person's risk for drug overdose death. But alcohol's contribution to overdose death risk has not been well quantified. We aimed to quantify the role of excessive alcohol use, particularly as defined by a blood alcohol concentration (BAC) ≥0.08 g/dL, in drug overdose deaths in New Mexico (NM). METHODS: The study was conducted in 2018. We abstracted death records (scene investigation, toxicology, pathology) for all drug overdose deaths in NM during 2015-2016, information on BAC, other indications of alcohol, risk factors, comorbidities, and drug type and linked this information with demographic characteristics on death certificates. A Poisson regression model was used to determine independent associations between decedents' characteristics and alcohol involvement among drug overdose decedents. RESULTS: Approximately 18 % (n = 170) of the 946 drug overdose decedents in this study had a BAC ≥ 0.08 g/dL. After adjustment, drug overdose decedents who were American Indian/Alaska Native or had a history of alcohol use disorder were more likely to have had a BAC ≥ 0.08 g/dL at the time of death. However, decedents who had methamphetamine involved in their death or who had a history of diabetes, mental illness, or chronic pain were less likely to have a BAC ≥ 0.08 g/dL at the time of death. CONCLUSIONS: Nearly 1 in 5 overdose decedents had a BAC ≥ 0.08 g/dL at the time of death, suggesting that evidence-based alcohol prevention strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) could reduce the risk of drug overdose death.

Causas de defunción mal definidas en las provincias de Argentina, 2001-2013 / Ill-defined causes of death in the provinces of Argentina,2001-2013

El objetivo fue analizar los niveles y tendencias en el porcentaje de muertes con causas mal definidas en las provincias de Argentina, durante los años 2001 a 2013. Este fue un estudio descriptivo, de tipo cuantitativo. Se utilizó la base de datos de registros de defunción de la Dirección de Estadísticas e Información en Salud. A partir del porcentaje de defunciones con causas mal definidas, se clasificó a las provincias según niveles de exactitud: alta (<5%), buena (≥ 5% <10%), regular (≥ 10% <20%) y baja (≥ 20%). Se analizó la distribución relativa de las muertes según el grupo de códigos más frecuentes: signos y síntomas (R00-R69), hallazgos anormales clínicos y de laboratorio (R70-R94) y causas desconocidas y mal definidas propiamente dichas (R95-R99). La tendencia temporal se estableció mediante el cambio porcentual. En 11 provincias la exactitud fue alta, en 5 buena y en 8 regular. En todas las jurisdicciones, los códigos más frecuentes fueron las causas desconocidas o mal definidas propiamente dichas, aunque éstas fueron proporcionalmente menos importantes en las provincias con nivel alto de exactitud. Además, en este grupo de jurisdicciones se observaron las reducciones más importantes del porcentaje de causas mal definidas. Solo dos provincias con niveles intermedios de exactitud presentaron la misma pauta. El análisis de las causas de muerte mal definidas, permitió reconocer problemas básicos en la información, y proporcionó indicios válidos para investigaciones futuras. Resulta de interés identificar las buenas prácticas implementadas en las provincias menos afectadas por este inconveniente.

The objective was to analyze levels and trends in the percentage of deaths with ill-definedcauses in the provinces of Argentina, during the years 2001-2013. This was a quantitativedescriptive study. Database of death records from the Department of Health Statistics andInformation was used. From the percentage of deaths with ill-defined causes, provinceswere classified into four accuracy levels: high (<5%), good (≥ 5% <10%), regular (≥ 10%<20%) and low (≥ 20%). The relative distribution of deaths was analyzed according to thegroup of more frequent codes: symptoms and signs (R00-R69), abnormal clinical andlaboratory findings (R70-R94) and ill-defined and unknown causes of death (R95-R99).Time trend was established with the relative variation. Eleven provinces had an excellentlevel of accuracy, five provinces had a very good level of accuracy and eight provinces had agood level of accuracy. In all jurisdictions, the most common codes were the unknown orill-defined causes, although they were proportionally less important in the provinces withhigh accuracy. Besides, the most significant reductions were observed in this group. Only two provinces with intermediate levels showed the same pattern. The analysis of the illdefinedcauses of death identified the most basic problems in the information, and providedvalid evidence to guide future research. It is interesting to analyze the good practices thathave been implemented by the provinces that are less affected by this problem.

