Have inequalities in completeness of death registration between states in India narrowed during two decades of civil registration system strengthening?

Abstract Background In India the number of registered deaths increased substantially in recent years, improving the potential of the civil registration and vital statistics (CRVS) system to be the primary source of mortality data and providing more families of decedents with the benefits of possessing a death certificate. This study aims to identify whether inequalities in the completeness of death registration between states in India, including by sex, have narrowed during this period of CRVS system strengthening. Methods Data used in this study are registered deaths by state and year from 2000 to 2018 (and by sex from 2009 to 2018) reported in the Civil Registration Reports published by the Office of Registrar General of India. Completeness of death registration is calculated using the empirical completeness method. Levels and trends inequalities in completeness are measured in each state a socio-economic indicator – the Socio-Demographic Index (SDI). Results Estimated completeness of death registration in India increased from 58% in 2000 to 81% in 2018. Male completeness rose from 60% in 2009 to 85% in 2018 and was much higher than female completeness, which increased from 54 to 74% in the same period. Completeness remained very low in some states, particularly from the eastern (e.g. Bihar) and north-eastern regions. However, in states from the northern region (e.g. Uttar Pradesh) completeness increased significantly from a low level. There was a narrowing of inequalities in completeness according to the SDI during the period, however large inequalities between states remain. Conclusions The increase in completeness of death registration in India is a substantial achievement and increases the potential of the death registration system as a routine source of mortality data. Although narrowing of inequalities in completeness demonstrates that the benefits of higher levels of death registration have spread to relatively poorer states of India in recent years, the continued low completeness in some states and for females are concerning. The Indian CRVS system also needs to increase the number of registered deaths with age at death reported to improve their usability for mortality statistics.

Download Full-text

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

American Journal of Public Health ◽

10.2105/ajph.2021.306203 ◽

2021 ◽

pp. e1-e9

Author(s):

Carla AbouZahr ◽

Martin W. Bratschi ◽

Emily Cercone ◽

Anushka Mangharam ◽

Don de Savigny ◽

...

Keyword(s):

Web Sites ◽

Vital Statistics ◽

Data Systems ◽

Death Registration ◽

Registration System ◽

Civil Registration ◽

Essential Services ◽

Core Components ◽

Media Reports ◽

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. (Am J Public Health. Published online ahead of print April 15, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306203 )

Download Full-text

Evaluation of civil registration and vital statistics system in the Maldives: Focus on mortality statistics

Statistical Journal of the IAOS ◽

10.3233/sji-200748 ◽

2020 ◽

Vol 36 (4) ◽

pp. 933-941

Author(s):

Sofoora Kawsar Usman ◽

Sheena Moosa

Keyword(s):

Cause Of Death ◽

Causes Of Death ◽

Time Lag ◽

International Classification Of Diseases ◽

Vital Statistics ◽

Mortality Data ◽

Death Registration ◽

Quality Of Data ◽

Civil Registration

An efficient Civil Registration and Vital Statistics (CRVS) system is a development imperative. Data on death registration and causes of death are important for measuring health outcomes. This paper evaluates the completeness and quality of data on death registration and causes of death (CoD) based on analysis of the registration records on death and causes of death for the period 2009–2018. Using established methods and approaches, we observed that CRVS system performed well on death registration completeness, quality of age and sex reporting. However, the quality of cause of death data was poor with 50% of the International Classification of Diseases (ICD) codes classified as “major garbage codes” and significant time lag was observed in the transmission and production of vital statistics. The CRVS system in Maldives is complete with all deaths occurring within its territory registered and causes of death recorded. The two areas that require attention are the time taken for publication of vital statistics and quality of cause of death reporting. Appropriate re-engineering of the existing business process can build real-time mortality data, and regular quality assessment of death certificates with feedback to health facilities can bring sustained improvements in quality of vital statistics.

Download Full-text

The Epidemiology of Human Mortality in West Azerbaijan Province, Iran, 2016

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v10i4.30049 ◽

2020 ◽

Vol 10 (4) ◽

pp. 30049.1-30049.9

Author(s):

Flora Farivarnia ◽

◽

Rasool Entezarmahdi ◽

Mohammad Delirrad ◽

◽

...

