Assessment of the quality of the vital registration system for under-5 mortality in Yucatan, Mexico.

INTRODUCTION: Vital registration is an important element in health information systems which can inform policy and strengthen health systems. Mexico has a well-functioning vital registration system; however, there is still room for improvement, especially for deaths of children under 5. This study assesses the quality of the vital registration system in capturing deaths and evaluates the quality of cause of death certification in under-5 deaths in Yucatan, Mexico. METHODS: We collected information on under-5 deaths that occurred in 2015 and 2016 in Yucatan, Mexico. We calculated the Vital Statistics Performance Index (VSPI) to have a general assessment of the vital registration performance. We examined the agreement between vital registration records and medical records at the individual and population levels using the chance-corrected concordance (CCC) and cause-specific mortality fraction (CSMF) accuracy as quality metrics. RESULTS: We identified 966 records from the vital registry for all under-5 deaths, and 390 were linked to medical records of deaths occurring at public hospitals. The Yucatan vital registration system captured 94.8% of the expected under-5 deaths, with an overall VSPI score of 87.2%. Concordance between underlying cause of death listed in the vital registry and the cause determined by the medical record review varied substantially across causes, with a mean overall chance-corrected concordance across causes of 6.9% for neonates and 46.9% for children. Children had the highest concordance for digestive diseases, and neonates had the highest concordance for meningitis/sepsis. At the population level, the CSMF accuracy for identifying the underlying cause listed was 35.3% for neonates and 67.7% for children. CONCLUSIONS: Although the vital registration system has overall good performance, there are still problems in information about causes of death for children under 5 that are related mostly to certification of the causes of death. The accuracy of information can vary substantially across age groups and causes, with causes reported for neonates being generally less reliable than those for older children. Results highlight the need to implement strategies to improve the certification of causes of death in this population.

Rapid topographical plasticity of the visuomotor spatial transformation.

Information about the world is often encoded in the brain as topographic maps. These internal representations are not always static but can have a dynamic nature, allowing for constant adjustments that depend on factors like experience or injury. Recently, it has been shown that areas involved in visuomotor transformations also show topographical organization. These findings suggest that it could be possible to observe plastic modifications in specific parts of the representation in response to a local perturbation that affects only a part of the space that is represented. Here, we tested this hypothesis using an adaptation paradigm with hemiprisms. Our results suggest that, initially, the system tries to modify the visuomotor transformation in the whole spatial representation; however, if feedback is available from both hemifields, the system can perform specific regional topographical realignments. The results also suggest that access to the rearranged visuomotor transformation is independent of eye position, in contrast with previous studies that found a kind of conditional learning. Also, whereas prism adaptation experiments using ballistic movements do not show intermanual transfer of learning, the topographical modification found here is available to both hands. These results provide strong evidence for rapid topographical plasticity that can modify space transformations between two different modalities.