Hacia el seguimiento de los determinantes sociales de la salud: alcances y limitaciones de las estadísticas de defunción en la Argentina (2001-2009) / Towards the monitoring of the social determinants of health: the scope and limitations of death statistics in Argentina ( (2001-2009)

OBJETIVOS: describir la precisión de las variables sobre estratificación social del fallecido y el impacto de factores personales, profesionales e institucionales en la exactitud de los datos de las estadísticas de defunción producidas entre los años 2001 y 2009 en la Argentina. METODOLOGIA: estudio descriptivo que utiliza las bases de datos de la Dirección de Estadísticas e Información de Salud de la Argentina. Se realiza un análisis estadístico descriptivo para determinar el nivel y la tendencia en la precisión de las variables seleccionadas y regresiones logísticas para determinar la influencia de diferentes factores en la exactitud de la información. RESULTADOS: se verifican niveles de precisión excelentes (dos variables), regulares (dos variables) y malos (cuatro variables). Los dos primeros grupos tienden a mantener o mejorar su situación a lo largo del tiempo, mientras que el tercero tiende a empeorarla. La inexactitud de la mayoría de las variables mostró una elevada asociación con ciertas regiones de residencia, etapas del ciclo vital, tipos de establecimientos de salud y modalidades de atención y certificación médica. DISCUSION:el uso de las estadísticas de defunción para el seguimiento de los determinantes sociales de la salud exige el mejoramiento de la exactitud de las variables sobre estratificación social del fallecido. Se recomienda implementar campañas de sensibilización, mejorar la capacitación de los médicos, actualizar los mecanismos de control de calidad e incrementar la infraestructura física y organizacional.

OBJECTIVE: To describe the accuracy of social stratification variables of the deceased, and the impact of personal, professional and institutional factors in the accuracy of the data, in death statistics from Argentina (2001-2009). METHODOLOGY: An exploratory-descriptive study, using the databases of the Department of Health Statistics and Information of Argentina. Descriptive statistic was used to determine the level and trend in the accuracy of a set of variables. Logistic regression was used to determine the influence of different factors on the accuracy of the information. RESULTS: Two variables had excellent accuracy, two variables had regular accuracy, and four variables had unsatisfactory accuracy. The first two groups of variables improve their situation. The third group makes it worse. The inaccuracy of most variables showed a high association with certain regions of residence, lifecycle stages, and certain types of health care and medical certification. DISCUSSION: The use of death statistics for monitoring the social determinants of health requires improving the accuracy of the variables on social stratification of the deceased. We recommend implementing awareness campaigns, improve training of doctors, upgrade quality control mechanisms and increase physical and organizational infrastructure.

Problemas no preenchimento da declaração de óbito: estudo exploratório / Problemas en la cumplimentación de la declaración de defunción (DO): estudio exploratorio / Problems filling out death certificates: exploratory study

Os dados do Sistema de Informação sobre Mortalidade (SIM) representam a principal fonte de informações sobre mortalidade no Brasil, embora apresentem com frequência alguma inconsistência. Uma dificuldade para a geração dos dados de mortalidade confiáveis é o correto preenchimento da Declaração de Óbito (DO), instrumento de alimentação de dados para o SIM. O artigo relata estudo exploratório sobre problemas de preenchimento da DO, utilizando abordagem semiqualitativa. A coleta dos dados foi realizada por meio de entrevistas semiestruturadas e questionários estruturados aplicados a médicos. Os resultados mostram que os principais problemas relacionados ao preenchimento da DO são o desconhecimento médico acerca da importância do correto preenchimento de todos os campos do formulário, a pouca utilização dos materiais de instrução fornecidos aos médicos pelos órgãos e instituições responsáveis, o desconhecimento sobre a importância do detalhamento e a adequação da cadeia de eventos patológicos no campo das possíveis causas de morte.

