Vital Statistics and Data Management
for Evidence Health Situation
and Trend Assessment
Workshop on Civil Registration and Vital Statistics in
UNESCWA Region, Cairo, Egypt, 3-6 December 2007
By
Dr Samuel Mikhail
EMRO/WHO
Content
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Introduction
vital statistics
The country's / EMRO system
Appropriate use of health statistics
Vital Statistics and discrepancies
Barriers and constraints
Discrepancies on Country’s / UN Estimates
Unification of Database
– Inter-country
– inter-UN organizations
Introduction:
- Policies and programmes to combat diseases and
injuries should be based on current information
about he nature and extent of health problems, their
determinants, and how the impact of such diseases
and injuries is changing, both with respect to
magnitude and distribution in populations. - priorities
for health research should, in part at least, be based
on a thorough assessment of the relative importance
of various diseases and injuries affecting the
population's health
-- commonly used data for meeting these needs,
and related needs for health policy, are statistics on the
number of people who die, by age and sex, and on the
causes of those deaths, classified according to a standard
set of medical criteria.
- Almost all countries have legislation that establishes vital
registration systems to collect and collate statistics on who
dies from what cause..
- Indeed, such systems are still inoperative for a large
proportion of the world's population, especially in
countries with high burdens of disease.
- There's a lack of information on causes of death in many
developing countries nevertheless Eastern Mediterranean
Region countries, which draw the attention for the urgent
need of the WHO and other international health agencies
to take a lead in redressing this situation.
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- World health statistics has been collated from
publications and database produced by WHO’s technical
programmes and regional member states .
- The core set of indicators was selected on the basis of
their relevance to global health, the availability and
quality of the data, and the accuracy and comparability
of estimates .
- The statistics for the indicators are derived from an
interactive process of data collection, compilation, quality
assessment and estimation occurring among WHO’s
technical programmes and its Member States.
- The core of indicators do not aim to capture all relevant
aspects of health but to provide a comprehensive
summary of the current status of a population’s health
and the health system at country level.
- These indicators include : mortality
outcomes, morbidity outcomes ,risk
factors, coverage of selected health
interventions, health systems, inequalities
in health, and demographic and
socioeconomic statistics.
 - World health statistics will be updated
regularly ,and it includes the most recent
estimates and time-series of relevant
health statistics .
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The vital statistics
Variables
 Definitions
 Concepts
 Ensuring comparability
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The current level of existence and functioning of
the country's / EMRO system
Data Pooling
Data request
Countries
Ministry of
Health
Data
Resent for
approval
Approved
Data request
EMRO/EST
unit
Revised
Data
Refined data with
priority for
Technical Unit data
Final data revised
and approved by
countries
Technical
Units
(programs)
Regional
0ffice
Regional
Health
Database
Country
profiles &
different
reports
Monitoring progress: appropriate use of
health statistics
- For monitoring, it is important to distinguish between
corrected and predicted statistics.
- Corrected statistics use adjustments made for known biases
and, if needed, are based on a systemic reconciliation of data
from multiple sources using established, transparent
methods.
- This mismatch was created partly by the demand for more
timely statistics and partly by the lack of data and good
measurement strategies for certain statistics.
- It is crucial for the international community to invest in data
collection and use indicators that are valid, reliable and
comparable - the international community must also have
well-defined measurement strategies for monitoring progress
and evaluating health programmes.
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The civil registration systems of many countries are not well
functioning leading to difficulties and challenges when faced
with the need of reliable source of statistics especially on vital
events. For efficiently and effectively functioning health
systems and for countries to be able to identify with their health
needs, complete and reliable information on births and deaths by
age, sex and cause are needed as are other recordings of vital
events on a continuous and complete bases.
The result of such systems is an unstable impact upon decision
making, policy formulation, and measurement of health
programs.
Furthermore, differences in definitions and concepts of vital
events and registration provide difficulty with comparability.
Hence, the international standards & guidelines developed by
the United Nations need to be applied so that universal
comparison is possible.
Barriers and constraints:
- In many countries and programs; definitions, classifications and
method of calculation do not entirely conform to the WHO or
international standards.
- People (even in statistical offices) still mix between year of
estimate and year of reporting.
- Delay of reporting the updated and published data either from
some countries or UN technical units.
- Many countries impose upon the indicators figures by using the
same figures which were implied for many years ago for updating
recent years.
- Countries generally derive their estimates from reported services
which are not always available and accurate.
