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PubMed1989

Tropical epidemiology: a system for continuous demographic monitoring of a study population.

Epidemiologists in many developing countries, where official demographic services are unavailable, have to include some demographic functions in their work. The usual method of documenting a study population for epidemiological research in a developing country consists of three stages: mapping, enumeration and vital registration. This paper considers the last element of this process, detailing the development of a suitable data system and explaining how its implementation using microcomputers and a database management system can help in the creation of an on-line continuous vital registration system for a study population as an epidemiological tool. The issues covered are data collection, entry and analysis, and the advantages of such a system for use in epidemiological research in developing countries are also discussed.

Africa, Western↗
PubMed1988

A study of vital and health statistics of the Kainji Lake Area of Nigeria.

A survey of vital and health statistics, and the evaluation of collection of these data in the registration centres of Kainji Lake Area, are presented. Forty-two per cent of all deaths occurred below 10 years of age, with the largest percentage occurring below 5 years of age. The leading causes of all deaths were malaria, gastro-intestinal disorders and measles. Occurrence of an epidemic was found to be significant to the overall mortality. The role of traditional healers in the control of childhood mortality is discussed. About 34% of the women had married more than once and 56% of the divorces occurred after the first marriage. The causes of divorces were largely due to loss of affection and neglect. The number of deliveries in the hospitals was more than the number of registered births and no death was registered at the centres. A unique system of collection of vital information was suggested for the Kainji Lake Area.

Adolescent↗
PubMedDate not supplied

Analysis of unlinked infant death certificates from the NIMS project.

The National Infant Mortality Surveillance (NIMS) project used linked birth and infant death certificates to calculate birth weight-specific infant mortality risks for the 1980 U.S. birth cohort. Record linkage depends on complete registration of vital events, interstate exchange of vital records, accurate information on certificates, and a comprehensive linkage system. States reported 2,604 unlinked infant death certificates for 1980, ranging from 0 to 397 per State. Age at death for these infants ranged from 1 minute to 11 months. More than 41 percent of the unlinked death certificates were for postneonates, compared with 32.5 percent found in the cohort's total infant death experience. Only 38.2 percent of the unlinked infant death certificates showed strictly intrastate events (birth and death occurrence, and residence at death all in one State), compared with 92.9 percent in the cohort's total infant death experience. Estimates of the percentage successfully linked by State ranged from 86.0 to 100.0. After adjusting for the certainly unlinked infant death certificates, nine States' infant mortality risks increased by more than 0.2 per 1,000 live births. Improvements are needed both within and between States to ensure more complete birth and infant death certificate linkage.

Birth Certificates↗
PubMedDate not supplied

Experiences with linked birth and infant death certificates from the NIMS project.

The National Infant Mortality Surveillance (NIMS) project aggregated data provided by 53 vital statistics reporting areas--50 States, New York City, the District of Columbia, and Puerto Rico (subsequently called States)--from their files of linked birth and death certificates and compared individual States' total infant mortality experiences for the 1980 birth cohort by age at death, race, birth weight, and plurality. Therefore, it was essential to achieve maximum uniformity among the separate data sets and to specify when this uniformity could not be obtained. In working with these multiple sources, we identified five key issues that relate to data from linked birth and death certificates: Variations in definitions of variables are often embedded in data that have been gathered from several independent sources. (For NIMS, the sources were 53 reporting areas and the National Center for Health Statistics.) Variations in States' linking procedures--these are based on an individual State's primary purpose for linking the data--affect the completeness and comparability of the 1980 resident birth cohorts used for NIMS. Variations in the recording of some pregnancy outcomes as fetal deaths or live births are known to be a problem in vital statistics data that particularly affects data for events among infants weighing less than 500 g at birth. Ambiguities occur frequently in unknowns or zero values. For NIMS this effect was most pronounced for the pregnancy history variables. Examination of the values reported for unknown or zero categories helps in uncovering problems with and improving quality of data. (e) Analysis from a new perspective may reveal unexpected data problems. These problems tend to surface only during a reexamination of underlying data that is prompted by unusual findings.Continued alertness to these issues may improve further the quality of data in files of linked birth and death certificates and assure the integrity of analysis based on these data.

Birth Certificates↗
PubMedDate not supplied

Review of death certificates to assess completeness of AIDS case reporting.