Los datos del Sistema de Información sobre Mortalidad (SIM) representan la principal fuente de información sobre mortalidad en Brasil, aunque presenten con frecuencia alguna inconsistencia. Una dificultad para la generación de datos de mortalidad fiables es la correcta cumplimentación de la Declaración de Defunción (DO), instrumento de alimentación de datos del SIM. El artículo versa sobre un estudio exploratorio acerca de problemas de cumplimentación de la DO, utilizando un enfoque semicualitativo. La recogida de datos fue realizada mediante entrevistas semiestructuradas y cuestionarios estructurados aplicados a médicos. Los resultados muestran que los principales problemas relacionados con la cumplimentación de la DO son el desconocimiento médico, acerca de la importancia de la correcta cumplimentación de todos los campos del formulario; la poca utilización de los materiales de instrucción proporcionados a los médicos por los órganos e instituciones responsables; el desconocimiento sobre la importancia de documentos detallados y la adecuación de la cadena de eventos patológicos en el campo de las posibles causas de muerte.

Data from the Brazilian Mortality Information System (SIM, in Portuguese) represent the main source of information on mortality in Brazil, even though the system contains many inconsistencies. One difficulty in generating reliable data on mortality is the correct filling out of death certificates (DOs), which are source instruments for the SIM system. This article describes an exploratory study on problems related to the filling out of DOs, using a semi-qualitative approach. The data was collected in semi-structured interviews and questionnaires with medical doctors. The results show that the main problems related to filling out DOs are lack of medical information regarding the importance of the correct filling out of all the fields on the form, the limited use of the instructions issued by responsible organs and institutions, and lack of knowledge as to the importance of certain details and descriptions of the chain of pathological events in the field of possible causes of death.

[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

Sex ratio at birth deviations in modern Venezuela: the Trivers-Willard effect.

This study evaluates the impact of the Trivers-Willard (T-W) effect on human populations, using demographic data collected from vital registration data in Venezuela. The evaluation of the sex ratio at birth (SRB) and of fetal and infant deaths supports the existence of T-W effect in the Venezuelan population in extreme conditions. This T-W effect was observable in the SRB but not at later ages and is related to the marital status of the mother. The results indicate that the investment in females associated with environmental adversity is greater than the investment in males associated with good environmental conditions.

PIP: This study relies on stepwise discriminant analysis to evaluate the influence of socioeconomic status (SES) factors according to marital status on the probability of the child being born a male or a female. Data were obtained from the 1988 and 1990 Venezuelan death and birth registers in the Central Office of Statistics and Information. Fetal and infant deaths numbered 87,229. Births numbered 577,976 and were reported for a variety of demographic/socioeconomic variables. The study evaluates the Trivers and Willard (1973) hypothesis that the sex ratio at birth is correlated with socioeconomic status. The focus is on the deviations in the sex ratio at birth (SRB) in Venezuela. The authors refer to studies confirming sex biases in mortality and sex biases in allocating resources and care and refuting the Trivers-Willard (T-W) effect. Findings indicate that the SRB was 0.5124 and confirms other estimates. The SRB for married and cohabiting couples was 0.512 and 0.514, respectively. The SRB was lower for single women (0.508). Differences were all statistically significant. Findings suggest that the T-W effect may be stronger in women who do not live with a male partner. Sex ratio deviations varied by SES. Higher educational status was associated with a higher SRB. Extreme poverty was associated with lower SRB and had a stronger impact on SRB than high SES. The T-W effect appeared stronger prior to conception. The T-W effect varied by maternal marital status. Females were more advantaged when mothers were unmarried. The sex ratio of neonatal deaths was 0.562; that for infant deaths was 0.574. The sex ratios for mortality did not differ for any of the SES indicators. There were differences by type of births and gestation time. Single births and early gestational times had higher male mortality. Infant deaths among mothers aged 30-34 years showed a higher sex ratio.

