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Epidemiological Bulletin Pan American Health Organization: Celebrating 100 Years of Health

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Epidemiological Bulletin Pan American Health Organization: Celebrating 100 Years of Health Epidemiological Bulletin Pan American Health Organization: Celebrating 100 Years of Health Vol. 23, No. 2 June 2002 Situation Analysis of Mortality in Bolivia Introduction crude mortality rates and life expectancy at birth for Latin The latest report on mortality in Bolivia was issued in America, Bolivia, and the 9 departments of Bolivia in the pe- 2 1990. The three leading causes of death were infectious and riods 1990-1995 and 2000-2005. parasitic diseases (23.9%), diseases of the circulatory sys- The most recent survey on demography and health, im- tem (19.5%), and diseases of the respiratory tract (14%), fol- plemented in 1998, estimated the infant mortality rate in Bo- lowed by accidents and violence (9.8%), disorders of the livia at 67 per 1,000 live births and the under five mortality digestive system (8.6%), affections originating in the perina- rate at 92 per 1,000 live births for the period 1993-1997.3 For tal period (7.4%), and tumors (4%).1 the year 2002, MHSW and PAHO estimated those rates at 50 4 Bolivia lacks a national vital statistics information sys- and 72 per 1,000 live births, respectively. Figure 1 presents tem and the process of automation and modernization of the the proportional distribution of mortality in the under 5 by 4 national civil registration system, which is dependent on the registered cause. National Electoral Court (Corte Nacional Electoral, CNE), is Under-registration of mortality was estimated at 63% in slow in coming. A recent inter-institutional coordination ef- 1999, with variations in the departments ranging between fort by the Ministry of Health and Social Welfare (MHSW), 47% in Beni and 89% in Pando. Table 2 presents estimates the National Directorate of Civil Registration (Dirección Na- provided by the DNRC of mortality under-registration by de- cional de Registro Civil, DNRC), and the National Institute of partment for this same year, calculated from estimated popu- Statistics (Instituto Nacional de Estadísticas, INE) is trying lation data, crude mortality rates, and expected and regis- to solve this problem. In 2002, a collection system for medi- cally certified deaths has been put in place in all the hospitals Table 1: Crude mortality rate and life expectancy at birth of the national health system, using a standard death certif- for Latin America and Bolivia and its departments, 1990-1995 and 2000-2005 icate. Crude mortality rate Life expectancy at birth As part of the technical cooperation that PAHO pro- (both sexes) (both sexes) vides to the Ministry of Health to strengthen the health in- 1990-1995 2000-2005 1990-1995 2000-2005 formation system, epidemiological surveillance, and health situation analysis in the country, a plan for the study of mor- Latin America 8.3 7.7 65.4 68.1 tality was implemented, covering the years 2000 and 2001. Bolivia 10.2 8.2 59.3 63.6 This study was carried out using registries of medically cer- La Paz 9.8 8.6 60.5 61.7 tified deaths from 9 cemeteries located in departmental capi- Santa Cruz 7.2 5.9 63.7 67.7 10.5 8.3 59.1 63.2 tal cities, representing about 43% of the Bolivian population. Cochabamba Tarija 8.1 6.6 63.1 67.3 Current situation Potosi 14.7 11.1 53.0 58.9 For 2000-2005, INE and the Latin American Demography Beni 10.5 8.0 57.4 61.9 Center (CELADE for its Spanish name) estimates Bolivia’s Pando 9.7 7.8 58.0 62.6 11.8 8.9 57.8 62.2 crude death rate to be 8.2 per 1,000 population and life ex- Chuquisaca Oruro 13.3 10.8 53.7 59.3 pectancy 63.6 years for the same period. Table 1 presents the Source: INE/CELADE IN THIS ISSUE . • Health Situation Analysis: • Norms and Standards in Epidemiology: − Situation Analysis of Mortality in Bolivia − Case definitions: Acute Viral Hepatitis; Leprosy. − The Global Youth Tobacco Survey: Results in the Americas • A Glossary for Social Epidemiology (Part II) Figure 1: Proportional distribution of mortality in migratory movements to these departments recorded in oth- children under five years of age by major groups of causes er demographic reports.6 To reduce the natality under-regis- of death, Bolivia, 1994-1997 tration, a proposal is in place to cancel the present fees for the registration of newborns in civil registration offices. Study of Mortality 2000 The study included 10,744 medically certified death records in 21 cemeteries in the 9 departmental capitals (1 by city, except Santa Cruz, where 13 cemeteries were used). Cem- eteries