Birth and Death Registration Statistics- Compilation of Indicators Anandasagar Reddy, M.B.A District Statistical Officer, Bidar

Birth and Death Registration Statistics- Compilation of Indicators “A group of official facts, which shows such things, as number of births and deaths in a particular area.” Birth and Death statistics are perhaps the most widely used national, state, and local data for identifying and addressing major public health issues .i.e. the data relating to birth or natality, death or mortality, health and disease or morbidity.

The History of Vital Statistics The registration of births, marriages, and deaths has a long history in the United States, beginning with registration laws enacted by the Grand Assembly of Virginia in 1632 and the General Court of the Massachusetts Bay Colony in 1639. The origin of vital statistics in the modern sense can be traced to an analysis of the English bills of mortality published by John Graunt in 1662. Similarly, the clergyman Cotton Mather noted, in 1721, during a severe smallpox epidemic in Boston, that more than one in six of the natural cases died, but only one in sixty of the inoculated cases died.

In the nineteenth century, the industrial revolution resulted in rapid urbanization, overcrowding of cities, and a deterioration of social and living conditions for large sectors of the population. Public health reformers became acutely conscious of the need for general sanitary reform as a means of controlling epidemics of disease, particularly cholera. These early sanitarians used the crude death statistics of the time to arouse public awareness of the need for improved sanitation, and in the process they pressed for more precise statistics through effective registration practices and laws. Thus, the history of public health is largely the history of vital registration and statistics.

Present Status of Birth and Death Statistics A Civil Registration System of recording vital events such as Births and Deaths is a legal requirement after the enactment of Births and Deaths Act 1969. The Registrar General of India in consultation with the law ministry has brought out model rules in 1970. Consequently the model rules were revised and Karnataka Registration of Births and Deaths rules 1999 have been brought. Registration of Birth/Death provides to citizens a gateway to social status and individual benefits.

The system provides the individual with a unique identity (his/her name) with a record of parental relationships provides a statement of place of birth of the child and usually of one or both parents, which are the basic grounds on which nationality can be established depending on the law.

The birth registration record is required for Establishing proof of age for school entry, Employment, Obtaining a driving license, Entering into legal contracts, Marriage , Passport etc., The death registration record may be required for Settlement of inheritance, Insurance claims, Claiming family allowances and other social security benefits etc.,

Measures of Birth and Death Statistics The Birth and Death statistics system provides counts of the number of times specified Birth and Death events have occurred. These counts are useful in themselves. For example, the numbers of Births and Deaths are used in the estimation of population size. For most purposes, however, other statistical measures are needed. For example, a comparison of births in one place with those in another requires information on the population size of each area.

The simplest and cleanest method of making such comparisons is to compute rates that relate the events to the population exposed to the risk of the event (e.g., the number of births to the number of women of child-bearing age). Many types of relative numbers are used in the analysis of vital statistics. Those used most frequently are listed below. Crude Rate: - The number of events in a given time period divided by the population produces Crude Rates. The result is multiplied by a constant (typically 1,000 or 1,00,000) for ease of presentation. Common crude rates include Birth and Death. Specific Rate: - Crude Rates may be limited to a specific group, such as deaths from a specified cause or in a specific age group.

Infant Mortality Rate: - Infant Mortality Rates reflect the risk of Deaths to infants under the age of one year. For infant deaths, the most commonly used estimate of the population (denominator) is the number of live births during the period. Maternal Mortality Rate: - Maternal Mortality Rates reflect the risk of Deaths to mothers during pregnancy and delivery. Life tables and life expectancy: - A life table is used to measure the effect of mortality on longevity. It shows the mortality experience of a hypothetical group of infants born at the same time and subject to the mortality rates of a specific population group. A life table provides numerous statistics; perhaps the most widely used is life expectancy at birth.

International Classification of Diseases:- Causes of death are classified for purposes of statistical tabulation according to the International Classification of Diseases (ICD), which is published by the World Health Organization. Traditionally, a single cause of death is selected for statistical tabulations. When the certifying physician indicates that more than one cause contributed to death, a procedure is required for selecting the single cause to be tabulated.

The ICD provides the basic ground rules used to code and classify causes of death, to identify the underlying cause of death, and to compensate for inconsistencies in the reported cause-of-death statement. It also includes definitions of terms such as "underlying cause of death," "live birth," "maternal death," as well as tabulation lists which define the cause-of-death groupings to be used for international comparisons. The ICD delineates the format of the medical certification of death and specific regulations regarding the compilation and publication of statistics on diseases and causes of death.

Gaps 1.Deaths by cause of death compared to medically certified cause of deaths shows that Deaths for some of the ailments are under medical supervision only, for e.g. cholera, typhoid, TB, Leprosy, Malaria, Cancer, etc., during 2005. 2. Medically certified deaths showing the age not stated. The doctors are the authority for certification of age, for e.g. 24550 Deaths during 2005 and 6190 Deaths during 2010. 3. Since, the definite cause of death to remaining 70% of Total deaths is not available, drawing the inferences may mislead.