Registration of births, stillbirths and infant deaths in Jamaica.

BACKGROUND: Vital statistics underestimate the prevalence of perinatal and infant deaths. This is particularly significant when these parameters affect eligibility for international assistance for newly emerging nations. OBJECTIVE: To determine the level of registration of livebirths, stillbirths and infant deaths in Jamaica. METHODOLOGY: Births, stillbirths and neonatal deaths identified during a cross-sectional study (1986); and infant deaths identified in six parishes (1993) were matched to vital registration documents filed with the Registrar General. RESULTS: While 94% of livebirths were registered by one year of age (1986), only 13% of stillbirths (1986) and 25% of infant deaths (1993) were registered. Post neonatal deaths were more likely to be registered than early neonatal deaths. Frequently the birth was not registered when the infant died. Birth registration rates were highest in parishes with high rates of hospital deliveries (rs = 0.97, P < 0.001) where institutions notify the registrar of each birth. Hospital deaths, however, were less likely to be registered than community deaths as registrars are not automatically notified of these deaths. CONCLUSIONS: To improve vital registration, institutions should become registration centres for all vital events occurring there (births, stillbirths, deaths). Recommendations aimed at modernizing the vital registration system in Jamaica and other developing countries are also made.

PIP: Vital statistics indicate only part of the actual prevalence of perinatal and infant mortality. Findings are reported from a study conducted to determine the level of registration of live births, stillbirths, and infant deaths in Jamaica. Births, stillbirths, and neonatal deaths identified during a 1986 cross-sectional study and infant deaths identified in six parishes during 1993 were matched to vital registration documents filed with the Registrar General. While 94% of live births were registered by one year of age, only 13% of stillbirths and 25% of infant deaths were so registered. Post neonatal deaths were more likely to be registered than early neonatal deaths. Frequently the birth was not registered when the infant died. Birth registration rates were highest in parishes with high rates of hospital deliveries where institutions notify the registrar of each birth. Hospital deaths, however, were less likely to be registered than community deaths since registrars are not automatically noticed of such deaths. Institutions should register all vital events occurring there.

Guatemala: maternal mortality in Guatemala: assessing the gap, beginning to bridge it.

Developing countries which have somewhat reliable vital statistics but poor or incomplete information about maternal mortality must make the most of the data available. Such data may require modification for maternal mortality analyses. What is important, however, is the decision to use available information and to analyse it properly. The analysis of maternal mortality in Guatemala, using data from 1986 birth and death certificates, identified particular areas, health regions, and particular ethnic groups that had significantly higher maternal mortality ratios than others. Small but disproportionately affected populations that had no available maternal health assistance were identified-a problem found in many developing countries. These groups urgently need the services of traditional birth attendants or other forms of assistance before, during and after delivery. The analysis of vital statistics led to the beginning of operative research and the collection of background information for establishing an epidemiologic surveillance programme for maternal mortality.

PIP: Guatemala vital statistics data on maternal mortality from official sources is variable. Generally about 5% of all deaths among women 10-49 years old are attributed to maternal mortality. This analysis of birth and death certificates for 1986 reveals a J-shaped curve for the maternal mortality ratio by age. The indigenous population had higher rates in all departments. The highest maternal mortality ratio (MMR) in 22 departments was in the department of Alta Verapaz (214.2/100,000 live births). The lowest MMR was found in Progreso department. The MMR in 1986 was calculated as 132.5/100,000 live births for Guatemala, or 1 pregnant woman's death every day. Among 8 health regions, the northern health region had the highest MMR (213.3/100,000). The metropolitan region had the lowest MMR (84.9/100,000). Hospital deliveries ranged from 4.7% for the northwest region to 70.7% for the metropolitan region. MMR was found to decrease by about 1/100,000 for every increase in the percentage of hospital-based deliveries, with the exception of the indigenous population, where MMR increased for every 1% increase in hospital-based deliveries. MMR was higher in hospitals for most regions. Births without medical assistance in 6 out of 8 regions had higher MMRs. For example in the northern region MMR for births without assistance was 3539.8/100,000. 5.5% of Guatemalan women had no assistance with deliveries (98 deaths out of 17,532 live births). Physician-attended deliveries had a MMR of 91.5/100,000, and traditional birth attendant-deliveries had a MMR of 96.6/100,000. In 1986 a UN assessment team found registrations reasonably completed, and estimates of registration were determined to be about 90%. Problems in recording may be due to the absence of any reference to a pregnancy on the death certificate, or the absence of the final cause or autopsy findings on the death certificate.

