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Problem Bangladesh has no national system for registering deaths and determining their causes. As a result, policy-makers lack reliable and complete data to inform public health decisions. Approach In 2016, the government of Bangladesh introduced a pilot project to strengthen the civil registration and vital statistics system and generate cause of death data in Kaliganj Upazila. Community- based health workers were trained to notify births and deaths to the civil registrar, and to conduct verbal autopsy interviews with family members of a deceased person. International experts in cause-of-death certification and coding trained master trainers on how to complete the international medical certificate of cause of death. These trainers then trained physicians and coders. Local setting Kaliganj Upazila has an estimated population of 304 600, and 5600 births and 1550 deaths annually. Health assistants and family welfare assistants make regular visits to households to track certain health outcomes. Relevant changes Following the start of the project in 2016, the number of births registered within 45 days rose from 873 to 4630 in 2018. The number of deaths registered within 45 days increased from 458 to 1404. During this period, health assistants conducted 7837 verbal autopsy interviews. Between January 2017 and December 2018, 105 master trainers and more than 7000 physicians were trained to complete the international medical certificate of cause of death and they completed more than 12 000 certificates. Lessons learnt Training community-based health workers, physicians and coders were successful approaches to improve death registration completeness and availability of cause-of-death data. Probleme Le Bangladesh n'est dote d'aucun systeme national pour enregistrer les deces et determiner leurs causes. Les responsables politiques ne disposent done pas de donnees fiables et completes pouvant servir de base a la prise de decisions en matiere de sante publique. Approche En 2016, le gouvernement du Bangladesh a mis en place un projet pilote destine a renforcer le systeme des registres et des statistiques de l'etat civil et a obtenir des donnees sur les causes de deces dans l'upazila de Kaliganj. Des agents sanitaires de proximite ont appris a notifier les naissances et les deces a l'officier de l'etat civil, et a realiser des autopsies verbales aupres des membres de la famille d'une personne decedee. Des experts internationaux de la certification des causes de deces et du codage ont appris a des formateurs principaux a remplir le certificat medical international indiquant la cause du deces. Ces formateurs ont ensuite forme des medecins et des codeurs. Environnement local L'upazila de Kaliganj compte quelque 304 600 habitants et enregistre environ 5600 naissances et 1550 deces par an. Des aides-soignants et des auxiliaires en matiere de protection de la famille effectuent des visites a domicile regulieres pour suivre certains resultats cliniques. Changements significatifs A la suite du lancement du projet en 2016, le nombre de naissances enregistrees en 45 jours est passe de 873 a 4630 en 2018. Le nombre de deces enregistres en 45 jours est passe de 458 a 1404. Au cours de cette periode, les aides-soignants ont realise 7837 autopsies verbales. Entre janvier 2017 et decembre 2018, 105 formateurs principaux et plus de 7000 medecins ont appris a remplir le certificat medical international indiquant la cause du deces, et ils ont rempli plus de 12 000 certificats. Lemons tirees La formation d'agents sanitaires de proximite, de medecins et de codeurs s'est revelee efficace pour ameliorer l'enregistrement des deces et accroitre la disponibilite de donnees sur les causes de deces. Situacion Bangladesh no tiene un sistema nacional para registrar las muertes y determinar sus causas. Como resultado, los responsables de formular politicas carecen de datos fiables y completos que sirvan de base para la toma de decisiones en materia de salud publica. Enfoque En 2016, el gobierno de Bangladesh introdujo un proyecto piloto para fortalecer el registro civil y el sistema de estadisticas vitales y generar datos sobre las causas de muerte en Kaliganj Upazila. Se capacito a los trabajadores sanitarios de la comunidad para que notificaran los nacimientos y las defunciones al registro civil, y para que realizaran entrevistas de autopsia verbal con los familiares de una persona fallecida. Expertos internacionales en la certificacion de la causa de muerte y la codificacion de formadores expertos capacitados sobre como completar el certificado medico internacional de causa de muerte. Estos formadores luego capacitaron a medicos y codificadores. Marco regional Kaliganj Upazila tiene una poblacion estimada de 304 600 habitantes y 5 600 nacimientos y 1 550 defunciones anuales. Los asistentes sanitarios y los asistentes de bienestar familiar realizan visitas periodicas a los hogares para hacer un seguimiento de ciertos resultados sanitarios. Cambios importantes Tras el inicio del proyecto en 2016, el numero de nacimientos registrados en un plazo de 45 dias aumento de 873 a 4 630 en 2018. El numero de muertes registradas en 45 dias aumento de 458 a 1 404. Durante este periodo, los asistentes sanitarios realizaron 7 837 entrevistas de autopsia verbal. Entre enero de 2017 y diciembre de 2018, 105 formadores expertos y mas de 7 000 medicos recibieron capacitacion para completar el certificado medico internacional de causa de defuncion y completaron mas de 12 000 certificados. Lecciones aprendidas La capacitacion de los trabajadores sanitarios, los medicos y los codificadores de la comunidad fueron enfoques exitosos para mejorar la integridad del registro de defunciones y la disponibilidad de datos sobre la causa de la muerte., Introduction In 2018, Bangladesh had a population of approximately 165 million, of these around 104 million (63%) people were living in rural areas and about 48 million (29%) people were [...]

