Academic literature on the topic 'Underreporting of births'

Objectives— To evaluate the completeness of notifications of Down's syndrome live births and terminations to the Office for National Statistics (ONS) using data from the National Down Syndrome Cytogenetic Register (NDSCR). To examine the agreement of observed birth prevalence of Down's syndrome with the expected birth prevalence derived from published maternal age specific rates. Methods— The number of live births (adjusted to allow for the estimated under-ascertainment) and the number of terminations due to fetal Down's syndrome from NDSCR were compared with those figures reported to the ONS. Subsequently, using the NDSCR figures, the live birth prevalence of Down's syndrome that would have occurred in the absence of antenatal diagnosis and selective termination was calculated in England and Wales in the years 1990–1993. These figures were compared with those derived by applying published age specific prevalences to the maternal age distribution in England and Wales. Results— It is estimated that only 48% and 46% respectively of Down's syndrome live births and terminations of pregnancy were notified to ONS between 1990 and 1993. The annual expected birth prevalences of Down's syndrome obtained by applying maternal age specific prevalences to the maternal age distribution were in close agreement with observed rates from NDSCR. Conclusions— There is considerable underreporting of Down's syndrome births and terminations to ONS. The NDSCR data are more complete and therefore the effects of screening should be monitored using data from this source, or using estimates derived from the age specific rates of Down's syndrome.

Between the beginning of the 1950s and the early 1970s, China, like many other countries in Asia, Africa and Latin America, experienced rapid population growth. This was due mainly to a dramatic mortality decline not offset by any decline in the birth rate. In 1970, China had a crude birth rate of 33.43 (per 1,000), a crude death rate of 7.60 (per 1,000) and a rate of natural increase of 25.83. “Population growth” was identified as a fundamental obstacle to economic development, and the stage was set for large-scale state interventions in the process of human reproduction. The apotheosis of this intervention was the introduction, in 1979, of the One Child Policy, which was successfully implemented in the urban areas. In rural areas, policies promoting later marriage, one child – maximum two – per couple, and greater spacing of those births that are permitted contributed to the swift fertility decline witnessed over the last three decades. In 1996 China's birth and death rates were reported at 16.98 per 1,000 and 6.56 per 1,000 respectively and the population was growing at 10.42 per 1,000.

The aim of this study was to evaluate the coverage, validity and reliability of Brazil's Information System on Live Births (SINASC) for birth defects in a hospital in the city of Campinas (São Paulo State). The study population consisted of 2,823 newborn infants delivered in 2004 at the Women's Integrated Health Care Center (CAISM). A birth defect registry (ECLAMC) was used as the gold-standard. All birth defect cases reported at CAISM in 2004 (92 cases) were selected from SINASC data files. All 168 birth defect cases from the same city and year registered at ECLAMC were also retrieved. An underreporting of 46.8% was observed for all birth defects, and 36.4% when considering only the major birth defects. The ascertained sensitivity and specificity were, respectively, 54.2% and 99.8%. The reliability of three and four-digit ICD-10 coding for birth defects was 0.77 and 0.55 respectively (kappa statistic). These results suggest that information provided by birth certificates in Campinas still presents limitations when seeking to ascertain accurate estimates of the prevalence of birth defects, hence indicating the need for improvements in the SINASC database to enable it to portray birth defect prevalence at birth in this city.

Context. Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons.Objective. Description of perinatal health care quality assessment key indicators in Croatia.Methods. Retrospective review of reports from all maternities from 2001 to 2014.Results. According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM) was reduced by 31%, fetal mortality (FM) by 32%, and early neonatal mortality (ENM) by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks’ (wks) gestational age (GA) was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32–36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22–27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014.Conclusions. The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment.