[Use of vital statistics in maternal mortality prevention programs]. / Uso de las estadisticas vitales en programas de prevencion de las muertes maternas.

"In the first part of the article the vital statistics system of the Republic of Argentina is presented, highlighting its characteristics as a data source, the integrity of its death records, the quality of the medical certification as to the cause of death by means of indirect indicators and the under registration of maternal causes. In the second part, the results of a research on maternal mortality carried out in the Federal Capital from 1987 to 1989, which was later extended to other jurisdictions of the country (Cordoba, Tucuman and Corrientes), is synthesized.... The principal objectives were...to know the real structure of maternal mortality in the Federal Capital and to identify the factors associated with it, in order to orient the activity of the health services and reduce these deaths." (SUMMARY IN ENG)

[Evaluation of vital statistics for the study of causes of death in Latin America]. / Evaluacion del uso de las estadisticas vitales para estudios de causas de muerte en America Latina.

"The present article attempts to take a deeper look at the most relevant aspects of the problems presented by the data on adult mortality and causes of death in Latin America.... Statistical coverage of registered deaths by age and sex is analysed, finding important differences among the countries and higher coverage in the registration of adult deaths than of younger ones.... Data quality on causes of death...showed some improvement during the period studied.... Reference is made to topics related to the analysis of causes of death [that] generally complicate the work, such as the heterogeneity of coverage and data quality at subnational levels, the compatibility among different revisions of the ICD, the use of ill-defined causes and, finally, access and management of basic information." (SUMMARY IN ENG)

[Mortality: vital statistics, regulation, and analysis]. / La mortalidad: estadisticas vitales, reglamentacion y analisis.

PIP: The author assesses the quality and coverage of death reporting in Colombia. In spite of deficiencies in vital statistics registration, the data indicate much about mortality trends in the country. Two major trends are noted: an increase in violent deaths among young adults, and a decline in mortality due to transmittable and non-transmittable diseases.^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

[Probability of dying in the first year of life in an urban area of southern Brazil]. / Probabilidade de morrer no primeiro ano de vida em área urbana da região sul, Brasil.

A birth-cohort of 4,876 children born alive in hospital were selected and followed through up to the age of one year with a view to estimating the risk of dying in the first year of life. All of them were born in 1989, in one of the seven hospitals of an urban area of Southern Brazil and the only requirement for belonging to the cohort was that of residence on the area. The selected variables were: sex, birthweight, age at moment of death, underlying cause of death, and maternal age. The estimated probability of dying in the first year was of 19.9 per 1,000 (77.3% of the deaths occurred during the neonatal period). Perinatal causes and congenital malformations contributed to 80% of the deaths, and infectious diseases were the underlying cause of death in only 1.1% of the losses. The risk of dying in the first year of life due to afections arising during the perinatal period was higher among vaginally delivered babies (20.3 per 1,000) than it was for those born by cesarean section (9 per 1,000). A higher probability of death was present among infants born to adolescent mothers, and those with low birthweight (less than 2,500g). The results brought out the need for improving the quality of prenatal and infant care. They also suggested the hypothesis of a possible association between higher infant mortality and lower socio-economic level.

