Neo-natal and post-neo-natal mortality in a rural area of Bangladesh

Abstract An analysis of neo-natal and post-neo-natal mortality in 132 villages (population of 117,000) of Matlab thana indicates the following: (i) Neo-natal deaths accounted for 60% of the infant mortality rate of 125. This proportion was unexpectedly high since previous research had maintained that in countries with infant mortality rates over 100, neo-natal deaths account for less than one-third of all infant deaths. Since the present findings on the proportions of neo-natal deaths correspond exactly with results from an earlier registration system in East Pakistan, it is suggested that the long-accepted proposition, 'less developed' areas are characterized by lower proportions of neo-natal deaths than 'more developed' areas, be re-examined. (2) The infant death rate accounts for 36% of all deaths in the population. If the infant death rate were reduced by half the result would be a decrease in the current crude death rate from 16 to 13. Although this reduction would appear to be small, in the context of a current high growth rate of 3% (from 1966-67 to 1968-69) it exerts a sizeable impact. For example, it would take a reduction of eight points in the crude birth rate of 46 just to achieve a growth rate 2·5% under these circumstances. Obviously, continued efforts in death control without an effective birth control programme will perpetuate high rates of growth. (3) Neo-natal and post-neo-natal mortality exhibited the -expected 'U' shaped pattern with parity, and generally varied as expected with age and family size, except in the oldest age group and largest family size where the risk was smaller than in the preceding groups. An explanation for these findings is presented, based on the effect that births to high-parity women with low child mortality have upon the total neo-natal and post-neo-natal mortality rates. It was found that these births exhibit a much lower mortality risk than births to women of comparable parities and higher child mortality, and that their numbers account for the lower risk to the births in the oldest age group and largest family size. It was concluded that women with a combination of high parity and low child mortality most probably represent a group with superior socio-economic and or health conditions which contribute to the lower risk of neo-natal and post-neo-natal death.     

Russian Mortality Crisis and the Quality of Vital Statistics

Mortality from ill-defined conditions in Russia has the fastest rate of increase compared to all other major causes of death. High proportion of deaths in this category is indicative for low quality of mortality statistics. This article examines the trends and possible causes of mortality from ill-defined conditions in Russia. During 1991–2005, mortality from ill-defined conditions in Russia increased in all age groups. The pace of increase was particularly high at working ages and the mean expected age at death from ill-defined conditions has shifted to younger ages, particularly for men. The analysis of individual medical death certificates issued in Kirov and Smolensk regions of Russia demonstrate that 89–100% of working-age deaths from ill-defined conditions correspond to human bodies found in a state of decomposition. Data from Smolensk region shows that over 60% of these decedents were unemployed. Temporal trends of mortality from ill-defined conditions and injuries of undetermined intent in Moscow city suggest that deaths from the latter cause were probably misclassified as ill-defined conditions. This practice can lead to underestimation of mortality from external causes. Growing number of socially isolated marginalized people in Russia and insufficient investigation of the circumstances of their death contribute to the observed trends in mortality from ill-defined conditions.     

A method for deriving mortality estimates from incomplete vital Statistics

Summary Although they are available in many developing countries vital registration records are very little used for mortality estimation which is still mainly based on census returns. However, defective death records may yield accurate estimations of mortality. This procedure requires few data only; a sex-age distribution of the population (preferably at the middle of a period) and a sexage distribution of deaths, either derived from vital records or from census returns to questions relating to deaths during the preceding twelve months. This method is based on the observation that for a fixed age structure of the population, there is a one-one relation between the age structure of deaths (measured by the proportion of deaths at older ages) and the level of mortality (measured by the death rate above a certain minimum age). It is assumed that at ages above this minimum the rate of underregistration of deaths does not vary significantly with age. Therefore, the age distribution of registered deaths makes it possible to estimate the true proportion of deaths at older ages. This in its turn will permit the estimation of the true level of mortality, because of the relation which exists between age structure of deaths and level of mortality. The true level is then compared with the observed, to estimate the rate of underregistration, and observed age-specific death rates can be adjusted in the light of this knowledge.     