Keyword(s):

Urban Areas ◽

Causes Of Death ◽

Vital Statistics ◽

Mortality Data ◽

Local Health ◽

Death Registration ◽

Registration System ◽

Human Mortality ◽

Significant Difference ◽

West Azerbaijan

Background: This article presents the most recent mortality data in West Azerbaijan Province (WAP) of Iran in 2016 based on selected characteristics, including age, sex, state of residence, and cause of death. Methods: After the local Ethics Committee approval, we obtained the data for this systematic database study from the local health registration office. The causes of death are processed following the International Classification of Diseases, tenth revision (ICD-10). The vital statistics were refined from the yearbooks of the National Organization for Civil Registration. Results: In 2016, a total of 14688 deaths were registered in the Health Death Registration System (HDRS) and 14622 in the Civil Death Registration System (CDRS) of WAP (~4% of Iran’s mortality). The Crude Mortality Rate (CMR) was 4.30 per 1000, showing an increase of 7.5% from the 2011 rate. Of the deceased, 56.9% were males, and 60% were attributed to urban areas. On average, men died 4 years earlier than women (61.2 vs 65.3 years, respectively). The major causes of death in 2016 remained the same as in 2011. Conclusion: The pattern of human mortality in WAP is comparatively consistent with the other regions of Iran except for the higher rate of neoplasms (19.6% compared to 10.7% of the country average) and the lower ratio of certain infectious and parasitic diseases (1% compared to 3.8% of the national average). There was a significant difference in registering the state of residence between HDRS and CDRS, which is highly recommended for further investigation in future studies.

Download Full-text

Civil registration system (CRS) for birth and death registration in Assam – A rapid assessment

Clinical Epidemiology and Global Health ◽

10.1016/j.cegh.2019.05.006 ◽

2020 ◽

Vol 8 (1) ◽

pp. 117-122

Author(s):

Tushar Manohar Rane ◽

Tulika Goswami Mahanta ◽

Safikul Islam ◽

Pranjal Pratim Gogoi ◽

Bivash Gogoi

Keyword(s):

Rapid Assessment ◽

Death Registration ◽

Civil Registration System ◽

Registration System ◽

Civil Registration

Download Full-text

Assessing mortality registration in Kerala: the MARANAM study

Genus ◽

10.1186/s41118-021-00149-z ◽

2022 ◽

Vol 78 (1) ◽

Author(s):

Aashish Gupta ◽

Sneha Sarah Mani

Keyword(s):

Vital Statistics ◽

Middle Income ◽

Registration System ◽

Individual Level ◽

Civil Registration ◽

Middle Income Countries ◽

Registration Data ◽

Life Expectancy At Birth ◽

Sample Registration System ◽

Low And Middle Income

AbstractComplete or improving civil registration systems in sub-national areas in low- and middle-income countries provide several opportunities to better understand population health and its determinants. In this article, we provide an assessment of vital statistics in Kerala, India. Kerala is home to more than 33 million people and is a comparatively low-mortality context. We use individual-level vital registration data on more than 2.8 million deaths between 2006 and 2017 from the Kerala MARANAM (Mortality and Registration Assessment and Monitoring) Study. Comparing age-specific mortality rates from the Civil Registration System (CRS) to those from the Sample Registration System (SRS), we do not find evidence that the CRS underestimates mortality. Instead, CRS rates are smoother across ages and less variable across periods. In particular, the CRS records higher death rates than the SRS for ages, where mortality is usually low and for women. Using these data, we provide the first set of annual sex-specific life tables for any state in India. We find that life expectancy at birth was 77.9 years for women in 2017 and 71.4 years for men. Although Kerala is unique in many ways, our findings strengthen the case for more careful attention to mortality records within low- and middle-income countries, and for their better dissemination by government agencies.

Download Full-text

Gender Inequalities and Sex-Differential Mortality in Pre-War Greece: A Regional Perspective

Genealogy ◽

10.3390/genealogy6010005 ◽

2022 ◽

Vol 6 (1) ◽

pp. 5

Author(s):

Vasilis S. Gavalas ◽

Pavlos Baltas

Keyword(s):