To assess the level of reporting of acquired immunodeficiency syndrome (AIDS) cases, the authors reviewed death certificates for periods of 3 months during July through December 1985 in each of four cities: Washington, DC, New York City, Boston, and Chicago. Since reporting began in 1981, these cities have reported 38 percent of all AIDS cases in the United States. Death certificates were selected and matched to the AIDS surveillance registries in each city, and medical records of those not on the AIDS registry were reviewed to determine if AIDS had been diagnosed. The estimated completeness of AIDS case reporting to AIDS surveillance systems was high in all four cities (ranging from 83 percent to 100 percent). The unreported cases were similar to reported cases with respect to sex, race, risk factor, and specific diagnosis. Of the causes of death examined, AIDS, Pneumocystis carinii pneumonia, and Kaposi's sarcoma were predictive of AIDS as defined by the CDC case definition. However, 77 of 588 deaths (13 percent) attributed to 1 of these 3 causes occurred in cases that were presumptively AIDS but did not meet the diagnostic requirements to be classified as AIDS for reporting purposes. A review of death certificates provides an easy and rapid means of evaluating surveillance efforts and can be a useful adjunct to other methods of surveillance for AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1979

[Epidemiology of breast cancer in Austria (author's transl)].

In cooperation with the Austrian National Institute for Statistics the incidence-rates of breast cancer in Austria in the period of 1971-1975 were investigated. The incidence-rate of breast cancer (50 new cases/year/100,000 women) is higher than the incidence-rate of cervical or endometrium carcinoma. The increasing risk of the higher age-groups, which is especially expressed by the incidence-rate of 145 in the age-group of 70 or more years, is pointed out. This findings are of great consequence to the system of preventive medical care. In urban areas the incidence of breast cancer seems to be higher than in rural district.

Adolescent↗
PubMed1978

A comparative study of road traffic accidents in West Malaysia.

The problem of road traffic accidents in developing countries is now becoming a cause for concern. This is more so as preventive measures have not kept pace with economic progress and development. This paper reviews the present situation in West Malaysia, one of the better developed countries of the East, during the period 1970 to 1975. A comparative study has been made between the United States and Malaysia. To enable the urgency of the problem in developing countries to be appreciated the increases in the country's population and in the number of vehicles in use and their relation to the lesser increase in road mileage over the period of study have been discussed. The study has considered every aspect of the causative factors leading to traffic accidents, such as the effects of weather, seasonal variation, and road and lighting conditions. The common human errors leading to accidents have been discussed. Other factors, such as the ethnic distribution in Malaysia, and their relation to road accidents have shown the effect of the social structure on the problems. The data evaluated in this study make it clear that preventive measures are very necessary in underdeveloped as well as in developed countries.

Accidents, Traffic↗
PubMed1977

[Data cross-cut and the field of rehabilitation medicine at a vocational re-training centre (author's transl)].

Identified and evaluated were a number of medical and sociological data, e.g. diagnosis, age, population of the place of residence, financially responsible agencies, on 1399 rehabilitees who were admitted to the Dortmund vocational re-training centre during the first five years of its operation (1971-1975). The primary diagnoses (highly identical with those indicative of vocational rehabilitation) and the overall diagnoses (primary and secondary diagnoses) were classified into disease groups according to the ICD and compared with the frequency distribution in the 1970 microcensus. Significance computations determined yearly deviations of the different data, i.e., a significantly steady increase in emotional disturbances. The classification of diseases and disabilities clearly shows the problem complex of adequate comprehensive therapy and medical care, and marks the role of medicine at a vocational re-training centre.

Adolescent↗
PubMed1976

Properties of diagnostic data distributions.

In applications of statistical methods to medical diagnosis, information on patients' diseases and symptoms is collected and the resulting data-base is used to diagnose new patients. The data-structure is complicated by a number of factors, two of which are examined here: selection bias and unstable population. Under reasonable conditions, no correction for selection bias is required when assessing probabilities for diseases based on symptom information, and it is suggested that these "diagnostic distributions" should form the principal object of study. Transformation of these distributions under changing population structure is considered and shown to take on a simple form in many situations. It is argued that the prevailing paradigm of diagnostic statistics, which concentrates on incidence of symptoms for given disease, is largely inappropriate and should be replaced by an emphasis on diagnostic distributions. The generalized logistic model is seen to fit naturally into the new framework.

Biometry↗
PubMed1976

Skewness in commingled distributions.

A likelihood ratio test is given for distinguishing skewness from commingled distributions, using a power transform to remove skewness appropriately for each of the alternatives tested. The alternative hypotheses postulate that the transformed data are from one normal or a mixture of two or three normal homoscedastic distributions. Since each mixture has unique asymmetry, skewness is estimated simultaneously with the means, proportions and variance of components. Commingling cannot be rigorously proven in this way, as some other transform may provide a better approximation to normality. However, the error of asserting admixture whenever there is skewness has been avoided, and estimates of admixture parameters provide a basis for more conclusive tests in relatives or other populations. Two examples are given, one in which adjustment for skeweness left evidence of commingling.

Biometry↗