Early-life mortality clustering in families: A literature review

Research on early-life mortality in contemporary and historical populations has shown that infant and child mortality tend to cluster in a limited number of high-mortality families, a phenomenon known as ‘mortality clustering’. This paper is the first to review the literature on the role of the family in early-life mortality. Contemporary results, methodological and theoretical shortfalls, recent developments, and opportunities for future research are all discussed in this review. Four methodological approaches are distinguished: those based on sibling deaths, mother heterogeneity, thresholds, and excess deaths in populations. It has become clear from research to date that the death of an older child harms the survival chances of younger children in that family, and that fertility behaviour, earlier stillbirths, remarriages, and socio-economic status all explain mortality clustering to some extent.     

Maternal mortality in South Africa: lessons from a case study in the use of deaths reported by households in censuses and surveys

South Africa is unique in being a developing country which has asked questions on pregnancy-related deaths in both its 2001 census and 2007 household survey, and monitors maternal and pregnancy-related mortality through vital registration and a confidential enquiry into maternal deaths. These sources of data provide a wide range of estimates of maternal mortality for the country. This paper examines these estimates to assess to what extent the differences between them are due to data deficiencies, methodological deficiencies or definitional differences. The results show that since maternal deaths are relatively rare it is fairly difficult to establish the maternal mortality rate with a great degree of accuracy in a setting where data are less than perfect. They also show that to some extent the differences are due to differences and errors in processing of data but that pregnancy-related mortality should not be treated as synonymous with maternal mortality. However, after adjustment, pregnancy-related mortality from vital registration was comparable with the level that may be expected using several alternative approaches, while the rate reported by households in census and surveys was about double that from vital registration. Nonetheless, all the data indicate an upward trend in maternal mortality that is in keeping with the impact of the HIV/AIDS epidemic, which is likely to have contributed to the discrepancies.     

Infant mortality in the Marshall Islands

Levy and Booth present previously unpublished infant mortality rates for the Marshall Islands. They use an indirect method to estimate infant mortality from the 1973 and 1980 censuses, then apply indirect and direct methods of estimation to data from the Marshall Islands Women's Health Survey of 1985. Comparing the results with estimates of infant mortality obtained from vital registration data enables them to estimate the extent of underregistration of infant deaths. The authors conclude that 1973 census appears to be the most valid information source. Direct estimates from the Women's Health Survey data suggest that infant mortality has increased since 1970-1974, whereas the indirect estimates indicate a decreasing trend in infant mortality rates, converging with the direct estimates in more recent years. In view of increased efforts to improve maternal and child health in the mid-1970s, the decreasing trend is plausible. It is impossible to estimate accurately infant mortality in the Marshall Islands during 1980-1984 from the available data. Estimates based on registration data for 1975-1979 are at least 40% too low. The authors speculate that the estimate of 33 deaths per 1000 live births obtained from registration data for 1984 is 40-50% too low. In round figures, a value of 60 deaths per 1000 may be taken as the final estimate for 1980-1984.     

Estimating the completeness of reporting of adult deaths in populations that are approximately stable

An elaboration of Preston's (Preston and Hill, 1980) procedure for determining the completeness with which deaths are recorded in approximately stable populations is presented. Both the procedures of Preston and that of Brass are conventionally limited to mortality beyond early childhood, to mortality above age 5 or age 10. The method considered here is based on characteristics of stable populations, i.e., populations that have been subject for a long time to little variation in age-specific mortality schedules or in overall levels of fertility. The essential features of a stable population are maintained even if fertility has changed. This is the case as long as no strong trend in fertility existed more than 15 or 20 years before the date at which the population is observed. Recent changes in fertility may affect the structure of the population at adult ages, but the effect on estimates of completeness of death records can generally be kept within tolerably narrow limits. Prior to showing how explicit estimates of the relative completeness of recording of numbers of deaths and persons can be derived from counts of deaths and persons by age, it is noted that a life table for a stable population can be constructed directly from the recorded distribution of deaths by age, or from the recorded distribution of persons. The procedures described are applied to several different populations in order to illustrate the computational steps necessary to estimate the completeness of death records at ages above childhood in populations that are approximately stable.     