Sex Ratios ◽

Vital Statistics ◽

Differential Mortality ◽

Gender Inequalities ◽

Registration System ◽

Civil Registration ◽

Unequal Treatment ◽

Demographic Indices ◽

Gender Based ◽

Sex Differential Mortality

Previous studies have indicated gender-based discriminatory practices as a result of son preference up to the first half of the 20th century in Greece. Demographic indices calculated from published vital statistics, such as sex ratios at birth and at childhood, were distorted to such an extent that certain scholars suggest that this distortion was due to sex-selective infanticide and neglect of the girls. Although we cannot exclude this possibility, the aim of this paper is to assess to what extent under-registration of female births (in the civil registration system) and under-enumeration of females (in censuses) accounted for the skewed sex ratios and to pinpoint that gender-based discrimination was not the same all over Greece. There were areas in insular Greece, notably the Ionian islands and the Aegean Archipelago, and one area in mainland Greece (Epirus) where demographic indices imply that gender inequalities were less acute. On the other hand, there were areas in mainland Greece, notably in Thessaly, where sex-differential mortality denotes extremely unequal treatment of girls.

Download Full-text

Temporal and spatial estimates of adult mortality for small areas in Brazil, 1980-2010

10.31219/osf.io/jk67t ◽

2017 ◽

Author(s):

Bernardo L Queiroz ◽

Everton Lima ◽

Flávio Freire ◽

Marcos Roberto Gonzaga

Keyword(s):

Health Planning ◽

Population Data ◽

Adult Mortality ◽

Vital Statistics ◽

Mortality Data ◽

Mortality Pattern ◽

Registration System ◽

Small Areas ◽

Over Time

BACKGROUNDThe study of mortality level and trends in developing countries is limited by the quality of vital registration system and population data, especially for small areas. However, understanding regional differences in data quality and mortality is crucial for public health planning. OBJECTIVEThe paper aims to estimate adult mortality levels for small-areas in Brazil and to examine variations and spatial patterns of adult mortality across regions, overtime and by sex in the countryMETHODSWe combine a three-method strategy. We apply a standardization technique to smooth rates in small areas. We then obtained measures of completeness of death counts coverage using Death Distribution Methods. And spatial analysis to investigate variations and patterns of adult mortality in small areas of the country.RESULTSWe find that completeness of death counts coverage improved overtime across the country. We observed that regions in the south and southeast have complete death registration systems and areas in the less developed regions are improving. We observe a large and constant differential in adult mortality by sex and regions.CONCLUSIONSWe find that the quality of mortality data in Brazil and regions is improving over time. The improvement is mostly explain by public investments in collection health data. Gender differences remained high over the period of analysis due to the increase in external causes of deaths for males. This increase also explains the concentration of high mortality levels for males in some areas of the country. CONTRIBUTIONA new methodological procedure on estimating and analyzing the evolutions on adult mortality pattern over time and across smaller areas on the presence of defective data, on both vital statistics and population data.

Download Full-text

Benefits of linking civil registration and vital statistics with identity management systems for measuring and achieving Sustainable Development Goal 3 indicators

Journal of Health Population and Nutrition ◽

10.1186/s41043-019-0178-0 ◽

2019 ◽

Vol 38 (S1) ◽

Cited By ~ 3

Author(s):

Samuel Mills ◽

Jane Kim Lee ◽

Bahie Mary Rassekh

Keyword(s):

Health Care ◽

Sustainable Development ◽

Vital Statistics ◽

Identification System ◽

Sustainable Development Goal ◽

Registration System ◽

Development Goal ◽

Civil Registration ◽

National Identification ◽

The Government

Abstract A complete civil registration and vital statistics system is the best source of data for measuring most of the Sustainable Development Goal 3 indicators. However, civil registration does not include migration data, which are necessary for calculating the actual number of people living in a given area and their characteristics such as age and sex. This information is needed to facilitate planning, for example, for school places, health care, infrastructure, etc. It is also needed as the denominator for the calculation of a range of health and socioeconomic indicators. Obtaining and using these data can be particularly beneficial for measuring and achieving universal health coverage (Target 3.8), because civil registration can help to identify persons in need of health care and enable decision-makers to plan for the delivery of essential services to all persons in the country, including the most disadvantaged populations. By assigning unique identification numbers to individuals, for example, at birth registration, then using these numbers to link the individuals’ data from civil registration, national identification, and other functional registers, including registers for migration and health care, more accurate and disaggregated population values can be obtained. This is also a key to improving the effectiveness of and access to social services such as education, health, social welfare, and financial services. When civil registration system in a country is linked with its national identification system, it benefits both the government and its citizens. For the government, having reliable and up-to-date vital events information on its citizens supports making informed program and policy decisions, ensuring the accurate use of funds and monitoring of development programs at all levels. For individuals, it makes it easier to prove one’s identity and the occurrence of vital events to claim public services such as survivor benefits or child grants.

