Basic Indicators. health situation in the americas. Quality of mortality data in the Americas, 2003 or most recent year

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1 health situation in the americas Basic Indicators N Quality of mortality data in the Americas, or most recent year good medium poor very poor no data Regional Office of the World Health Organization Office of the Assistant Director Health Surveillance, Disease Prevention and Control Health Information and Analysis

2 preface This fourteenth pulication on the health situation of the Region of the Americas includes a set of asic indicators and provides the latest information availale on 5 asic indicators for 4 countries and territories, as well as for groupings of countries or suregions. Resolution CD40.R0, Collection and Use of Core Health Data, requires the Memer States of the Pan American Health Organization (PAHO) to gather data in order to develop these asic indicators. This year the pulication includes an analysis of the quality of mortality data ased on the proportion of mortality underregistration and on the proportion of deaths assigned to illdefined and unknown causes. This information was used to develop an index for classifying the quality of mortality data. The results show that of the 32 countries studied, 9 (59%) have good quality mortality data, and 7 countries (%) have poor or very poor quality mortality data. In addition to prolems with data quality, 2 countries from Central America and 4 Cariean countries were excluded from the analysis due to their critical situation in the availaility of mortality data. There is also a comparison etween estimated infant and maternal mortality using the World Health Organization methodology and those calculated from data reported y the countries. This comparison allows for etter visualization of differences etween different ways of measuring the same indicator and provides a parameter for discussing the validity of these important health indicators. Information required for decisionmaking must e availale, ut also accurate and timely. In this pulication we want to emphasize those aspects that reveal differences in the quality of data oserved among the different countries in the Region. By doing so, it is expected that those responsile for health statistics in the countries of the Americas will e encouraged to implement improvements in the collection, validation, analysis and dissemination of data. Strengthening and improving health information is everyone s responsiility, therefore, PAHO developed the Regional Plan of Action for Strengthening Vital and Health Statistics, approved y the Executive Committee (Resolution CE42.R4, June ). The Plan requests PAHO to provide technical cooperation to countries in order to improve the quality and coverage of vital and health statistics, to promote horizontal cooperation, to estalish a collaoration mechanism among the different areas of PAHO, and to coordinate actions with other international agencies and relevant actors in order to strengthen the health information systems of the countries in the Region. The material presented in this rochure has een compiled, drafted, and reviewed y PAHO staff at Headquarters and country levels and staff from ministries of health. For more information, including all asic indicators and their definitions, please refer to Mirta Roses Periago Director () More information can e found at For this pulication: Latin America includes Mexico, the Central American Isthmus, the Latin Cariean, the Andean Area, Brazil, and the Southern Cone. Latin America and the Cariean comprise Latin America and nonlatin Cariean. Brazil and Mexico appear separately due to their population sizes.

3 demographic indicators population (thousands) 2 crude irth rate (,000 pop) 3 annual irths average (thousands) 4 annual deaths average (thousands) 5 annual pop growth (%) fertility rate (child/woman) 7 uran population (%) dependency ratio (00 pop) 9T 9M 9F life expectancy at irth (years) male female The Americas,420,052., North America Bermuda Canada United States of America 342, ,70 30, ,3.4 4,39.4 2, , Latin America & the Cariean 579,35 9.5,39.2 3, Latin America 572,3 9., 3, Mexico 07, , Central American Isthmus Belize Costa Rica El Salvador Guatemala Honduras Nicaragua Panama 4,7 2 4,534,3 3, 7,24 5,7 3, , Latin Cariean Cua Dominican Repulic French Guiana Guadeloupe Haiti Martinique Puerto Rico 35,,25 9, , , Andean Area Bolivia Colomia Ecuador Peru Venezuela 2,259 9, 4,74 3,4 2, 2, , Brazil,. 3,72., Southern Cone Argentina Chile Paraguay Uruguay,325 39,4,03,23 3,350 2, NonLatin Cariean Anguilla Antigua & Baruda Arua Bahamas Barados Cayman Islands Dominica Grenada Guyana Jamaica Montserrat Netherlands Antilles Saint Kitts & Nevis Saint Lucia Saint Vincent & the Grenadines Suriname Trinidad & Toago Turks & Caicos Islands Virgin Islands (UK) Virgin Islands (US), , , BI 9: countries with less than 00,000 inhaitants: US Census Bureau; otherwise: United Nations (UN) estimates. Both agencies are currently reviewing the population projections taking into account the last census. BI 2 9: linear interpolation of indicators from UN.

4 mortality indicators 0 maternal mortality ratio (00,000 l) or numer of deaths (Nº) ratio (Nº) year infant mortality rate (,000 l) or numer of deaths (Nº) rate (Nº) year 2 3 estimated under 5 mortality (,000 l) 200 y UN y WHO 4 5 registered deaths under 5 due to ADD ARI (%) (%) year illdefined and unknown causes (%) () 7 mortality underregistration (%) (05) The Americas North America Bermuda Canada United States of America a.3.0. d Latin America & the Cariean Latin America Mexico e Central American Isthmus Belize Costa Rica El Salvador Guatemala Honduras Nicaragua Panama c 0.4 a a.2 e 2. e 7. d 3..2 d Latin Cariean Cua Dominican Repulic French Guiana Guadeloupe Haiti Martinique Puerto Rico a a d 9 d. Andean Area Bolivia Colomia Ecuador Peru Venezuela a d 0. Brazil Southern Cone Argentina Chile Paraguay Uruguay a.4 e 3 e f NonLatin Cariean Anguilla Antigua & Baruda Arua Bahamas Barados Cayman Islands Dominica Grenada Guyana Jamaica Montserrat Netherlands Antilles Saint Kitts & Nevis Saint Lucia Saint Vincent & the Grenadines Suriname Trinidad & Toago Turks & Caicos Islands Virgin Islands (UK) Virgin Islands (US) a a g a a.7 g d 7. d d BI 7: (a) value ; () value 200; (c) value ; (d) value 2002; (e) value 200; (f) value 200,, ; (g) value.

