Poster Session on Health, mortality and longevity (4)

Mortality Information System (MIS) with responsibility for compiling cause of death data in Brazil was created by Ministry of Heath in 1975. Despite MIS continuous improvements, Brazil was categorized in 2000 as producing medium-quality death registration data. The aim of this proposal is to evaluate the evolution of quality of causes of death data, to describe the profile of deceased with ill-defined or unspecified cause of death and to evaluate the impact of the improvement of quality of data on mortality levels from some specific causes of death among adults and elders (15-59 and 60+) in Brazil from 1980 to 2010. For evaluating cause of death data quality we considered the criteria of completeness and validity. To analyze the profile of deceased with ill-defined cause of death, socio-demographic characteristics and variables on circumstances of death and its certification are considered. Although the important improvement in levels of completeness and validity of causes of death data in Brazil, especially after 2005, differences in quality of data among regions, age and other characteristics persist. With population rapidly aging, to assess quality of data on adult and elderly mortality in order to better evaluate health policy for these age groups is extremely important.

In the slums of Nairobi, like elsewhere in Africa, children whose mothers were never married or divorced face a significantly higher risk of dying than children whose parents are married. Drawing on both qualitative and longitudinal quantitative data from two informal settlements in Nairobi, this study explores possible causal mechanisms, paying particular attention to the importance of poverty. We find that children living in the wealthiest households are 22% less likely to have a single mother than children residing in the poorest households. In-depth interviews support these findings and reveal the daily struggles single mothers face in meeting their children’s basic needs. However, in contrast to studies from Western societies, we find little evidence that poverty is the missing link explaining the increased risk of mortality among children of single mothers. Instead, we contend that limited support from fathers, coupled with isolation from kin and discrimination from neighbors render these children particularly vulnerable.

The rate of decline in child mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five mortality by two-thirds between 1990 and 2015. Effective strategies to monitor child mortality are needed to help Governments assess and report on progress and to target their child survival programs. We present results from a test of a mortality monitoring approach based on recording of births and deaths by specially-trained community health workers (CHW) in Malawi. Mortality data collected by randomly-selected CHWs in two districts are compared to those of a “gold-standard” mortality survey. Results indicate that CHW reports under-estimated child mortality by 24% to 49%, and the level of under-estimation increased over time. The approach appears to hold some promise, however, because the vital events that were reported by the CHWs were accurate and reliable. We are now investigating further to determine patterns of errors so that CHW performance can be improved and sustained.

Deaths are not randomly distributed in the course of the year; they often exhibit distinct seasonal variations. In the northern hemisphere, seasonal patterns are mostly characterized by a summer trough and a winter peak in adult mortality, predominantly due to respiratory, cerebrovascular, and ischemic heart diseases. There has been little research conducted on seasonal mortality in developing countries because of the lack of adequate data. Tacking advantage of a long series of death records registered in the urban setting of Antananarivo since 1976, we examine seasonal patterns of all-cause and cause-specific mortality. We show that the seasonality of mortality is much more marked in young children and the elderly than in adults of working age. Child mortality is higher during the rainy season because of infectious and parasitic diseases, as well as nutritional deficiencies. By contrast, the elderly die more during the cold months of July and August, mainly because of diseases of the circulatory and respiratory systems. The seasonality of child deaths has significantly reduced over the last thirty years whereas it has not changed for people aged 60 and over.

The impact of housing conditions on under-five mortality will be examined in four major capital cities of the Regional States of Ethiopia.
There had been many studies on the influence of background and demographic variables on infant and childhood mortality, but, little studies and analysis have been done to investigate the housing determinants of infant and childhood mortality, despite the fact that Ethiopia has collected abundant empirical housing data from the previous censuses and DHS studies. Accordingly, the author is motivated to know how housing components determine the quality of urban life through the health status of under- five years of children.
The rationale and objectives of this study are to explore the influence of housing variables on under-five mortality rates and suggest recommendations for awareness to the urban health planners before the end of 2015 worldwide MDG.
With respect to methodology, use of frequency distributions of univariate and bivariate tables, indirect techniques of mortality estimations(ratios of observed and expected patterns, applying appropriate model life tables across various housing characteristics) and also application of multivariate and logistic regression analysis, where under-five mortality as dependent variable and housing characteristics as covariate.

Adult mortality in sub-Saharan Africa is very high and has been rising in the last two decades. Vital registration systems as main sources of adult mortality data are poorly developed in Kenya and many African countries. This paper explores adult mortality using data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) in two slums in Nairobi. These data are used to estimate levels, trends, causes of and factors associated with adult mortality. Using survival analysis and standard life table methodologies, mortality is estimated over a period of 5 years. A total of 1,513 adult deaths occurred.