- Most countries do not cover the data on various types of
government and private health services.
- Some countries derive these data from survey, but
since survey questions and definitions differ across
countries, the estimate may not strictly comparable.
- Most countries do not cover the data on various types of
government and private health services.
- Several figures related to the same indicator for the
same year reported in different values and/or previous
values.
- Some figures reported from country to various regional
office units with different values.
- Consistency of the data in some indicators is
questionable as it is published by several MOH units with
different figures on the same dates.
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Some figures reported to UN technical units and
never been routed to WHO/EMRO and/or routed with
different figures.
Some Countries not provide future estimations or
projections except on population based country figures
while some UN sources do that.
Some Countries not covering, collecting and/or
reporting all indicators required all users such as
MDG indicators
Some UN technical units might think that some of the
national data reported by the countries is not accurate
or reliable.
Discrepancies
on
Country’s / UN
Estimates
Population (000S)
Country
Bahrain
Country’s
estimates
UN estimates (World
population reports )
743 (06)
739 (06)
Egypt
72 010 (06)
75 437 (06)
Iraq
27 963 (06)
29551 (06)
Jordan
5 600 (06)
5 837 (06)
Kuwait
3 051 (06)
2 765 (06)
Lebanon
4 141 (06)
3 614 (06)
Oman
2577 (06)
2612 (06)
Palestine
3952 (06)
4000 (07)
838 (06)
839 (06)
Saudi Arabia
23 678 (06)
25 193 (06)
Syria
18 717 (06)
19 512 (06)
4106 (05)
4657 (06)
20 892 (06)
21 639 (06)
Qatar
UAE
Yemen
Population growth rate
Country
Country’s
estimates
UN estimates (World
population reports)
Bahrain
2.7(06)
1.6 (00-06)
Egypt
1.9 (06)
1.9 (00-06)
Iraq
2.7 (04)
2.8 (00-06)
Jordan
2.3 (06)
2.7 (00-06)
Kuwait
8.4 (05)
3.7 (00-06)
Lebanon
1.5 (06)
1.0 (00-06)
Oman
2.2 (06)
1.0 (00-06)
Palestine
3.3 (06)
2.9 (06)
Qatar
5.2 (05)
5.9 (00-06))
Saudi Arabia
2.3 (06)
2.7 (00-06)
Syria
2.5 (06)
2.5 (00-06)
UAE
4.9 (05)
6.5 (00-06)
Yemen
3.0 (04)
3.1 (00-06)
Total Fertility Rate
Country
Country’s
estimates
UN estimates (World
population reports)
Bahrain
2.5 (06)
2.5 (00-06)
Egypt
3.1 (05)
3.3 (00-06)
Iraq
6.0 (04)
4.8 (00-06)
Jordan
3.2 (05)
3.5 (00-06)
Kuwait
2.3 (02)
2.4 (00-06)
Lebanon
1.9 (04)
2.3 (00-06)
Oman
3.2 (06)
3.8 (00-06)
Palestine
4.6 (04)
4.6 (06)
Qatar
2.6 (05)
3.0(00-06)
Saudi Arabia
3.2 (06)
4.1 (00-06)
Syria
3.6 (06)
3.5 (00-06)
UAE
2.1 (05)
2.5 (00-06)
Yemen
6.2 (05)
6.2 (00-06)
Infant Mortality Rate/1000 Live births
Country
Country’s estimates UN estimates (World
population reports)
Bahrain
7.6 (06)
14 (00-06)
Egypt
20.5 (05)
37 (00-06)
Iraq
107.9 (03)
94 (00-06)
Jordan
22.0 (02)
23 (00-06)
Kuwait
8.2 (05)
10 (00-06)
Lebanon
18.6 (04)
22 (00-06)
Oman
10.3 (05)
16 (00-06)
Palestine
24.2 (05)
25 (06)
Qatar
8.1 (06)
12 (00-06)
Saudi Arabia
18.6 (06)
23 (00-06)
Syria
18.0 (06)
18 (00-06)
UAE
7.7 (05)
9 (00-06)
Yemen
75.0 (03)
69 (00-06)
Under 5 Mortality
Country
Country’s
estimates
UN estimates (World
population reports)
Bahrain
10.1 (06)
14.0 (05-10)
Egypt
26.2 (05)
34.0 (05-10)
Iraq
130 (03)
105.0 (05-10)
Jordan
27.0 (02)
22.0 (05-10)
Kuwait
10.0 (05)
10 (05-10)
Lebanon
19.1 (04)
26.0 (05-10)
Oman
11.0 (05)
14.0 (05-10)
Palestine
28.5 (05)
20.0 (05-10)
Qatar
10.7 (06)
10.0 (05-10)
Saudi Arabia
21.7 (06)
22.0 (05-10)
Syria
22.0 (06)
18.0 (05-10)
UAE
9.9 (05)
9.0 (05-10)
Yemen
102.0 (03)
79.0 (05-10)
Maternal Mortality
Country
Country’s
estimates
UN estimates (World
population reports)
Bahrain
1.0 (06)
28.0 (00)
Egypt
63.0 (05)
84.0 (00)
Iraq
294.0 (03)
250.0 + (00)
Jordan
41.0 (06)
41.0 (00)
Kuwait
4.0 (05)
5.0 (00)
Lebanon
86 (04)
150.0+ (00)
Oman
15.0 (05)
87.0+ (00)
Palestine
8.0 (05)
100.0 (00)
Qatar
7.0 (06)
7.0 (00)
Saudi Arabia
16.0 (04)
23.0 (00)
Syria
58.0 (06)
160.0 (00)
UAE
1.0 (05)
54.0+ (00)
Yemen
366.0 (03)
570.0 (00)
Unification of Database
