Quality of perinatal death registration. A study in Hainaut, Belgium.

The quality of national perinatal mortality statistics was evaluated from a survey in nine maternity hospitals in Hainaut, Belgium (total births: 7862). The overall completeness of perinatal death registration was 86%. Under-registration was especially frequent in low birth weight babies. In 69% of cases, the birth weight value reported on death certificates was in exact agreement with the value in hospital records. Using detailed categories of causes, there was, in 37% of cases, agreement between the underlying cause on death certificates and the main cause identified in hospital records. Using gross categories of causes, the level of agreement was 56%. Disagreement was mostly due to the lack of specificity of the underlying cause on death certificates. The authors suggest ways to improve the quality of registration.

[Definition and classification of perinatal mortality]. / Problèmes de définition et de classification des décès périnatals.

Analysis of problems related to the classification of perinatal mortality was made possible through the evaluation of data collected from the medical records of nine maternity hospitals in South-Hainaut. Medical records of 135 fetal and early neonatal deaths were investigated. Perinatal mortality statistics were compiled on the basis of five different definitions of perinatal mortality. Depending on which definition was used, perinatal mortality varied between 10.2% and 15.1%. This study shows that reporting of perinatal mortality in hospital registries according to the legal requirement is incomplete. Standard data should be collected for each pregnancy product, on the basis of clearly defined, national and international accepted definitions. It is suggested that the 1975 recommendations of the World Health Organization (International Classification of Diseases, 9th edition), be used for definition and classification of perinatal mortality.

Validity of the recording of meningococcal disease according to various sources of information.

A study was made in Belgium in order to assess the completeness and specificity of the recording of meningococcal disease by routine sources of information. Ninety-three cases identified in a hospital survey were linked with those recorded in mortality statistics, in the notification of communicable diseases, and by the National Reference Laboratory for meningococci. Statistics based on mortality data appeared to be of low validity. The overall completeness of recording was 44% for the notification of communicable disease, and 40% for the reference laboratory. When these two sources were used for surveillance, the completeness of case-finding increased to 56%. When the analysis was restricted to bacteriologically-confirmed cases, the completeness of recording was 62% for the notification system, 70% for the laboratory, and 84% for both sources. The surveillance of communicable diseases should rely on various sources of information. Laboratory data should be systematically used in order to improve both the completeness of recording and the specificity of case-ascertainment.

Mortality in meningococcal disease in Belgium.

A survey of children admitted with meningococcal disease to 53 paediatric units in Belgium between 1975 and 1979 was made in order to assess the case mortality rate (CMR) and to identify risk factors associated with death. A total of 309 cases (226 bacteriologically confirmed and 83 unconfirmed) was recorded. The overall CMR was 6.1 per cent. It was 4.4 for bacteriologically confirmed cases and 10.8 for unconfirmed cases. The CMR was higher for septicaemia without meningitis (22.2 per cent) than for meningitis with or without signs of septicaemia (3.4 per cent). The risk of death was not related to the sex or nationality of the patients. Age was a major determinant of the CMR, independently of the clinical picture. The highest risk of death was in children under one year of age. Poor socio-economic conditions were a significant risk factor. Failure to recognise the severity of the disease by some poorly educated mothers, and the admission of the patient to a hospital lacking adequate facilities for managing severely affected children, were the two significant causes of delay of adequate treatment.

Meningococcal disease in Belgium. Secondary attack rate among household, day-care nursery and pre-elementary school contacts.

During a recrudescence of meningococcal disease mainly due to serogroup B, 1913 notified cases were investigated in Belgium from 1971 to 1976. From 1971 to 1973, 76 secondary cases were reported out of a total of 1455 cases (5.2 per cent); and from 1974 to 1976, nine secondary cases were reported of a total of 458 cases (2.0 per cent). Seventy per cent of the secondary cases occurred within seven days after the Index case. The 4.7 per cent fatality rate among secondary cases was lower than the 9.8 per cent fatality rate among primary cases. The estimated secondary attack rate was 685 per 100 000 among household contacts, 404 per 100 000 among day-care nursery contacts and 77 per 100 000 among pre-elementary school contacts. These attack rates were significantly higher (P less than 0.001) than the incidence rates in the corresponding age-groups in the general community, indicating the need for prophylaxis in these contacts.