The COVID-19 Pandemic: Effects on Civil Registration of Births and Deaths and on Availability and Utility of Vital Events Data.

The complex and evolving picture of COVID-19-related mortality highlights the need for data to guide the response. Yet many countries are struggling to maintain their data systems, including the civil registration system, which is the foundation for detailed and continuously available mortality statistics. We conducted a search of country and development agency Web sites and partner and media reports describing disruptions to the civil registration of births and deaths associated with COVID-19 related restrictions.We found considerable intercountry variation and grouped countries according to the level of disruption to birth and particularly death registration. Only a minority of the 66 countries were able to maintain service continuity during the COVID-19 restrictions. In the majority, a combination of legal and operational challenges resulted in declines in birth and death registration. Few countries established business continuity plans or developed strategies to deal with the backlog when restrictions are lifted.Civil registration systems and the vital statistics they generate must be strengthened as essential services during health emergencies and as core components of the response to COVID-19.

Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group.

BACKGROUND: Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030. METHODS: We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources. RESULTS: We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%. INTERPRETATION: Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths. FUNDING: National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

Identifying and quantifying misclassified and under-reported AIDS deaths in Brazil: a retrospective analysis from 1985 to 2009.

BACKGROUND: A retrospective analysis of deaths registered in the Brazilian Mortality System was conducted to quantify the under-reporting of HIV/AIDS deaths and those misclassified to AIDS-related conditions in the 15-49 years old population in Brazil. METHODS: Death rates for AIDS-related diseases were calculated by age and sex for 1985-2009. Changes in the age-sex-specific death rates over time were used to identify conditions likely to be misclassified AIDS deaths and to quantify the corresponding number of misclassified deaths. Deaths due to ill-defined causes were redistributed across all other natural causes of death. The resulting total number of AIDS deaths was further adjusted for incompleteness of the mortality reporting system. RESULTS: Out of the 28 potential causes of death investigated, five increased in the same distinct age pattern as AIDS: pneumonia, Kaposi's sarcoma, other immunodeficiencies, other septicaemia and toxoplasmosis. 18 490 deaths due to these five causes were recoded to HIV/AIDS from 1985 to 2009. 38 145 deaths due to ill-defined causes were redistributed to AIDS and 15 485 were added to the number of AIDS deaths to correct for completeness of the mortality system in Brazil. Altogether, 72 120 deaths were recoded to AIDS between 1985 and 2009 and added to the reported 194 445 AIDS related deaths in the country, representing 27% misclassification of AIDS deaths in Brazil. CONCLUSIONS: This study demonstrated that AIDS mortality is underestimated by the official mortality information system in Brazil. Efforts need to be made to reduce misclassification of causes of death in the future and identify ways in which the confidentiality of information regarding cause of death can be maintained.

Estimating causes of death where there is no medical certification: evolution and state of the art of verbal autopsy.

Over the past 70 years, significant advances have been made in determining the causes of death in populations not served by official medical certification of cause at the time of death using a technique known as Verbal Autopsy (VA). VA involves an interview of the family or caregivers of the deceased after a suitable bereavement interval about the circumstances, signs and symptoms of the deceased in the period leading to death. The VA interview data are then interpreted by physicians or, more recently, computer algorithms, to assign a probable cause of death. VA was originally developed and applied in field research settings. This paper traces the evolution of VA methods with special emphasis on the World Health Organization's (WHO)'s efforts to standardize VA instruments and methods for expanded use in routine health information and vital statistics systems in low- and middle-income countries (LMICs). These advances in VA methods are culminating this year with the release of the 2022 WHO Standard Verbal Autopsy (VA) Toolkit. This paper highlights the many contributions the late Professor Peter Byass made to the current VA standards and methods, most notably, the development of InterVA, the most commonly used automated computer algorithm for interpreting data collected in the WHO standard instruments, and the capacity building in low- and middle-income countries (LMICs) that he promoted. This paper also provides an overview of the methods used to improve the current WHO VA standards, a catalogue of the changes and improvements in the instruments, and a mapping of current applications of the WHO VA standard approach in LMICs. It also provides access to tools and guidance needed for VA implementation in Civil Registration and Vital Statistics Systems at scale.

The way forward.

Good public-health decisionmaking is dependent on reliable and timely statistics on births and deaths (including the medical causes of death). All high-income countries, without exception, have national civil registration systems that record these events and generate regular, frequent, and timely vital statistics. By contrast, these statistics are not available in many low-income and lower-middle-income countries, even though it is in such settings that premature mortality is most severe and the need for robust evidence to back decisionmaking most critical. Civil registration also has a range of benefits for individuals in terms of legal status, and the protection of economic, social, and human rights. However, over the past 30 years, the global health and development community has failed to provide the needed technical and financial support to countries to develop civil registration systems. There is no single blueprint for establishing and maintaining such systems and ensuring the availability of sound vital statistics. Each country faces a different set of challenges, and strategies must be tailored accordingly. There are steps that can be taken, however, and we propose an approach that couples the application of methods to generate better vital statistics in the short term with capacity-building for comprehensive civil registration systems in the long run.

The global mortality of infectious and parasitic diseases in children.

Although considerable advances in the reduction of global child morbidity and mortality have been made since 1970, when more than 17 million children died, the burden of child mortality is still intolerably high today. An estimated 10.5 million younger than the age of 5 years died in the year 2002 from largely preventable diseases, such as those having infectious, parasitic, and perinatal causes. The reductions in rates of mortality observed did not take place uniformly across time and regions of the world, but the success stories in developing countries demonstrate clearly that low mortality levels are achievable in those settings. If the whole world came to share the current child mortality experience of Northern European countries, more than 10 million deaths of children could be prevented each year. This work aims to answer the questions concerning where and why so many of the world's children still succumb to largely preventable causes.

Counting the dead and what they died from: an assessment of the global status of cause of death data.

OBJECTIVE: We sought to assess the current status of global data on death registration and to examine several indicators of data completeness and quality. METHODS: We summarized the availability of death registration data by year and country. Indicators of data quality were assessed for each country and included the timeliness, completeness and coverage of registration and the proportion of deaths assigned to ill-defined causes. FINDINGS: At the end of 2003 data on death registration were available from 115 countries, although they were essentially complete for only 64 countries. Coverage of death registration varies from close to 100% in the WHO European Region to less than 10% in the African Region. Only 23 countries have data that are more than 90% complete, where ill-defined causes account for less than 10% of total of causes of death, and where ICD-9 or ICD-10 codes are used. There are 28 countries where less than 70% of the data are complete or where ill-defined codes are assigned to more than 20% of deaths. Twelve high-income countries in western Europe are included among the 55 countries with intermediate-quality data. CONCLUSION: Few countries have good-quality data on mortality that can be used to adequately support policy development and implementation. There is an urgent need for countries to implement death registration systems, even if only through sample registration, or enhance their existing systems in order to rapidly improve knowledge about the most basic of health statistics: who dies from what?