Life expectancy and adult mortality estimates indicate a high risk of adult death in the slums with a mortality disadvantage for women. Life expectancy at 15 at the Nairobi DSS is lower than that many of the other surveillance sites. There were mortality differentials by slum of residence, gender, wealth status, ethnicity and education. Like it has been reported in some other populations affected by HIV/AIDS, adult mortality is higher among women contrary to expectation. HIV/AIDS and injuries are leading cause of death in women and men respectively. The decline in mortally over the years is real particularly among women and is attributable to reduction in HIV/AIDS-related deaths.

The aim of this study is to analyze mortality in relation to domestic migration. Swedish administrative registry data was used, and all Swedish born residents alive at the end of the year 2000 were included, 7,74 million people.

Migration was measured over the life course and defined as crossing the border of the birth municipality. This is the first time smaller geographic areas than birth counties has been analyzed for Sweden. We use three main groups of migration status: non-migrants, migrants and return migrants. Return migrants have lived part of their lives in another municipality but has returned to their birth municipality later.

Mortality was followed-up for the period 2001–2010. There were 833 000 deaths recorded. Measured by standardized mortality ratios, and for the entire country, domestic migrants had significantly low mortality, and non-migrants had significantly elevated mortality. Men who were classified as return migrants had the same elevated mortality as non-migrants. Among women return migrants had average mortality.

The variation in mortality by migration status differed by birth cohort and type of municipality. Preliminary findings from regression modeling suggest that education contributes to mortality differences by migration status in Sweden.

At present maternal mortality in Bangladesh are 194 per 100,000 live births. Unavailability of human resources especially skilled provider, shortage of logistics/supplies and delay of clients to come to the facility, are the major causes of deaths at the health facility. Under pay-for-performance (P4P) at the facility based operation research, maternal and perinatal death review was introduced in the two intervention districts to contain deaths and take appropriate preventive measures. In order to carry out death reviews, facility-based death review teams formed and data was collected through death notification slip, death review form and agreed standard procedure. Findings shows that, 3 maternal deaths and 102 perinatal deaths occurs at the selected health facilities during the intervention period in these two districts. Most of the client admitted at the facility with unconsciousness and shock. Majority of neonatal deaths were due to perinatal asphyxia, sepsis, and birth trauma. Delay in decision making of client’s family, shortage of manpower and logistics at facilities, delay to refer are the major causes of maternal and perinatal death. Data collection on death and analysis of causes of death at the facility will contribute to take appropriate action to reduce maternal and perinatal death.

After seven years of implementation, the National Health Insurance Scheme (NHIS) has achieved varying levels of enrolment coverage within the 10 regions of Ghana with different rural-urban populations. Recent research has identified the determinants of enrolment in the NHIS to include income, age, marital status, employment status, self rated health status and perceived quality of health care services. Implementation problems such as delays in the production and distribution of NHIS ID cards, long waiting times, poor staff attitude, inadequate information on NHIS benefit package and delays in reimbursing health providers has significant deepened the fiscal and coverage challenges of the NHIS and threatens the long term sustainability of the scheme.
Using a sample of 7,084 individuals from the COHEiSION Project baseline survey and employing logistic regression, separate estimations are performed on the rural-urban samples to determine whether there are rural-urban differences in the determinants of demand for health insurance in Ghana. Due to differences in economic and social opportunities, we expect differences in insurance covariates among rural and urban dwellers which will aid in the formulation of policy interventions to address low enrolment in rural and urban populations.

• El objetivo de esta investigación es fortalecer el Sistema Interinstitucional de Vigilancia de la Mortalidad Materna del Ecuador , y el estudio identificó que uno de los problemas históricos del cálculo de la razón de mortalidad materna (RMM) ha sido el subregistro de muertes maternas y para esto este estudio documentó, a través de los informes provinciales de muerte materna en los años 2010 y 2011, los aproximadamente 500 casos y reclasificó la causa básica de muerte mejorando el subregistro de los datos, a la vez analizó los factores causales de la diferencia en la prestación de la atención en salud que condujeron a la muerte materna, a través de las tres demoras definidas.
• También homologa metodológicamente para que, en el futuro, la RMM del Ecuador sea un solo dato a nivel país.
• Igualmente el estudio sugiere utilizar como denominador de la RMM, a la estimación de nacidos vivos, a partir de las nuevas proyecciones poblacionales calculadas de acuerdo al Censo de Población efectuado en el año 2010.
Palabras claves: Razón de mortalidad Materna, estimación de nacidos vivos.