Download Full-text

Subnational mortality estimates for India in 2019: a baseline for evaluating excess deaths due to the COVID-19 pandemic

BMJ Global Health ◽

10.1136/bmjgh-2021-007399 ◽

2021 ◽

Vol 6 (11) ◽

pp. e007399

Author(s):

Chalapati Rao ◽

Amrit Jose John ◽

Ajit Kumar Yadav ◽

Mansha Siraj

Keyword(s):

Excess Mortality ◽

National Level ◽

Age Groups ◽

Uttar Pradesh ◽

The Elderly ◽

Registration System ◽

Infant Deaths ◽

Civil Registration ◽

The Impact ◽

Mortality Estimates

BackgroundEstimates of excess mortality are required to assess and compare the impact of the COVID-19 pandemic across populations. For India, reliable baseline prepandemic mortality patterns at national and subnational level are necessary for such assessments. However, available data from the Civil Registration System (CRS) is affected by incompleteness of death recording that varies by sex, age and location.MethodsUnder-reporting of CRS 2019 deaths was assessed for three age groups (< 5 years, 15–59 years and ≥60 years) at subnational level, through comparison with age-specific death rates from alternate sources. Age-specific corrections for under-reporting were applied to derive adjusted death counts by sex for each location. These were used to compute life expectancy (LE) at birth by sex in 2019, which were compared with subnational LEs from the Global Burden of Disease (GBD) 2019 Study.ResultsA total of 9.92 million deaths (95% UI 9.70 to 10.02) were estimated across India in 2019, about 2.28 million more than CRS reports. Adjustments to under-five and elderly mortality accounted for 30% and 56% of additional deaths, respectively. Adjustments in Bihar, Jharkhand, Madhya Pradesh, Maharashtra, Rajasthan and Uttar Pradesh accounted for 75% of all additional deaths. Adjusted LEs were below corresponding GBD estimates by ≥2 years for males at national level and in 20 states, and by ≥1 year for females in 12 states.ConclusionsThese results represent the first-ever subnational mortality estimates for India derived from CRS reported deaths, and serve as a baseline for assessing excess mortality from the COVID-19 pandemic. Adjusted life expectancies indicate higher mortality patterns in India than previously perceived. Under-reporting of infant deaths and those among women and the elderly is evident in many locations. Further CRS strengthening is required to improve the empirical basis for local mortality measurement across the country.

Download Full-text

Deficiency in civil registration and vital statistics reporting in remote areas: the case of Sabah, Malaysia

Genus ◽

10.1186/s41118-021-00132-8 ◽

2021 ◽

Vol 77 (1) ◽

Author(s):

Siow Li Lai ◽

Nai Peng Tey

Keyword(s):

National Level ◽

Data Entry ◽

Vital Statistics ◽

Birth Registration ◽

Registration System ◽

The Sustainable Development ◽

Remote Areas ◽

Civil Registration ◽

The 1960S ◽

Effective Development

AbstractMalaysia has a well-established civil registration system dating back to the 1960s. Birth registration is virtually complete at the national level. However, the quality of civil registration in some remote areas is doubtful, as evidenced by the abnormally low birth and death rates in several districts. This study focuses on identifying districts in Sabah, where the reporting of births seems problematic. Sabah is the least developed state in Malaysia, and it is sparsely populated, despite being the second most populous state in the country. Sabah’s civil registration lags behind the other states, to the extent that birth and death statistics were not reported for the state in the vital statistics report for the period 2000 to 2009. A 2016 study found that death registration is almost 100%, except for Sabah (88%). The plausible reasons behind the ultra-low birth rate reported in several remote districts in Sabah include misreporting of the place of occurrence as the usual residence, delayed reporting, non-coverage, ignorance of the law, inaccessibility, presence of a large number of migrants, miscommunication, and errors in data entry. The under-reporting of births may have serious consequences, such as misallocation of resources and deprivation of services to those affected. In line with the transformative promise of “leaving no one behind,” the Sustainable Development Goals urge all countries to strive to improve data quality for planning; this includes complete birth registration for creating effective development programs to reach target groups more effectively.

Download Full-text