Estimating the effect of child mortality on the number of births

This article rigorously derives the properties of the regression of births on child deaths. It is shown how the raw regression coefficient may be corrected for the effects of fertility on mortality so that the rate at which dead children are replaced may be estimated. The method is applied to data from Colombia. It is found that the mortality rate differs across individuals and is correlated with fertility. Such conditions vitiate the use of birth intervals and parity progression ratios yet can be dealt with using the new method. On average each death produces 0.2 new births as a direct result of the death. Fertility hoarding may raise the total fertility response to roughly one-half birth per death.     

Measures and effectiveness in controlling omission of reports on infant deaths in Shanghai metropolitan areas]

The infant mortality rate is a sensitive indicator of a country's or area's economic, cultural, and health care conditions, and in particular, it reflects the quality of health care for women and young children. Since liberation, great progress has been achieved in Shanghai's health and medical care in general as well as in health care for women and young children, and the infant mortality rate has dropped notably. However, the omission of reports on infant deaths is still a very serious problem. In order to control such omissions in reporting, the Shanghai municipal government and Department for Public Health have improved the methods of reporting deaths. Health care units are required to fill out a report on births and deaths, and census registers in the city government are responsible for registering all new births and deaths and preparing complete statistics on new births and deaths. At the end of each year, special investigators are sent to various hospitals to check on omissions of reports on infant deaths and they also help households to report infant deaths to census registers. The new measures have proved to be very effective. According to a new report released in 1980, the omission of reports on infant deaths has been reduced by 94.01% as compared with the 1972 statistics.     

Mortality of the chronically impaired

An analysis of the effects of diabetes and generalized atherosclerosis on death due to ischemic heart disease or stroke was conducted using multiple cause mortality statistics. Specifically, all U.S. deaths in 1969 were classified into two groups on the basis of whether diabetes or generalized atherosclerosis was mentioned anywhere on the death certificate. Then race and sex specific analyses were made of ischemic heart disease deaths (or alternately of stroke deaths) using modified life table techniques for each group (one with the specified chronic disease and one without). Comparisons were made of mortality due to the acute circulatory events (ischemic heart disease or stroke) in the two groups to determine the implications of the chronic disease for the progression of the circulatory disease events. It was found, according to expectations, that diabetes and generalized atherosclerosis play very different roles in deaths due to stroke and ischemic heart disease.     

Estimation of vital rates for Ghana

Abstract A complete and efficient registration system, of the type which would provide good data on births and deaths, does not exist in Ghana. However, registration of vital events is supposed to be compulsory in 39 towns in the country but the data collected in these areas are too inadequate and defective to provide a sound basis for the analysis of the dynamics of population growth. The results of the censuses conducted by the colonial governments are so defective and unreliable that they do not allow scientific research in the field of population analysis. Before 1960, therefore, when the national census and the post-enumeration survey (based on a 5% sample of the population) were carried out, estimates of fertility and mortality levels were little more than guesses. In this study an attempt has been made to utilize the information on the age-sex composition provided by the 1960 census and post-enumeration survey data on births and deaths to determine, as far as possible, the levels of fertility and mortality and the rates of population growth in Ghana. The fertility estimates-i.e. a crude birth rate of 50, total fertility rate of 6.9 and a gross reproduction rate of 3.4-show that Ghana's fertility is one of the highest in the world. An expectation of life at birth of 40 years, an infant mortality of 160 and a crude death rate of 23 appear to be the most plausible estimates. These estimates yield a rate of natural increase of 2.7% and a growth rate of 3.0% per annum.     