In many low- and middle-income countries, civil registration and vital statistics systems rely on passive reporting, with families expected to attend local registry offices to register vital events, such as [...]

Over the past decades, the health sector has forged a widespread network of health facilities and community health workers who carry out key public health interventions, aiming to reach the [...]

During an epidemic, rapid mortality surveillance provides essential information to formulate an evidence-based response. Weekly counts of deaths are a key indicator of overall epidemic impact and trajectory. (1, 2) [...]

ABSTRACT: Maternal mortality is an important measure of women?s health and indicative of the performance of health care systems. Several international conferences, most recently the Millennium Summit in 2000, have included the goal of reducing maternal mortality. However, monitoring progress towards the goal has proved to be problematic because maternal mortality is difficult to measure, especially in developing countries with weak health information and vital registration systems. This has led to interest in using alternative indicators for monitoring progress. This article examines recent trends in two indicators associated with maternal mortality: the percentage of births assisted by a skilled health care worker and rates of caesarean delivery. Globally, modest improvements in coverage of skilled care at delivery have occurred, with an average annual increase of 1.7% over the period 1989-99. Progress has been greatest in Asia, the Middle East and North Africa, with annual increases of over 2%. In sub-Saharan Africa, on the other hand, coverage has stagnated. In general, caesarean delivery rates were stable over the 1990s. Countries where rates of caesarean deliveries were the lowest - and where the needs were greatest - showed the least change. This analysis leads us to conclude that whereas there may be grounds for optimism regarding trends in maternal mortality in parts of North Africa, Latin America, Asia, and the Middle East, the situation in sub-Saharan Africa remains disquieting.

OBJECTIVE: To present estimates of maternal mortality in 188 countries, areas, and territories for 1995 using methodologies that attempt to improve comparability. METHODS: For countries having data directly relevant to the measurement of maternal mortality, a variety of adjustment procedures can be applied depending on the nature of the data used. Estimates for countries lacking relevant data may be made using a statistical model fitted to the information from countries that have data judged to be of good quality. Rather than estimate the Maternal Mortality Ratio (MMRatio) directly, this model estimates the proportion of deaths of women of reproductive age that are due to maternal causes. Estimates of the number of maternal deaths are then obtained by applying this proportion to the best available figure of the total number of deaths among women of reproductive age. FINDINGS: On the basis of this exercise, we have obtained a global estimate of 515 000 maternal deaths in 1995, with a worldwide MMRatio of 397 per 100 000 live births. The differences, by region, were very great, with over half (273 000 maternal deaths) occurring in Africa (MMRatio: >1000 per 100 000), compared with a total of only 2000 maternal deaths in Europe (MMRatio: 28 per 100 000). Lower and upper uncertainty bounds were also estimated, on the basis of which the global MMRatio was unlikely to be less than 234 or more than 635 per 100 000 live births. These uncertainty bounds and those of national estimates are so wide that comparisons between countries must be made with caution, and no valid conclusions can be drawn about trends over a period of time. CONCLUSION: The MMRatio is thus an imperfect indicator of reproductive health because it is hard to measure precisely. It is preferable to use process indicators for comparing reproductive health between countries or across time periods, and for monitoring and evaluation purposes.

