Transcript Excess female mortality within the reproductive age group in South Africa Presentation To Global Forum on Gender Statistics 11-13 October 2010 Manila, Philippines Statistics South Africa 11 October.

Excess female mortality within the reproductive age
group in South Africa
Presentation
To
Global Forum on Gender Statistics
11-13 October 2010
Manila, Philippines
Statistics South Africa
11 October 2010
ESA/STAT/AC.19/9
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Presentation outline
• Overview of the functioning of the civil registration system:
deaths
• Objectives
• Methods
• Results
• Limitations of the study and overall challenges faced
• Conclusion
• Way forward
2
Overview of the functioning of the death
registration system
• Statistics South Africa has a mandate to
publish vital statistics based on deaths
reported at the Department of Home
Affairs
• The registration of deaths is governed by
the Births and Deaths Registration Act,
1992 (Act No. 51 of 1992)
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Overview of the functioning of the death
registration system continued
• The Department of Home Affairs collects
information on deaths for administrative
purposes:
• To update the population register
• To issue death certificates
• The form used to report a death is the BI-1663
form: Notification / Register of Death / Stillbirth
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The BI-1663 form
 It consists of two pages
 The Department of Home Affairs (DHA) is responsible for
the first page.
 It includes socio-demographic details of the deceased
and particulars of the informant and funeral undertaker.
 The Department of Health (DoH) is responsible for the
second page.
 It includes information on the causes of death.
 The second page from DoH is submitted to DHA where
the two pages are matched.
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Page one of the death notification form
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Page two of the death notification form
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Processing of death notification forms
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ICD-10 coding
Classification of causes of death
 International Classification of Diseases, 10th revision
(ICD-10) coding used to classify causes of death
 “Code what you see” Rule
 Code up to three characters
Coding staff




20 Trained and experienced coders
Regular up-dates and re-fresher courses
Trained in anatomy and physiology, medical terminology
Attend ICD-10 Standards meetings and NHISSA
meetings
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Derivation of the underlying cause
ACME (2000 version) is used to
automatically derive the underlying cause
of death
ACME usually fails to derive about 1% of
the total of deaths in a particular year
Rejected cases derived manually by
selected staff
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Objectives of the study
• To assess the potential for usability of death
registration data for maternal mortality
estimation
• To verify the suspicion that there is excess
female mortality at the reproductive age group in
the era of HIV/AIDS
• To establish causes of death associated with
excess female mortality
• To establish patterns and trends of maternal
deaths reflected in these data
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Methods
• The scope includes registered deaths from 1999-2005
• Indirect methods of estimating completeness are used
• Comparison of sex ratios between the periods 1999-2001
and 2002-2005
• Comparison of leading causes between the two study
periods
• Maternal mortality ratios are also provided
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Results
• Completeness was found to be at about 91%:
applying GGB and SEG
• Total numbers of female deaths aged 12-50 in 1999-2005
Pregnancy
status
Number
Pregnant
Not pregnant
9932
202709
Unknown
Unspecified
Total
Source: South African death registration data
Note: Figures may have been updated over time
1249
560616
774506
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Percentages of female deaths who died while pregnant, aged
12-50: 1999-2005
Causes of death grouped according to ICD-10 chapters
%
Deaths
Pregnancy, childbirth and puerperium (O00-O99)
31
Infectious diseases (A00-B99)
26
Respiratory diseases (J00-J99)
9
Disorders of the immune mechanism (D80-D89)
7
External causes (V01-Y98)
7
Other natural causes
20
N
9932
Source: South African death registration data
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Comparison of sex ratios – female deaths per
100 male deaths
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The ten leading natural causes of death for
females aged 20-29
1999-2001
Causes of death based on the Tenth Revision of the ICD
Rank
2002-2005
Frequency
%
Rank
Frequency
%
Tuberculosis (A15-A19)
1
15249
22.2
1
34104
22.9
Influenza and pneumonia (J10-J18)
2
8177
11.9
2
20773
14.0
Certain disorders involving the immune mechanism (D80D89)
3
5523
8.0
5
11837
7.9
Human immunodeficiency virus [HIV] disease (B20-B24)
4
5036
7.3
3
9317
6.3
Intestinal infectious diseases (A00-A09)
5
4431
6.4
4
7937
5.3
Other viral diseases (B25-B34)
6
1990
2.9
6
5100
3.4
Other forms of heart disease (I30-I52)
7
1955
2.8
8
4062
2.7
Inflammatory diseases of the central nervous system (G00G09)
8
1320
1.9
7
3096
2.1
Noninfective enteritis and colitis (K50-K52)
9
888
1.3
…
2589
1.7
Chronic lower respiratory diseases (J40-J47)
10
881
1.3
9
2353
1.6
Protozoal diseases (B50-B64)
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863
1.3
10
1867
1.3
9122
13.3
18910
12.7
13269
19.3
26961
18.1
68704
100.0
148906
100.0
Ill-defined and unknown causes of mortality (R95-R99)
Other natural causes
Total
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Adjusted numbers of maternal deaths:
1999-2005
700
number of maternal deaths
600
500
400
300
200
100
0
15-19
20-24
25-29
30-34
35-39
40-44
45-49
age
1999
2000
2001
2003
2004
2005
2002
• Adjusted for completeness of death registration for each age group, Estimated completeness using Extinct
Generation Method
• Adjusted for unspecified pregnancy status: Proportional allocation of missing information based on specified
pregnancy status
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Comparison of maternal mortality ratios
maternal deaths per 100 000 live births
700
600
500
400
300
200
100
0
1998
1999
2000
2001
2002
2003
Census 2001
UN
2004
2005
year
Death registration
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DHS 1998
Limitations of the study
•
Incompleteness of death notification forms
•
The proportions of unspecified for pregnancy
status at the time of death range from 68% in
1999 to 75% in 2005
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Challenges faced: recording of information
• Lack of adherence to the guidelines for
completing the death notification form provided
on the Department of Health website
• Inconsistent information among variables on the
death notification form
• High proportions of non-response for some
demographic variables
• Invalid responses recorded on some variables
• Under reporting of female deaths
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Methodological and administrative issues
among stakeholder departments
• Lack of a checking point for content quality at the
Department of Home Affairs
• There is no cut-off date for collection of death
notification forms for a specific statistical release
• Some forms that are separated during data
capturing at the DHA may not be reconciled
during processing
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Conclusions
• Vital registration data provides expected age patterns and trends
of maternal mortality, therefore, usability is confirmed
• However, maternal mortality ratios derived from these data are
implausibly low compared to those derived from enumerated data
• Excess female mortality is linked to the age group 20-29 in 20022005
• Leading causes of death for females aged 20-29 seem to be
HIV/AIDS-related, also, shifting of rankings and proportions of
deaths due to selected diseases signify misclassification of causes
of death
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Way forward
 Improvements required in civil registration:
o Department of Home Affairs – coverage; fully completed and accurate information
collected
o Department of Health – accurate and detailed certification of causes of death
o Statistics South Africa – accurate and timely production of vital statistics
 Prioritising civil registration and vital statistics nationally and
internationally, e.g.
o African Ministers responsible for civil registration took a resolution that African
statisticians must prioritise civil registration and vital statistics (recommended as the
next theme of African Symposia for Statistical Development)
 Statistics South Africa to take the lead through National Statistics System
to address problems identified with civil registration by forming
partnerships to improve civil registration.
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Thank you
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