Annual mortality rates and excess deaths of children under five in Iraq, 1991-98

Data from two parallel household surveys conducted in Iraq by UNICEF in 1999 show that under-5 mortality declined steadily from 1974 to 1990, reaching about 63 per 1,000 live births in the period 1986-90. It then rose dramatically to 118 per 1,000 in 1991, the year of the Gulf War. The number of 'excess' under-5 deaths (i.e., the number in excess of the number predicted from past trends) in Iraq between 1991 and 1998 was calculated assuming that, instead of the rates measured by the 1999 survey for this period, either (a) average mortality rates for the period 1986-90 had been maintained, or (b) mortality had continued to decline at the rate observed between 1974 and 1990. According to these calculations, the estimated number of excess deaths resulting from the Gulf War and its aftermath up to 1998 was between 400,000 (assumption a) and 500,000 (assumption b).     

The effect of inbreeding on early childhood mortality: Twelve generations of an amish settlement

An unresolved issue in research on child survival is the extent to which familial mortality risk in infancy is due to biological influences net of sociodemographic and economic factors. We examine the effect of consanguinity on early childhood mortality in an Old Order Amish settlement by using the inbreeding coefficient, an explicit measure of the degree of relatedness in one's ancestry. Inbreeding has a net positive effect on neonatal and postneonatal deaths. We find social, demographic, and population-based sociocultural explanations for this effect among the Amish population which is known to experience certain genetically transmitted defects associated with mortality.     

A modification for use in destabilized populations of brass's technique for estimating completeness of death registration

Summary Brass has developed a method of estimating completeness of death registration using only data on deaths and population by age and sex. In this paper, his method is briefly outlined and the assumptions upon which it is based are discussed. In particular, the implications of the failure of the assumption of stability of the population are investigated. It is found that in populations where mortality has been declining, use of the technique leads to underestimation of completeness. A modification of the technique based on knowledge of the duration and rate of mortality change is proposed for use in such populations. Using simulated destabilized populations, the modification is tested and found to yield more accurate estimates of completeness of death registration than the unmodified technique. The usefulness of the modified technique is further illustrated by applying it to data for Costa Rican females in 1963.     

Mortality in England and Wales from 1848 to 1947

This is a survey of the changing causes of death in England and Wales during the past 100 years. Based on the published mortality statistics of the General Register Office the framework of the survey is a series of specially prepared tables of death rates by sex, age and cause of death for the periods 1848–72, 1901–10, 1921, 1931, 1939 and 1947. Adjustments were made wherever necessary to compensate for changes in medical nomenclature and in the statistical classification of disease.

After allowance has been made for the changing age structure of the population, the male death rate at all ages in 1947 was 42% of the rate in 1846–50, and the female rate 35 %. Maximum improvement was among girls aged 5–9 years, whose death rate in 1947 was 9% of the rate 100 years before.

In 1848–72 the group to which were allocated the largest proportion of the deaths at all ages were the infectious diseases with one-third of the total; and these were followed by the respiratory, nervous and digestive diseases. In 1947, on the other hand, diseases of the circulatory system came first with rather more than one-third of the total at all ages, and these were followed by cancer.

Changes in proportionate mortality rates from various causes have been examined at successive ages from infancy to old age. There was a decline in proportionate mortality from the infectious diseases other than tuberculosis, but increased mortality from tuberculosis in the younger age groups and from violence, circulatory diseases and cancer.

The trends of absolute mortality from the various causes were also studied. The reduction in total mortality was such that whereas there were half a million deaths of civilians registered in England and Wales in 1947, the total would have been over a million had the death rates of 1848–72 still prevailed.

The article concludes with a brief review of the factors responsible for the changes that have taken place.     

A Comparison of US and Canadian Mortality in 1998

On average, Americans die earlier than Canadians. An estimate based on comparing the number of actual US deaths with the number that would have obtained had Canadian age‐ and sex‐specific death rates applied to the US population shows an excess number of US deaths in 1998 amounting approximately to 253,000. Excess US deaths were especially numerous among older women, middle‐aged men, and nonwhites. Circulatory diseases were the major cause of excess deaths. Prevalences of two of the major risk factors for circulatory deaths—smoking and hypertension—were higher in Canada than in the US. But obesity was higher in the US, suggesting a likely important role that obesity plays in higher mortality in the US relative to Canada. Comparisons of the level, age pattern, and causes of US and Canadian mortality, however, raise more questions than currently available data can answer.     