Epidemiologists and public health researchers are moving very slowly in the data sharing revolution, and agencies that maintain global health databases are reluctant to share data too. Once investments in infrastructure have been made, recycling and combining data provide access to maximum knowledge for minimal additional cost. By refusing to share data, researchers are slowing progress towards reducing illness and death and are denying a public good to taxpayers who support most of the research. Funders of public health research are beginning to call for change and developing data sharing policies. However they are not yet adequately addressing the obstacles that underpin the failure to share data. These include professional structures that reward publication of analysis but not of data, and funding streams and career paths that continue to undervalue critical data management work. Practical issues need to be sorted out too: how and where should data be stored for the long term, who wilt control access, and who will pay for those services? Existing metadata standards need to be extended to cope with health data. These obstacles have been known for some time; most can be overcome in the field of public health just as they have been overcome in other fields. However no institution has taken the lead in defining a work plan and carving up the tasks and the bill. In this round table paper, we suggest goals for data sharing and a work plan for reaching them, and challenge respondents to move beyond well intentioned but largely aspirational data sharing plans. Les epidemiologistes et les chercheurs en sante publique s'engagent tres lentement dans la revolution que subit le partage des donnees et les agences chargees d'entretenir les bases de donnees mondiales sur la sante sont reticentes a ce partage. Une fois certains investissements consentis dans les infrastructures, le recyclage et la combinaison des donnees peuvent donner acces a un maximum de connaissances pour un cout additionnel minimal. En refusant le partage des donnees, les chercheurs ralentissent les progres vers la reduction de la morbidite et de la mortalite et interdisent l'acces a l'information a un public tout juste bon a payer les impots qui financent la plupart de leurs recherches. Les apporteurs de fonds pour la recherche en sante publique commencent a appeler au changement et a developper des politiques de partage des donnees. Cependant, lis n'ont pas encare trouve de moyens adequats pour aplanir ies obstacles responsables de l'echec de ce partage. II s'agit notamment de structures professionnelles qui recompensent la publication d'une analyse, mais pas celle des donnees, et de flux de financement et d'evolutions de carriere qui continuent de sous-evaluer le travail essentiel de gestion des donnees. II convient aussi de serier les problemes pratiques: ou et comment les donnees doivent-elles etre stockees sur le Iong terme, qui exercera un controle sur les acces et qui paiera pour ces services? Les normes existantes pour les metadonnees doivent etre etendues pour couvrir les donnees relatives a la sante. Ces obstacles sont connus depuis un certain temps ;la plupart d'entre eux peuvent etre surmontes dans le domaine de la sante publique tout comme lis l'ont ete dans d'autres secteurs. Neanmoins, aucune institution n'a pris la direction des operations pour definir un plan de travail et repartir les taches et la facture. Dans cet article destine a une table ronde, naus proposons des objectifs pour le partage des donnees et un plan de travail pour les atteindre et naus sollicitons des reponses pour aller au-dela de plans de partage des donnees bien intentionnes, mais largement utopistes. Los epidemiologos e investigadores en salud publica estan avanzando muy lentamente en la revolucion dei intercambio de datas, y ademas los organismos que mantienen las bases de datas mundiales sobre salud se muestran reacios a compartir su informacion. Una vez realizadas las inversiones en infraestructuras, la reutilizacion y combinacion de datas brindan acceso a un maximo de conocimientos con un costa adicional minimo. Al negarse a compartir los datas, los investigadores estan frenando los progresos hacia la reduccion de la morbilidad y la mortalidad y estan negando un bien publico a contribuyentes que apoyan la mayor parte de las investigaciones. Los agentes de financiacion de las investigaciones en salud publica estan empezando a exigir cambias y a elaborar politicas de intercambio de datas. Sin embargo, aun no estan abordando adecuadamente los obstaculos que impiden compartir esos datas. Entre ellos cabe citar unas estructuras profesionales que recompensan la publicacion de analisis, pero no de datas, y unas fuentes de financiacion y unas perspectivas de carrera que siguen sin reconocer el caracter crucial de la gestion de datas. Es preciso esclarecer tambien algunos aspectos practicos: como y donde deben conservarse los datas a largo plazo, quien controlara el acceso y quien pagara esos servicios. Las normas existentes sobre metadatos deben ampliarse para poder manejar los datas sanitarios. Estas dificultades son conocidas desde hace ya algun tiempo, pero la mayoria pueden ser superadas en el campo de la salud publica ai igual que han sido superadas en otros campos. Sin embargo, ninguna institucion ha tomado la iniciativa para definir un plan de trabajo y repartirse las tareas y los costas asociados. En este articulo de la mesa redonda proponemos metas para el intercambio de datas y un plan de trabajo para su consecucion, y alentamos a los encuestados a trazar algo mas que unos planes de intercambio de datas bienintencionados peta demasiado ambiciosos. Une traducion en francais de ce resume figure a, la fin de l'article. Al final del articulo se facilita una traduccion al espanol. [TEXT NOT REPRODUCIBLE IN ASCII], Introduction As they prepare for careers in science, today's students doubtless hear the same cliches as we did a generation ago: science advances collaboratively; we reproduce and extend the work [...]

Public health decision-making is critically dependent on the timely availability of sound data. The role of health information systems is to generate, analyse and disseminate such data. In practice, health information systems rarely function systematically. The products of historical, social and economic forces, they are complex, fragmented and unresponsive to needs. International donors in health are largely responsible for the problem, having prioritized urgent needs for data over longer-term country capacity-building. The result is painfully apparent in the inability of most countries to generate the data needed to monitor progress towards the Millennium Development Goals. Solutions to the problem must be comprehensive; money alone is likely to be insufficient unless accompanied by sustained support to country systems development coupled with greater donor accountability and allocation of responsibilities. The Health Metrics Network, a global collaboration in the making, is intended to help bring such solutions to the countries most in need. Keywords Information systems/organization and administration; Statistics/organization and administration; Delivery of healthcare; Health status indicators; Data collection; Decision making; Policy making (source: MeSH, NLM). Mots cles Systeme information/organisation et administration; Statistique/organisation et administration; Delivrance soins; Indicateur etat sanitaire; Collecte donnees; Prise decision; Choix d'une politique (source: MeSH, INSERM). Palabras clave Sistemas de informacion/organizacion y administracion; Estadistica/organizacion y administracion; Prestacion de atencion de salud; Indicadores de salud; Recoleccion de datos; Toma de decisiones; Formulacion de politicas (fuente: DeC5, BIREME)., Measurement and public health "Nothing exists until it is measured" the physicist Niels Bohr famously stated in 1930. He was referring to quantum mechanics, but the idea is also relevant [...]