Abstract Introduction The impact on research findings that use pregnancy data from surveys with underreported abortions is not well-established. We estimate the percent of all pregnancies missing from women’s self-reported pregnancy histories because of abortion underreporting. Methods We obtained abortion and fetal loss data from the 2006–2015 National Survey of Family Growth (NSFG), annual counts of births from US vital statistics, and external abortion counts from the Guttmacher Institute. We estimated the completeness of abortion reporting in the NSFG as compared to the external counts, the proportion of pregnancies resolving in abortion, and the proportion of pregnancies missing in the NSFG due to missing abortions. Each measure was examined overall and by age, race/ethnicity, union status, and survey period. Results Fewer than half of abortions (40%, 95% CI 36–44) that occurred in the five calendar years preceding respondents’ interviews were reported in the NSFG. In 2006–2015, 18% of pregnancies resolved in abortion, with significant variation across demographic groups. Nearly 11% of pregnancies (95% CI 10–11) were missing from the 2006–2015 NSFG due to abortion underreporting. The extent of missing pregnancies varied across demographic groups and was highest among Black women and unmarried women (18% each); differences reflect both the patterns of abortion underreporting and the share of pregnancies ending in abortion. Discussion Incomplete reporting of pregnancy remains a fundamental shortcoming to the study of US fertility-related experiences. Efforts to improve abortion reporting are needed to strengthen the quality of pregnancy data to support maternal, child, and reproductive health research.

OBJECTIVE: To examine whether the low birth weight (LBW) paradox exists in Brazil. METHODS: LBW and cesarean section rates between 1995 and 2007 were estimated based on data from SINASC (Brazilian Live Births Database). Infant mortality rates (IMRs) were obtained using an indirect method that correct for underreporting. Schooling information was obtained from census data. Trends in LBW rate were assessed using joinpoint regression models. The correlations between LBW rate and other indicators were graphically assessed by lowess regression and tested using Spearman's rank correlation. RESULTS: In Brazil, LBW rate trends were non-linear and non-significant: the rate dropped from 7.9% in 1995 to 7.7% in 2000, then increased to 8.2% in 2003 and remained nearly steady thereafter at 8.2% in 2007. However, trends varied among Brazilian regions: there were significant increases in the North from 1999 to 2003 (2.7% per year), and in the South (1.0% per year) and Central-West regions (0.6% per year) from 1995 to 2007. For the entire period studied, higher LBW and lower IMRs were seen in more developed compared to less developed regions. In Brazilian States, in 2005, the higher the IMR rate, the lower the LBW rate (p=0.009); the lower the low schooling rate, the lower the LBW rate (p=0.007); the higher the number of neonatal intensive care beds per 1,000 live births, the higher the LBW rate (p=0.036). CONCLUSIONS: The low birth weight paradox was seen in Brazil. LBW rate is increasing in some Brazilian regions. Regional differences in LBW rate seem to be more associated to availability of perinatal care services than underlying social conditions.

In India, Civil registration was initiated under the registration of births and deaths act,1969 to give reliable estimates of fertility and mortality situation for the nation up to the lowest administrative levels, but due to its inadequate and underreporting, still the Sample Registration System is used to generate reliable indicators of fertility and mortality. In this paper, an attempt is made to compute certain indicators from the civil registration system for the period of 2001-14 in the State of Rajasthan, India. The major SDG indicators of goal 3 of ensuring healthy lives and promoting well-being for all at all ages; targets 3.1 (By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births) and 3.2 (By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births) with indicators of Under-five Mortality Rate (indicator 3.2.1) and Maternal Mortality Ratio (indicator 3.1.1) and other fertility and mortality indicators can be computed, if certain denominator bases are available every year. As the civil registration data has not been classified by the place of residence, it is not strictly comparable to SRS figures. But it has been presented here so as to serve as an indication and for the improvement of the system for generation of reliable vital rates at subnational levels using civil registration data, which is the need of the day for planning purposes for programme managers and policy makers.