Deaths by Cause of Deaths during 2005 Sl.no Cause of deaths Total Deaths Medically Certified Deaths Remarks Age not stated Age stated 1 2 3 4 5 6 7 Cholera 110 182 Typhoid 2355 Food Poisoning 337 Dysentery 48 1726 1094 Tuberculosis 270 7984 Leprosy 95 Diphtheria 29 8 Whooping Cough 25

1 2 3 4 5 6 7 9 Tetanus 562 396 10 Acute Polimyelitis 11 Measles 77 43 12 Rabies 8 428 240 13 Malaria 707 14 Cancer 261 7430 15 Diabetes Mellitus 254 5618 4575 16 Anaemia 139 2007 55 1706 17 Meningitis 74 1528 18 Heart Diseases &Heart Attacks 1441 36566 33862 19 Pneumonia 421 2664 352 2191

1 2 3 4 5 6 7 20 Bronchitis & Asthama 24708 7711 21 Jaundice 2895 1752 22 Chronic Liver Disease & Cirrohsis 180 3173 23 Ulcer of Stomach & Duodenum 292 1049 24 Appendicities 84 480 25 Syphilis &Other diseases of Genito Urinary System 182 2762 26 Abortions 65 27 Complication Related to Pregnancychild Birth 7689 972 28 Certain condition such as Birth-injuries 29 Paralysis 334 5294 30 Senility 14 47243 18246

1 2 3 4 5 6 7 31 Others not elsewhere classified 19387 91032 10466 56876 32 Bites of Stings of Venomous animal 135 944 11 556 33 Accidental Burn 95 2467 34 Falls & Drowning 74 537 254 35 Accidental Posising 202 3068 36 Transport Accidents 212 2630 2536 37 Other Accidents 137 1790 38 Suicide 1267 39 Homicide 182 40 Not Stated 35197 93842 9569 38578 Total 59450 364415 24550 221552

2. Medically certified deaths showing the age not stated 2. Medically certified deaths showing the age not stated. The doctors are the authority for certification of age, for e.g. 24550 Deaths during 2005 and 6190 Deaths during 2010

Deaths by Cause of Deaths during 2010 Sl.no Cause of deaths Medically Certified Deaths Remarks Age not stated Age stated 1 2 3 4 5 Certain Infectious and Parasitic 743 13900 Neoplasms 367 7567 Diseases of the blood & blood forming organs 142 1991 Endocrine, Nutritional and Metabolic Diseases 331 7786 Mental and Behavioural disorders 113 6 Diseases of the nervous system 186 3288 7 Diseases of the eye and adnexa 8 Diseases of the ear and mastoid process

1 2 3 4 5 9 Diseases of the circulatory 2163 37245 10 Diseases of the respiratory 615 10410 11 Diseases of the digestive system 530 7859 12 Diseases of the skin and subcutaneous tissue 43 688 13 Diseases of the musculoskeletal system and connective tissue 8 154 14 Diseases of the genitourinary system 241 4179 15 Pregnancy, childbirth and the puerperium 36 848 16 Certain condition originating in the perinatal period 10802 17 Congenital malformations, deformations &chromosomal abnormalities 1696 18 Symptoms, signs and abnormal clinical & laboratory 202 2315 19 Injury, poisoning and certain causes 581 10503 20 All Causes 6190 121347

3. Since, the definite cause of death to remaining 70% of Total deaths is not available, drawing the inferences may mislead.

Other Important Materials for the notice of Economics and Statistics Fraternity:- Reliable cause specific mortality statistics is required on a regular basis by Administrators, Policy Planners, Researchers and other Professionals for evidence based decision making with regard to resource allocation , monitoring of indicators. Identifying the Priorities for programmers and other related activities in the area of public health, the scheme of Medical Certification of Cause of Death (MCCD) was introduced in the Country under the provisions of Registration of Birth and Death (RBD) Act 1969. Section 10(2) of the Act empowers the State government to enforce the provision relating to Medical Certification of Cause of Death (MCCD) in specified area taking in to consideration the availability of medical facilities.

Section 10(3) of the Act provides for issuing of the cause of death by the medical practitioner who has attended on the deceased at the time of death. The age, sex and cause specific mortality rates are important indicators for evidence based monitoring of health trends in the population of state. The statistics on causes of death is essential for planners, administrators and medical professionals in undertaking appropriate curative and preventive measures for various health problems.

Recommendations to fill the Gaps: - To overcome the aforesaid problems, following are recommended. 1) Cause of Death should invariably obtained before the Registration of death, as the doctors say that more than 90% of deaths were treated by them in one way or other (both institutional & non-institutional death). 2) Age column of deaths should be filled compulsorily for medically certified before issuing the Death Certificate, as the Doctors have the authority to issue age certificate in the absence of records. 3) Once in five years, the census of deaths, to be conducted for getting the reliable data on the cause for all the deaths.

Conclusion The age of the deceased plays an important role in all the death cases. This helps in identifying the relationship between age and the death due to various diseases other than pregnancy and child birth causes. The age, sex and cause specific mortality rates are important indicators for evidence based monitoring of health trends in the population of a state. The statistics on causes of death is essential for planners, administrators and medical professionals in undertaking appropriate curative and preventive measures for various health problems.

Thank You Anandasagar Reddy, M.B.A District Statistical Officer, Bidar