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Database is one of the most powerful and important assets an operator
possesses. Unfortunately, it is extremely difficult to gather accurate
representations in multinomial, converged network environments where data
is often locked away in proprietary systems and fragmented across many
database. That’s why all operators urgently need a solution that can harness
data, wherever it resides, so they can reduce network complexity and cut the
time. And that solution needs to be open and flexible enough to help operators
migrate along their strategic path to converged programs. The solutions
provide the ability to greatly accelerate the launch and support of revenuegenerating programs.
The aims of the unification of database:
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Provide a conceptual framework of information domains.
establish a common language to improve communication; permit comparisons
of data
focus on multi-dimensional aspects of programs
Meet the needs of its different and varied users; and provide a platform for
users and developers.
Covering all the basic elements: hence the need for the clearness of
terminologies and vocabularies.
Provide a common reference point for reporting and statistical use.
Provide a configuration of data/and or information between the units of the
division
moreover,
Definitions need to be standardized,
- and vital statistic variables need to be
chosen. Without these norms there will
remain an inconsistency and
incomparability between the national
registration systems.
- Without comparability, national systems
will loose out on shared experiences to
built and improve upon. The system will
just be a system of the nation without
possible global interaction.
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Demographic Indicators
Area
sq. km
Population
Total
Urban %
Crude birth rate
Crude death rate
Population growth rate
Population
<15 years
65+ years
Dependency Ratio
Total fertility rate
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Socioeconomic Indicators
Adult literacy rate 15+ years
T%
M%
F%
Gross primary school enrollment ratio
T%
M%
F%
Gross secondary school enrollment ratio
T%
M%
F%
Per capita GNP US$
Population with access to safe drinking water %
Population with adequate excreta disposal facilities %
Unemployed %
Regular smokers 15+ years
T%
M%
F%
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Health Expenditure Indicators
GDP per capita,US$ Exchange rate
Total Health Expenditure per capita,US$ Exchange rate
General Government Expenditure on Health Per Capita, US$
Exchange rate
Total Health Expenditure as % of GDP
General Government Expenditure on Health as % of Total Health
Expenditure
Out Of Pocket as % of Total Health Expenditure
MOH's budget as a % of government budget
Human and Physical Resources Indicators, Rate per 10,000 pop
Physicians
Dentists
Pharmacists
Nursing and midwifery personnel
Hospital beds
PHC units and centers
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Indicators of Coverage with Primary Health Care services
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Population with access to local health services
Urban %
Rural %
Married women (15-49) using contraceptives %
Pregnant women attended by trained personnel %
Deliveries attended by trained personnel %
Infants attended by trained personnel %
Infants fully immunized with
BCG %
DPT %
OPV %
Measles Vaccine %
Hepatitis B Vaccine %
Pregnant women given TT2+ %
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Total %
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Health Status Indicators
Life expectancy at birth ( years)
T
M
F
Newborns with birth weight at least 2500 kg %
Children with acceptable weight for age %
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Infant mortality rate per 1000 live births
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Probability of dying before reaching 5th birthday per
1000 live births
Maternal mortality ratio per 10 000 live births
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Thank you