Background: Mortality and causes of death are among the most important statistics used in assessing the effectiveness of a country’s health system. Several countries do not have information systems for collecting these data, and they must therefore be estimated from surveys. Objective: This study analyzes mortality data retrieved from official government databases in Iraqi Kurdistan to describe ten-year trends in natural causes of death. Methods: Data for natural causes of death, reported from 2009 to 2018, were extracted from the databases of the Registration Bureau of Births and Deaths and of the Forensic Medicine of the Province of Sulaymaniyah. A sample of 16,433 causes of death was analyzed. Results: Causes of death were coded according to the ICD-10 classification. Overall, cardiovascular diseases were the leading cause of mortality (52.6%), followed by neoplasms (17.7%), infectious and parasitic diseases (8.9%), and genitourinary diseases (6.3%). Neonatal conditions, congenital anomalies, and neurological conditions each accounted for less than 1% each. Numbers of natural deaths by cause and cause-specific mortality rates have been estimated for the entire Region of Iraqi Kurdistan. Comparisons with other sources suggest that there is a substantial amount of underreporting, especially in relation to deaths of infants and under-five children. Conclusion: Our findings confirm that the region is facing a burden of non-communicable diseases, coupled with high proportions of infectious diseases. However, the lack of effective vital statistics with combined under-reported data collection highlights the need for implementation of health monitoring systems. Advancements in generating high-quality data are essential in improving health and reducing preventable deaths. The establishment of a novel Health Information System is discussed.

Abstract Background Infant mortality in Brazil has increased for the first time in 26 years. This study aimed to define the Zika Syndrome (ZS) perinatal case fatality rate (PCF) since the 2015 Zika outbreak in a Brazilian northeast state highly impacted by the virus. Methods Cross-sectional study conducted using data obtained through the State Health Department for cases of microcephaly (MCP) and congenital abnormalities (CA) in Rio Grande do Norte State (RN) from April 2015 to March 2, 2019. Perinatal period: commencing at 22 completed weeks (154 days) of gestation until 7 days after birth. PCF was defined as the number of deaths as a fraction of the number of sick persons with the specific disease (×100). Results There were 535 reported cases of MCP and others CA notified in RN during this period: 4 in 2014, 337 in 2015, 157 in 2016, 21 in 2017, 14 in 2018, and 2 in 2019. Of these, 151 were confirmed and 135 remain under investigation. The remaining 247 cases were ruled out by normal physical exams or due to noninfectious cause of MCP. Of the total confirmed cases, 35.8% (54/151) died after birth or during pregnancy. Zika virus infection during pregnancy was confirmed in 55.5% (30/54) of deaths and 1.8% (01/54) had a positive TORCH blood test. The odds ratio for the Zika PCF was found to be 1.57 (95% CI: 0.7940–3.1398; P = 0.1928). Deaths related to Zika were confirmed using a combination of clinical and epidemiological findings paired with either radiological information or molecular/serological data (RT–PCR and/or IgM/IgG antibodies against Zika). Twelve cases remain under investigation and 7 were ruled out as MCP. The highest number of confirmed MCP cases occurred between August 2015 and February 2016. The prevalence increased in September, with a peak in November 2015 (20.1 cases per 1,000 live births). Conclusion Before the recent Brazilian Zika outbreak, the incidence of MCP in RN between 2010 and 2014 was 1.8 cases/year. The real incidence and prevalence might be higher due to the underreporting and lack of resources for confirmatory diagnostic tests (laboratory and imaging). This study indicates that Zika virus accounted for a substantial proportion of MCP cases seen during the years studied, and suggests that ZS contributed to an increase in infant mortality in Brazil. Disclosures All authors: No reported disclosures.

Objective: The Dutch Cleft Palate Association (DCPA) registers all patients with cleft lip or palate and associated congenital anomalies in the Netherlands. The aim of this study was to assess if early registration of cleft patients leads to underreporting of associated congenital anomalies and, if so, whether reregistration is necessary. Methods: The DCPA registration of the birth cohort 1997 to 2001 was compared with the medical files of these cleft patients for prevalence, type, and moment of registration of associated congenital anomalies. To assess possible long-term underregistration, a second birth cohort of 1990 to 1991 was analyzed. Results: The percentage of cleft patients with associated congenital anomalies was 26% in the DCPA database and 33% in the retrospective medical file review. A syndrome, sequence, or association was recognized in 8% of the cleft patients by the DCPA compared with 13% in our medical file review. Of all associated congenital anomalies diagnosed during a follow-up of 12 years, 53% were diagnosed in the first year of life. The cumulative percentage was 59% after 2 years, 62% after 3 years, 80% after 6 years, and 97% after 10 years. Conclusion: Early registration of cleft patients leads to underreporting of other associated anomalies. For a complete registration of associated congenital anomalies in cleft patients, reregistration at a later age is necessary.