The estimation of adult mortality in Africa from data on orphanhood

Summary Until recently, very little information has been available about the levels and patterns of adult mortality in tropical Africa, but during the past decade several countries have included questions in censuses and surveys as to whether a person's father and mother are still alive. From the data so obtained, estimates of adult mortality have been prepared. This paper compares the results of three such exercises with alternative estimates of adult mortality derived from other sources. In the case of Chad, the orphanhood data obtained in the demographic sample survey of 1964 yielded estimates of mortality which agreed reasonably closely with those obtained from questions on deaths of household members occurring during the twelve months preceding the survey. The latter data however were themselves subject to substantial errors and had to be corrected using techniques based on stable population theory. For Kenya, the orphanhood questions were included in the 1969 census and the results were compared with the mortality estimates derived from inter-censal survival from 1962 to 1969. Once again, the data obtained from the latter were subject to error but in general appeared to be consistent with the orphanhood estimates. The third comparison was made from Malawi, where alternative mortality figures were available from the Malawi Population Change survey which was a 'dual record' type of operation, conducted in 1971/2. The agreement in this case was remarkably close, once the number of deaths had been corrected for omissions by both systems with allowance for positive correlation. It is concluded that as a simple and inexpensive technique of estimating adult mortality, the orphanhood approach has much to recommend it.     

Infant Mortality Rate as a Measure of a Country’s Health: A Robust Method to Improve Reliability and Comparability

Researchers and policymakers often rely on the infant mortality rate as an indicator of a country’s health. Despite arguments about its relevance, uniform measurement of infant mortality is necessary to guarantee its use as a valid measure of population health. Using important socioeconomic indicators, we develop a novel method to adjust country-specific reported infant mortality figures. We conclude that an augmented measure of mortality that includes both infant and late fetal deaths should be considered when assessing levels of social welfare in a country. In addition, mortality statistics that exhibit a substantially high ratio of late fetal to early neonatal deaths should be more closely scrutinized.     

Cardiovascular and Tuberculosis Mortality: The Contrasting Effects of Changes in Two Causes of Death

Tuberculosis was the largest source of deaths among younger adults, and cardiovascular disease among older adults, in the America of 1900. Decreases in deaths from tuberculosis since 1900 and cardiovascular disease since 1940 explain most of the mortality drops in those age groups over the century. This article, building on previous work by White and Preston, shows the results of increased survival from these two causes on the US population structure. Standard demographic cause-specific mortality calculations are used to generate life tables without deaths from cardiovascular disease or tuberculosis. Then fixed rates for these diseases from early in the century are assumed while all other causes of death are allowed to change as they did historically. Improvements in cardiovascular mortality and tuberculosis produce some seemingly illogical contrasts. More people are alive today because of the decrease in tuberculosis. Yet more deaths from cardiovascular disease have been prevented, and cardiovascular improvements have raised life expectancy more. Lower tuberculosis mortality had virtually no effect on the average age of the population. Lower cardiovascular mortality alone has raised that average more than all twentieth-century causes of improved mortality combined.     

A problem in measuring infant mortality]

Infant mortality rates refer to the number of infant deaths in a given calendar year divided by the total number of births for the same year. It is argued that this definition presents a logical problem, such that if "infant" is defined as any child less than 1 year old, then the set of criteria for infants born in January of the given calendar year is totally different for that of infants born in December. Due to the tremendous significance of infant mortality rates in assessing the socioeconomic growth of a given area, discrepancies such as the problem presented cannot be easily overlooked, particularly where small populations are concerned. A more accurate yet problematic approach for small populations, i.e., calculating the rate of infant mortality based on infant birthdays, using proposed linear regression scheme is presented.