Examining sex differences in the completeness of Peruvian CRVS data and adult mortality estimates

The production, compilation, and publication of death registration records is complex and usually involves many institutions. Assessing available data and the evolution of the completeness of the data compiled based on demographic techniques and other available data sources is of great importance for countries and for having timely and disaggregated mortality estimates. In this paper, we assess whether it is reasonable, based on the available data, to assume that there is a sex difference in the completeness of male and female death records in Peru in the last 30 years. In addition, we assess how the gap may have evolved with time by applying two-census death distribution methods on health-related registries and analyzing the information from the Demographic and Health Surveys and civil registries. Our findings suggest that there is no significant sex difference in the completeness of male and female health-related registries and, consequently, the sex gap currently observed in adult mortality estimates might be overestimated.

Applying Benford’s Law to Monitor Death Registration Data: A Management Tool for the COVID-19 Pandemic

In Spain, the COVID-19 pandemic has impacted the various regions of the country differently. The availability of reliable and up-to-date information has proved to be fundamental for the management of this health crisis. However, especially during the first wave of the pandemic (February–August 2020), the disparity in the recording criteria and in the timing of providing these figures to the central government created controversy and confusion regarding the real dimension of the pandemic. It is therefore necessary to have objective and homogeneous criteria at the national level to guide health managers in the correct recording and evaluation of the magnitude of the pandemic. Within this context, we propose using Benford’s Law as an auditing tool to monitor the reliability of the number of daily COVID-related deaths to identify possible deviations from the expected trend.

An Assessment of Knowledge, Attitude, and Practices of Birth and Death Registration in Kilifi County in the Coastal Region in Kenya

Background. Countries need vital statistics for social and economic planning. World Health Organization (WHO) recommends at least 80% coverage to use registration data on births and deaths for social and economic planning. However, registration remains low in developing countries. National coverage for Kenya in 2014 was 62.2% for births and 45.7% for deaths, with wide regional differentials. Kilifi County in the coastal region in Kenya reported rates below the national coverage at 56% for births and 41% for deaths in 2013. Objective. To determine level of knowledge and practice and reasons for low coverage of birth and death in Kilifi County. Method. This is a descriptive cross-sectional study that employed multistage cluster random sampling procedure to select a sample of 420 households from which household heads and women with children below five years old were surveyed. Results. Out of the 420 households sampled, about all respondents (99%) were aware of birth registration while death was 77%. Their main sources of information were assistant chiefs at 77% for both birth and death registration and family and friends at 67% for deaths and 52% for births. Coverage for birth registration was 85% and death 63%. More deaths occurred at home (55%) than in hospital (44%) while 55% of deliveries occurred in hospital and 44% at home. Main reasons for not registering death were ignorance (77%) and transport and opportunity cost (21%) while for birth registration were ignorance (42%), travel and opportunity cost (41%), lack of identification documents (9%), and home deliveries (7%). Conclusion. Registration of birth and death has improved in Kilifi County. The drivers are legal and requirements to access social rights. Reasons for not registering are ignorance and opportunity costs. Community should be sensitized on the importance of registration, address home deliveries and deaths, and increase efficiency in registration. Further research is recommended to determine the severity of teenage pregnancy and orphanhood in the county.

Are there sex differences in completeness of death registration and quality of cause of death statistics? Results from a global analysis

IntroductionRecent studies suggest that more male than female deaths are registered and a higher proportion of female deaths are certified as ‘garbage’ causes (ie, vague or ill-defined causes of limited policy value). This can reduce the utility of sex-specific mortality statistics for governments to address health problems. To assess whether there are sex differences in completeness and quality of data from civil registration and vital statistics systems, we analysed available global death registration and cause of death data.MethodsCompleteness of death registration for females and males was compared in 112 countries, and in subsets of countries with incomplete death registration. For 64 countries with medical certificate of cause of death data, the level, severity and type of garbage causes was compared between females and males, standardised for the older age distribution and different cause composition of female compared with male deaths.ResultsFor 42 countries with completeness of less than 95% (both sexes), average female completeness was 1.2 percentage points (p.p.) lower (95% uncertainty interval (UI) −2.5 to –0.2 p.p.) than for males. Aggregate female completeness for these countries was 7.1 p.p. lower (95% UI −12.2 to −2.0 p.p.; female 72.9%, male 80.1%), due to much higher male completeness in nine countries including India. Garbage causes were higher for females than males in 58 of 64 countries (statistically significant in 48 countries), but only by an average 1.4 p.p. (1.3–1.6 p.p.); results were consistent by severity and type of garbage.ConclusionAlthough in most countries analysed there was no clear bias against females in death registration, there was clear evidence in a few countries of systematic undercounting of female deaths which substantially reduces the utility of mortality data. In countries with cause of death data, it was only of marginally poorer quality for females than males.

Motivations and barriers to death registration in Dakar, Senegal

Strengthening civil registration systems requires a better understanding of motivations and barriers related to the registration of deaths. We used data from the 2013 Senegalese census to identify deaths that are more likely to be registered in the Dakar region, where the completeness of death registration is higher than 80%. We also interviewed relatives of the deceased whose death had been registered to collect data on reasons for registration and sources of information about the process. The likelihood of death registration was positively associated with age at death and household wealth. Death registration was also more likely in households whose head was older, had attended school, and had a birth certificate. At the borough commune level, the geographical accessibility of civil registration centres and population density were both positively associated with completeness of death registration. The main motivations for registering deaths were compliance with the legal obligation to do so and willingness to obtain a burial permit and a death certificate. Families, health facilities, and friends were the primary sources of information about death registration. Further research is needed to identify effective interventions to increase death registration completeness in Dakar, particularly amongst the poorest households and neighbourhoods on the outskirts of the city.

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

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.

International Completeness of Death Registration 2015-2019

Death registration completeness, the share of deaths captured by countries' vital registration systems, vary substantially across countries. Estimates of completeness, even recent ones, are outdated or contradictory for many countries. In this short paper, I utilize the annual amount of deaths registered in 139 vital registration systems around the world to provide the most up-to-date estimates of death-registration completeness from 2015 to 2019.

Adjusting Reported COVID-19 Deaths for the Prevailing Routine Death Surveillance in India

In India, the “low mortality” narrative based on the reported COVID-19 deaths may be causing more harm than benefit. The extent to which COVID-19 deaths get reported depends on the coverage of routine death surveillance [death registration along with medical certification of cause of death (MCCD)] and the errors in MCCD. In India, the coverage of routine death surveillance is 18.1%. This is compounded by the fact that COVID-19 death reporting is focused among reported cases and the case detection ratio is low. To adjust for the coverage of routine death surveillance and errors in MCCD, we calculated a correction (multiplication) factor at national and state level to produce an estimated number of COVID-19 deaths. As on July 31, 2020, we calculated the infection fatality ratio (IFR) for India (0.58:100–1.16:100) using these estimated COVID-19 deaths; this is comparable with the IFR range in countries with near perfect routine death surveillance. We recommend the release of excess deaths data during COVID-19 (at least in states with high death registration) and post-mortem COVID-19 testing as a surveillance activity for a better understanding of under-reporting. In its absence, we should adjust reported COVID-19 deaths for the coverage of routine death surveillance and errors in MCCD. This way we will have a clear idea of the true burden of deaths and our public health response will never be inadequate. We recommend that “reported” or “estimated” is added before the COVID-19 death data and related indicators for better clarity and interpretation.