PIP: A birth cohort of 4876 children born alive in 7 hospitals in an urban area of southern Brazil was selected and followed through up to the age of one year, with a view to estimating the risk of dying in the first year of life. Information on death was collected from death certificates. A total of 103 deaths were located in Maringa, of which 97 occurred in 1989. All of them were born in 1989, and the only requirement for belonging to the cohort was that of residence in the area. The selected variables were: sex, birth weight (low, adequate, and normal), age at moment of death (neonatal, late neonatal, and post neonatal) underlying cause of death (according to the International Classification of Diseases--9th Revision), and maternal age. The estimated probability of dying in the first year was of 19.9 per 1000 (77.3% of the deaths occurred during the neonatal period) in contrast with the official rate of 22.6/1000. The probability of dying in late infancy was 4.5/1000 compared to 15.4 in neonatal age. Perinatal causes and congenital malformations contributed to 80% of the deaths, and infectious diseases were the underlying cause of death in only 1.1% of the losses. 63.8% of infant deaths were caused by ailments acquired in the perinatal period, yielding a probability of death of 12.3/1000. The risk of a female infant dying was 1.4 higher than that of a male. The risk of dying in the fist year of life owing to ailments arising during the perinatal period was higher among vaginally delivered babies (20.3 per 1000) than it was for those born by caesarian section (9 per 1000). A higher probability of death was present among infants born to adolescent mothers, and those with low birth weight (less than 2500 g). The results signify the need to improve the quality of prenatal and infant care, and suggest the possible association between high infant mortality and lower socioeconomic level.

[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

A short-cut method for estimating death registration completeness in destabilized populations.

"This paper proposes a simple method for evaluating death registration completeness during intercensal periods. It is easier to implement than alternative methods but its main advantage is making explicit the dependence of results on the quality of readily observed demographic variables. Applications are made to data from South Korea and Argentina."

Infant mortality in a Mexican-American community: Laredo, Texas, 1950-1977.

Published infant mortality rates (IMR's) for Mexican-American populations frequently are lower than expected given the socioeconomic status (SES) of these populations. It has been speculated that this is due to bias or incompleteness in Mexican-American vital statistics. In this paper an extensive genealogical data base constructed from Catholic church records and civil records for the border city of Laredo, Texas is used to study this problem. The infant mortality probabilities (IMP's) since 1950 are compared to conventional IMR's, both based strictly on the population at risk defined by baptisms, in which the deaths are a proper subset of the denominator, and these are compared with IMR's calculated in the usual way from aggregate civil records of births and infant deaths for Laredo. We find that when these data are used, the IMR's for the most recent years are about twice the conventional rates computed from registered vital statistics.

PIP: Infant mortality rate (IMR) and infant mortality probability (IMP) were computed for the border city Loredo, Texas, from an extensive set of genealogies generated from baptismal and marriage records of 12 Catholic parishes from 1850-1977, Loredo death records since the beginning of registration through 1988, and hospital morbidity records from 1910-1980. Data were linked by a computer algorithm and verified manually. 254,000 individuals and 83,000 nuclear families were included. IMRs for Mexican American groups are often much lower than expected for their socioeconomic status. Loredo IMRs until 1940 were much too high, ranging from 173 to 465, because of unreported birth sin private dwellings. Later there were more registered births than baptisms, because Mexican nationals giving birth in Loredo in hopes of getting a U.S. Birth certificate. The 1970 IMR was a 42% underestimate, the 1977 IMR a 54% underestimate. IMPs computed from baptism closely resembled those for U.S. non-whites after 1950. This study shows that currently computed IMRs for border Mexican-American populations may be about 50% of the true risks.

[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)

The seasonality of infant deaths due to diarrheal and respiratory diseases in southern Brazil, 1974-1978.

