Vital statistics

VITAL STATISTICS
 What is vital statistics?
Vital statistics is accumulated data gathered on
live births, deaths, fetal deaths, marriages and
divorces.
 Vital statistics relate to life and death events and
need standard and uniform definitions to allow
comparison of data in different parts of the world.
PURPOSE
1) Community Health: To describe the level of community health, to
diagnose community illness & to discover solutions to health problems.
2) Administrative purpose: It provides clues for administrative action
to create administrative standards of health activities.
3) Health programmed organization: To determine success or failure
of specific health programmed or undertake overall evaluation of public
health work.
4) Legislation purpose: To promote health legislation at local, state,&
national level.
5) Government Purpose: To develope, policies, procedure at state and
central level.
USES
 To evaluate the impact of various National Health
Programmes.
 To plan for better future measures of disease control.
 To explain the heridetary nature of the disease
 To plan and evaluate economic and social development.
 It is a primary tool in research activities.
 To determine the health status of individual.
 To compare the health status of individual one nation
with others.
SOURCE OF VITAL STASTICS
 1. Civil Registration System:
It is defined as the continous permanent and
compulsory recording of the occurrence of vital
events like live births, deaths, fetal deaths,
marriages, divorces, as well as annulments, judicial
separation, adoption. Civil registration is performed
under a law and regulation so as to provide legal
basis to the records and certificate made from
system.
2. National Sample Survey:
The data collected from the census are not
very reliable and available only once in 10 years. In
absence of reliable data from the civil registration
system(SRS), the need for reliable statistics at
national and state levels is being met through
sample surveys launched from time to time.
3. Sample Registration System:
In this system, there is continous enumeration
of births and deaths in a sample of villages/urban
blocks by a resident parttime enumerator and then
an independent six monthly retrospective survey by
a full time supervisor.
4. Health Surveys:
A few important sources for demographic data have
emerged. These are National Family Health Surveys(NFHS)
and the District Levels Household Surveys (DLHS)
conducted for evaluation of reproductive and child health
programmes. NFHS provide estimates of fertility, child
mortality and a no. of fertility, child mortality and a no. of
health parameters relating to infants and children at state
level. The DLHS provide information at the district level on
a no. of indicators relating to child health, reproductive
health problems and quality of services availability to them.
 MATERNAL MORTALITY (DEATH)
 Definition
 As per the tenth revision the International Statistical Classification of Disease
(ICD-10), Death of a woman while pregnant or within 42 days of the
termination of pregnancy irrespective of the duration and the
site of pregnancy, from any cause related to or
aggravated by the pregnancy or its management but not
from accidental or incidental causes.
 Hence, deaths from abortion and ectopic pregnancy are
included in it.
 Maternal deaths are sub-divided into three subgroups-
direct, indirect and incidental deaths
 MATERNAL MORTALITY RATIO
 Maternal mortality ratio is defined as the number of maternal deaths
per 100,000 live births.
 It was 212 in india in 2007-2009 (Sample Registration System, Registrar
General of India, 2011) (230 in 2008 by UNICEF).
 The denomination is large as number of maternal deaths are very few in
developed countries.
 It is calculated by:

=no of maternal deaths occurring in given year(usually 1 year)*100000

Total number of live birth in same year
 MATERNAL MORTALITY RATE
 Maternal mortality rate is the number of maternal
deaths per 100,000 women of reproductive age (15-45
years) and reflects the medical risk of pregnancy and
level of fertility in a population.
 It is about 120 in India as compared with only 0.5 in
USA.
 INCIDENCE OF MATERNAL
MORTALITY
 Maternal mortality is much higher in developing countries
than developed countries.
 Maternal mortality has remarkably dropped in the
developed countries due to improved obstetric care, status
of women, nutritional status, better sanitary and living
conditions and due to spending of large sums of money
towards welfare and healthcare in these countries.
 Sri Lanka has low MMR.
 Low maternal mortality of China is due to universal peoples’
education on maternal and child health care (MCH), rise in
age of marriage, use of family planning with one child norm
and universal maternity care.
CONTI………..

 In india MMR has declined from 167 in 2011-2013 to 130 in 2014-2016 and
to 122 in 2015-17, registering a 6.15 per cent reduction since the last survey
figures of 2014-2016, according to the special bulletin of the Office of the
Registrar General.
 Maternal Mortality Ratio (MMR) of Gujarat has reduced from 172 per 1 lakh
live births in year 2001 – 2003 to 87 per 1 lakh live births in year 2015 –
2017 (SRS).
 CAUSES OF MATERNAL MORTALITY
1. Direct Maternal Deaths
 Direct maternal deaths relate to resulting from
complication of pregnancy, labor or the
puerperium due to interventions, omission or
incorrect treatments.
 Leading causes of direct maternal deaths are:
• Hemorrhage
• Sepsis
• Pre eclampsia and eclampsia
• Prolonged and obstructed labor
2. INDIRECT MATERNAL DEATHS
 Indirect maternal deaths include deaths resulting from previous existing
diseases or diseases that developed during pregnancy but got worsened
by physiological effects of pregnancy or stress of labor.
 They cause about 25% maternal deaths.
 Leading cause of indirect maternal deaths are:
• Anemia
• Hepatitis
• Heart disease
• Tetanus
3. INCIDENTAL DEATHS
 Incidental maternal deaths are those deaths
which result from accidents, malignant neoplasm,
etc.
 They are not counted in maternal mortality and
are called non maternal deaths
FACTORS AFFECTING MATERNAL MORTALITY

1. Socio economic status

2. Maternal health status
INTERVENTIONS TO PREVENT MATERNAL DEATHS

 Promotion of family planning services, delay in age of marriage and child

birth.
 Early registration of pregnancy and hospital antenatal check ups.
 Dietary supplementation and prophylaxis for anemia to be given to every
women and tetanus toxoid.
 The presence of skilled attendant at delivery and provision of safe abortion.
 Drugs and supplies are essential in ensuring
maternal survival.
 A functional referral system to a facility which can
provide comprehensive emergency obstetric care
including cesarean section, laparotmy and blood
transfusions.
 Essential obstetric care should be provided at the
doorstep of the pregnant women, i. e. at first
referral level hospital.
CONTI……….