were selected for their geographic location, whether they belonged to the municipal or public system, and the availability of mortality records and data from the year 2000.7 Information was collected from death certificates in the civil registry from the year 2000. When the medical death certification was issued on a document that did not corre- spond to the official death certificate, the information was collected through a specially-designed, validated instrument. This process was followed in less than 5% of the cases. Du- tered deaths. In the case of the Department of La Paz, the plicate certificates, certificates issued for persons who had information is also presented for the capital city, called “Sala died outside of the country, and incomplete certificates (with- Murillo”, and for the remainder of the Department. out age, sex, or diagnosis) were excluded. These correspond- ed to 2.4% of all registries. The International Statistical Clas- Aside from under-registration, another problem in mor- sification of Diseases and Related Health Problems, Tenth tality data is the quality of death certification. A study of the Revision, was used to code the data. PAHO’s 6/67 list (6 quality of death registration in the La Paz general cemetery groups, 67 subgroups) was used to group mortality causes.8 (S. Murillo), found that “cardio-respiratory arrest” was used in 57% of the certificates, which only indicates that the per- Estimated numbers of deaths were based on the regis- son died, without providing any information on the cause of tered deaths collected for the study, using procedures rec- 5 death. ommended by PAHO to adjust for under-registration and ill- defined deaths.9 Table 4 presents the number of collected The limitations in the mortality registration, whether re- certificates and estimated deaths by capital city, as well as lated to coverage (under-registration) or data quality, are also the reference population. The reference population was de- encountered in the birth registry system. In 1999, under-reg- fined as the fraction of the departmental population propor- istration of births was estimated at 34%, with values ranging tional to the “collection coverage” for each cemetery. The between 0% in Tarija and Pando and 63% in Santa Cruz (table “collection coverage” was defined in each cemetery as the 3). Reported under-registration of 0% in the departments of proportion of certificates collected, with respect to the total Tarija and Pando may be attributed to the use of demograph- of deaths in the civil registry in each department in 1999. ic estimators that do not take into account recent substantial Table 2: Estimation of mortality under-registration in the National Vital Statistics System, based on civil registration, Bolivia and departments, 1999 Crude Mortality Rate Expected Registered Under-registration Department Population1 (per 1,000)2 deaths deaths % registered (%) La Paz 2,359,724 9.3 21,899 9,901 45 55 Sala Murillo 786,812 9.3 7,302 6,807 93 7 Rest of the Department 1,572,912 9.3 14,597 3,094 21 79 Santa Cruz 1,757,409 6.5 11,458 2,789 24 76 Cochabamba 1,484,867 9.4 13,913 6,056 44 56 Tarija 391,225 7.3 2,844 1,441 51 49 Potosi 765,254 12.5 9,566 3,040 32 68 Beni 355,983 9.0 3,186 1,700 53 47 Pando 55,885 8.6 479 54 11 89 Chuquisaca 576,287 10.1 5,838 811 14 86 Oruro 390,478 11.9 4,627 1,724 37 63 Total 8,137,112 9.1 73,966 27,516 37 63 Source: 1 INE projection, 1999, 2 INE estimation, PRODEM 2.0, CELADE, INE, 1996, 3 National Civil Registration Directorate, National Electoral Court, 1999 2 Epidemiological Bulletin / PAHO, Vol. 23, No. 2 (2002) Table 3: Estimation of natality under-registration in the National Vital Statistics System, based on civil registration, Bolivia and departments, 1999 Crude Birth Rate (p. Registered Under- Department Population1 1,000)2 Expected births births % registered registration (%) La Paz 2,359,724 31.4 74,095 51,626 70 30 Sala Murillo 786,812 31.4 24,706 22,124 90 10 Rest of the Department 1,572,912 31.4 49,389 29,502 60 40 Santa Cruz 1,757,409 33.7 59,277 21,830 37 63 Cochabamba 1,484,867 34.3 50,886 44,340 87 13 Tarija 391,225 33.3 13,016 13,006 100 0 Potosi 765,254 33.6 25,713 23,143 90 10 Beni 355,983 36.7 13,061 7,250 56 44 Pando 55,885 32.4 1,808 1,802 100 0 Chuquisaca 576,287 36.2 20,844 9,355 45 55 Oruro 390,478 30.4 11,851 7,462 63 37 Total 8,137,112 33.2 270,478 179,814 66 34 Source: 1 INE projection, 1999, 2 INE estimation, PRODEM 2.0, CELADE, INE, 1996, 3 DNRC, CNE, 1999 The proportional distribution of mortality by major cause 100,000 population for the 9 capital cities studied and for of death groups is presented in table 5.
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