PIP: Death certificate information was used to examine seasonal variations in infant deaths attributable to diarrheal and respiratory diseases during a 5-year period (1974-78) in the Brazilian state of Rio Grande do Sol. The state has a subtropical climate with 4 marked seasons in which the temperature ranges from 14 degrees Centigrade to 24 degrees Centigrade. Rainfall is fairly evenly distributed througout the year but varies from year to year. Death registration is relatively high in the area, and deaths are coded according to the 8th revision of the International Classification of Diseases. In this study all diseases classified as 000-009 were considered to be diarrheal deaths, and all those classified as 460-519 were considered to be respiratory deaths. A total of 40,219 infants deaths were recorded during the 5-year period. Monthly mortality rates were computed. The denominator for all monthly rates was the number of infants alive at the midpoint of the 5-year period as estimated from census materials. The same denominator could be used since there was little change in the birth rate during the 5-year period and little seasonal variation in birth rates. 16.2% of the infant deaths occurring during 1974-78 were attributable to diarrheal diseases, and 19.8% were attributable to respiratory diseases. About 1/2 of all the respiratory and diarrheal deaths occurred during the 1st 4 months of life. For example, the diarrheal death rate at months 0-3 was 120/100,000 infants, and by the 12th month the rate declined to 7.5/100,000 infants. 30.5% of the deaths attributed to respiratory diseases occurred during the 1st month of life, and then the rate declined sharply. There were marked and statistically significant seasonal variations in deaths due to both causes. The incidence of diarrheal deaths was almost 4 times higher during the summer months (January-February) than during the winter months (July-October). This correlation was significant at the 0.0008 level. The pattern was reversed for respiratory deaths. The respiratory death rate was twice as high during the winter months June-July as during the summer months of December-Februray. This correlation was significant at the 0.0002 level. There was no significant relationship between rainfall and deaths due to respiratory and diarrheal diseases. Multiple linear regression analysis revealed that temperature explained 68.9% of the variation in diarrheal deaths and 85.9% of the variation in respiratory deaths. Infants born in October through December (the months just preceding the summer months) had a higher risk of diarrheal death than infants born during other months. In contrast, infants born in March through July had a higher risk of death from respiratory disease than infants born during other months. The overall rate of infant deaths due to respiratory disease was 860.4/100,000 infants. The overall rate of infant deaths due to diaarheal diseases was 70.4/100,000 infants. Some caution should be used in interpreting the results of the study. The overall rate for diarrheal deaths appears to be relatively low for the region and may indicate an underreporting of deaths. Furthermore, the cause of death noted on the death certificate was accepted without further checking. Data on the major causes of all infant deaths in also provided.^ieng

Lessons from the study of immigrant mortality.

PIP: This paper reports the results of a systematic review of mortality among immigrant groups in England and Wales. Mortality rates in 1970-72 were compared with rates both in the countries of origin and in England and Wales. All-cause male mortality was lower in immigrants from italy, the Caribbean, and Poland than in the countries of origin, suggesting a selection effect among migrants. The opposite patttern was noted for imigrants from Ireland, however, indicating social and health disadvantages may be a stimulus to migration. The high mortality from tuberculosis in immigrants from the indian subcontinent and Ireland, low mortality from ischemic heart disease and high mortality from cerebrovascular disease in Caribbean men, and low mortality from cancer of the lung and intestine in all but Irish men reflect the influence of the migrants' original country. A possible influence of the host country on determining disease rates is seen in adaptation of immigrant mortality ratios toward the England and Wales average. For example, immigrants from several countries analyzed had ischemic heart disease mortalty ratios intermediate between those for the original country and for England and Wales. In addition, British people born in the Indian subcontinent showed a mortality pattern intermediate between that of the Indians and the England and Wales average, supporting the argument that environmental rather than genetic determinants may be involved in the principal chronic diseases. Particularly high mortality from complications of pregnancy and childbirthwas noted in indian and Caribbean immigrants, indicating that there may be social and cultural barriers to the receipt of adequate medical care. Finally, social class differences did not account for mortality differences among immigrant groups. Mortality was higher for the Irish than the English or Welsh in each social class group, which suggests there are cultural influences on mortality that act independently of social class influences.^ieng