How fast and how far China’s fertility declined in the 1990s has long been a matter of considerable debate, despite very low fertility consistently being reported in a number of statistical investigations over time. Most demographers interpreted this as a result of serious underreporting of births in population statistics, due to the family planning program, especially the program strengthening after 1991. Consequently, they suggested that fertility fell only moderately below-replacement level, around 1.8 children per woman from the early 1990s. But some demographers argued that surveys and census may have reflected a real decline of fertility even allowing for some underreporting of births, given the consistency between data sources and over time. They believed that fertility declined substantially in the 1990s, very likely in the range between 1.5 and 1.6 by the year 2000.¶ The controversy over fertility is primarily related to the problem of underreporting of births, in particular the different estimations of the extent of underreporting. However, a correct interpretation of fertility data goes far beyond the pure numbers, which calls for a thorough understanding of different data sources, the programmatic and societal changes that occurred in the 1990s, and their effects on both fertility changes and data collection efforts. This thesis aims to address the question whether the reported far-below-replacement level fertility was a reality of substantial fertility decline or just an illusion arising from underreporting of births. Given the nature of the controversy, it devotes most efforts in assessing data quality, through examining the patterns, causes and extent of underreporting of births in each data source; reconstructing the decline of fertility in the 1990s; and searching corroborating evidence for the decline.¶ After reviewing programmatic changes in the 1990s, this thesis suggests that the program efforts were greatly strengthened, which would help to bring fertility down, but the birth control policy and program target were not tightened as generally believed. The program does affect individual reporting of births, but the completeness of births in each data source is greatly dependent on who collects fertility data and how the data are collected. The thesis then carefully examines the data collection operations and underreporting of births in five sets of fertility data: the hukou statistics, the family planning statistics, population census, annual survey and retrospective survey. The analysis does not find convincing evidence that fertility data deteriorated more seriously in the 1990s than the preceding decade. Rather, it finds that surveys and censuses have a far more complete reporting of births than the registration-based statistics, because they directly obtain information from respondents, largely avoiding intermediate interference from local program workers. In addition, the detailed examination suggests that less than 10 percent births may have been unreported in surveys and censuses. The annual surveys, which included many higher-order our-of-plan births being misreported as first-order births, have more complete reporting of births than censuses, which were affected by the increasing population mobility and field enumeration difficulties, and retrospective surveys, which suffered from underreporting of higher-order births.¶ Using the unadjusted data of annual surveys from 1991 to 1999, 1995 sample census and 2000 census, this research shows that fertility first dropped from 2.3 to 1.7 in the first half of the 1990s, and further declined to a lower level around 1.5-1.6 in the second half of the decade. The comparison with other independent sources corroborates the reliability of this estimation. Putting China’s fertility decline in international perspective, comparison with the experiences of Thailand and Korea also supports such a rapid decline. Subsequently, the thesis reveals an increasingly narrow gap between state demands and popular fertility preferences, and great contributions from delayed marriage and nearly universal contraception. It is concluded that the fertility declined substantially over the course of the 1990s and dropped to a very low level by the end of last century. It is very likely that the combination of a government-enforced birth control program and rapid societal changes quickly moved China into the group of very low-fertility countries earlier than that might have been anticipated, as almost all the others are developed countries.