 Medical disorder of pregnancy particularly anemia, diabetes,

hypertension and cardiac disease which are important indirect causes of
maternal deaths should be managed jointly by different specialists in
tertiary hospitals.
 There should be provisions for good anesthetic facilities, blood bank,
specialists services in the labor room in the hospitals.
 Training courses for training of health workers should be arranged.
 PERINATAL MORTALITY
 Definition
Perinatal death is defined as death of fetus during the perinatal period which is from 28
weeks (24 weeks in UK) of gestational age more than 1000g birth weight to first week of
neonatal life.
 It includes late fetal deaths in utero, stillbirths and early neonatal deaths.
 PERINATAL MORTALITY RATE
PNMR is defined as number of such deaths per 1000 live birth.
 It is calculated by:
number of fetal death after 28 week of gestation in given
year * 1000

total number of live birth in same year

FACTORS AFFECTING PERINATAL MORTALITY

1. Maternal age
2. Parity
3. Socio economic status
CAUSES OF PERINATAL MORTALITY
 The causes of perinatal mortality include neonatal deaths are following:
I. Prematurity
II. Fetal growth restriction
III. Birth asphyxia
IV. Infections
V. Congenital anomalies
VI. Birth trauma
VII. Respiratory distress syndrome
VIII. Metabolic and other problems
IX. Miscelleneous causes
 STRATEGIES TO REDUCE PERINATAL
MORTALITY
• Improving the standards of living.
• Raising the social status of women.
• Universal prenatal care for all pregnant woman.
• High risk approach to pregnancy care.
• Strengthening the referral system.
• Facilitating early transport of high risk mothers to suitable centers.
• Raising the standards of intrapartum care, e.g. by adopting partograms.
• Better neonatal care and establishment of neonatal intensive care units.
• Maternal steroids administration in preterm labor reduces perinatal mortality.
• Maternal dietary supplementation of malnourished women reduces perinatal
mortality.
 STILLBIRTHS
 A stillbirth is a birth of a newborn after 28th completed week (weighing 1000gm or
more) when the baby does not breathe or not show any sign of life after delivery.
 Such deaths include antepartum deaths and intrapartum deaths.
 STILLBIRTH RATE:
 Still birth rate is the number of such deaths per 1000 total births.
 It is calculated by:
Foetal deaths weighing over 1000gm at birth during the year * 1000.
Total number of live + still birth in the same year
 NEONATAL MORTALITY
 Neonatal mortality rate (NMR) is the number of neonatal deaths
commencing at birth and ending at 28 completed days after birth in a
given year per 1000 live births in that year.

number of deaths of babies under 28 days of age in a year * 1000

NMR

Total live births in the same

 In 2018, neonatal mortality rate for India was
22.7 deaths per thousand live births. Neonatal
mortality rate of India fell gradually from 85.2
deaths per thousand live births in 1969 to 22.7
deaths per thousand live births in 2018.
 CAUSES
 About two-thirds of the neonatal deaths are related to prematurity
and majority of the deaths occur within 48 hours of birth.
1) Low birth weight

2) Birth injury due to difficult labor

3) Congenital anomalies
4) Hemolytic disease of the newborn
5) Conditions of placenta and cord
6) Acute respiratory infections
7) Tetanus
8) Diarrheal diseases
 INFANT MORTALITY RATE (IMR)
 Infant mortality rate is defined as the number of infants
per 1000 live births in a year.
 It is given by the formula:
IMR Number of deaths of children less than one year of age in a
year * 1000
No of live births in the same year
 It is below 10 per 1000 live births in developed countries but is
about 60-70 in India.
 The infant mortality rate for India in 2019 was
30.924 deaths per 1000 live births, a 3.36%
decline from 2018.
 In 2017, infant mortality rate for Gujarat was 30
per 1000 live births. Infant mortality rate of
Gujarat fell gradually from 55 per 1000 live
births in 2007 to 30 per 1000 live births in 2017.
 The decrease in IMR is due to:
1) Improved obstetric and perinatal care
2) Improvement in quality of life
3) Better control of communicable disease
4) Advances in chemotherapy, antibiotics and insecticides
5) Better nutrition with emphasis on breastfeeding
6) Family planning, e. g. birth spacing
 SUMMARY
 Definition
 Maternal mortality
 Maternal mortality ratio
 Maternal mortality rate
 Incidence of maternal mortality
 Causes of maternal mortality
 Factors affecting maternal mortality
 Interventions to prevent maternal deaths
 Perinatal mortality
 Factors affecting perinatal mortality
 Causes
 Strategies
 Stillbirth
 Neonatal mortality
 Infant mortality rate