After decades of decrease, maternal mortality rates have shown a slight increase in Europe. Immigrants, especially Africans, have shown to be at higher risk than native women. This could not be explained solely by well-known obstetric and socio-economic risk factors. The aim of this thesis was to study incidence, classification and quality of care of maternal deaths in Sweden, with focus on the foreign-born population. The study population was identified through linkage of the Cause of Death Register, Medical Birth Register, and National Patient Register, and medical records obtained from hospitals. Data from registers, death certificates, and medical records were reviewed. Suboptimal care was studied by structured implicit review of medical records. Differences between foreign- and Swedish-born women were analysed by relative risks, Chi2- and Fisher’s exact test. Underreporting of maternal mortality was shown to be substantial: as compared to the official statistics, 64% more maternal deaths were identified. Women born in low-income countries were identified as being at highest risk of dying during reproductive age in Sweden. The relative risk of dying from diseases related to pregnancy was 6.6 (95% confidence interval 2.6–16.5) for women born in low-income countries, as compared to Swedish-born women. Major and minor suboptimal factors related to care-seeking, accessibility, and quality of care were found to be associated with a majority of maternal deaths and significantly more often to foreign-born women. Suboptimal factors identified included non-compliance, communication barriers, and inadequate care. The rate of suicides during pregnancy or within one year after delivery did not change during the last three decades, and was higher for foreign-born women. A majority of women who committed suicide had been under psychiatric care, but such documentation at antenatal care was inconsistent, and planning for follow-up postpartum was generally lacking. The conclusion of this thesis is that foreign-born women are a high-risk group for maternal death and morbidity that calls for clinical awareness with respect to their somatic and psychiatric history, care-seeking behaviour, and communication barriers. Cross-disciplinary care is necessary, both in obstetric emergencies and in cases of maternal psychiatric illness, to avert maternal death and suicide.

Partindo de hipóteses básicas onde o processo saúde-doença no período perinatal apresenta-se, por um lado, como expressão de condições particulares ás quais famílias estão submetidas, de maneira diferencial, em função de sua adscrição de classe e, por outro, como expressão da articulação de um conjunto de condições biológicas e sociais em permanente relação, o presente trabalho procura, em uma amostra de parturientes e recém-nascidos de hospitais de São Luis do Maranhão, refletir sobre o assunto. Conclui pela pertinência do emprego do conceito sociológico de classe social ao estudo de eventos perinatais que, articulado a esquemas teóricos mais elaborados do campo da Perinatologia, permite ampliar o nível de explicação do fenômeno.
This work searches for empirical sustenance concerning reflection on basic hypotheses whereby the health dickness process in the perinatal periode expresses particular conditions which families are undergoing especially as to their insertion in social classes, on one hand, and especially on the other, articulation of biological and social conditions in permanent relation. It is based on a sample of women-in-labour and newborn children in hospitals in São Luis do Maranhão, Brazil. It is concluded that Sociological concept of social class is pertinent whilst studying perinatal events along with more elaborate theoretical schemes in the field of Perinatology.

Contradictions between central policy goals and local interests can be resolved through cadres’ mediation at the village level. Village leaders act as mediators between central policy directives and rural residents. This compromise is attributable to the level of autonomy that village cadres enjoy, which affords them some discretion in the implementation of policies and regulations. The theory of the street-level bureaucrat explains how local cadres, at both the village and town levels, from the 1980s to the early 2000s, were able to use underreporting of out-of-plan births to mediate the conflicts between central policy goals and local interests. Underreporting goes beyond selective policy implementation and is a result of mutual noncompliance between villagers and cadres. One of the long-term implications of current changes in demographics is that as more rural residents permanently migrate to urban areas, the village community structure that allowed cadres to mediate between central policy and local interests may be disappearing.

There are three distinct time periods in which the social and political environments influenced incentives to hide or not hide infants, children, and young adults: the pre-PRC period before 1949, the Maoist era (1949–1976), and the reform era, after 1979. Rural families and local officials avoided census counts and registration for males and females from the late Qing Empire in the 1800s right up through modern times. After 1979 came the most critical outcome of the state birth control policy: the country’s abnormally high sex ratio at birth statistic. According to an assessment of the 2010 population census, the number of girls truly missing from the population between 1980 and 2010 was estimated to be about 20 million. However, an examination of the two key assumptions behind these skewed statistics shows the number of hidden girls to be closer to 10 million, or about half of the estimated number of “missing girls.”