5 mortality indicators Tc Ta Mc Ma Fc Fa general mortality rates (all causes) (,000 pop) () male female 9Tc 9Ta 9Mc 9Ma 9Fc 9Fa mortality rates from communicale diseases (00,000 pop) () male female The Americas North America Bermuda Canada a United States of America Latin America & the Cariean Latin America Mexico Central American Isthmus Belize Costa Rica El Salvador Guatemala a Honduras Nicaragua Panama a Latin Cariean Cua Dominican Repulic a French Guiana Guadeloupe Haiti a Martinique Puerto Rico Andean Area Bolivia Colomia Ecuador Peru a Venezuela Brazil Southern Cone Argentina Chile Paraguay Uruguay c NonLatin Cariean Anguilla Antigua & Baruda a Arua a Bahamas Barados Cayman Islands a Dominica a Grenada Guyana Jamaica Montserrat Netherlands Antilles Saint Kitts & Nevis Saint Lucia Saint Vincent & the Grenadines a Suriname Trinidad & Toago a Turks & Caicos Islands Virgin Islands (UK) Virgin Islands (US) BI 2: (a) value 2002; () value 200; (c) URY refers to 200 for general mortality and to 200,, for causespecific mortality. BI 9: ICD0 codes A00B, G00G03, J00J; ICD9 codes 0039, 3203, 404, 4047.

6 mortality indicators land transport accidents 20Tc 20Ta 20Mc 20Ma 20Fc 20Fa mortality rates from malignant neoplasms (00,000 pop) () male female 2Tc 2Ta 2Mc 2Ma 2Fc 2Fa mortality rates from external causes (00,000 pop) () male female 25 rate ratio homicide mortality male:female (05) corrected mortality rate () (00,000 pop) (00,000 male pop) suicide BI 23: ICD0 codes V0 V9. BI 24: ICD0 codes X5 Y09. male homicide

7 mortality indicators 2Tc 2Ta 2Mc 2Ma 2Fc 2Fa mortality rates from diaetes mellitus (00,000 pop) () male female 2Tc 2Ta 2Mc 2Ma 2Fc 2Fa mortality rates from cererovascular diseases (00,000 pop) () male female 27Tc 27Ta 27Mc 27Ma 27Fc 27Fa mortality rates from ischemic heart diseases (00,000 pop) () male female

8 moridity indicators tuerculosis incidence rate (00,000 pop) 200 SS+ 3 malaria risk areas pop (%) 32 malaria API (,000 pop) 33 malaria reported cases 34 dengue reported cases 35 aids incidence rate (00,000 pop) male:female ratio of aids cases proportion of low irthweight (<2,500 g) (%) 07, lay The Americas ,055 2, North America Bermuda Canada United States of America Latin America & the Cariean ,732, c,54, c 7, , a a Cholera, country cases Latin America Mexico Central American Isthmus Belize Costa Rica El Salvador Guatemala Honduras Nicaragua Panama Latin Cariean Cua Dominican Repulic French Guiana Guadeloupe Haiti Martinique Puerto Rico Andean Area Bolivia Colomia Ecuador Peru Venezuela a, g a, g a, g a a ,5 2,54 3, 45,3 49 5,32,5,35,2 3, ,525 4,074 23, ,73 4,45 07,9,44 4,7 4,749 c, c, c c 9,2 4, 3,7 40 2,440 2,47 5, 33,50,45 3,402 29, 2 9,2 3,2 5,02,02 49,03 7,332,54 0,57,7 0, CAN USA country CAN USA VEN (imported) 7 (includes 4 imported) Measles &, cases & cases related to importation * * Brazil Southern Cone Argentina Chile Paraguay Uruguay NonLatin Cariean Anguilla Antigua & Baruda Arua Bahamas Barados Cayman Islands Dominica Grenada Guyana Jamaica Montserrat Netherlands Antilles Saint Kitts & Nevis Saint Lucia Saint Vincent & the Grenadines Suriname Trinidad & Toago Turks & Caicos Islands Virgin Islands (UK) Virgin Islands (US) a a ,47, c 23 5, c 5, , ,3 4, c a, c, c, c c 559,4 2, , 3,54,42 352, a a d e a.7..4 a, f Yellow Fever, country BOL BRA COL PRY PER cases deaths * Source: Prevention and Control of Communicale Diseases; PAHO, and Comprehensive Family Immunization Project; PAHO, * BI 29 3: (a) value ; () value 200; (c) imported; (d) 7:0; (e) 4:0; (f) 0:; (g) from Bulletin Epidémiologique Hedomaire, () p.; () new and relapse cases.

9 resources, access & coverage indicators human resources per 0,000 pop physicians nurses dentists c c c 4 hospital eds per,000 pop 07, lay 42A 42B national health expenditure as a % of GDP pulic private prenatal 44 health care y trained personnel (%) at irth year immunization coverage (%) under year of age year of age DPT3 Polio3 BCG measles/mmr 49 contraceptive use (women, all methods) (%) 0, lay The Americas North America Bermuda Canada United States of America n. s.4, p 4., p h f, h h h 9 h h Latin America & the Cariean Latin America Mexico , q Central American Isthmus Belize Costa Rica El Salvador Guatemala Honduras Nicaragua Panama a.3 a 0..0 a.9 4. c c, n.5 p c, q c, q 4., q, q 4., r, q a e a *, l 00 * * 7 *, l 9 00 *, l 9 00 * *, l 9 00 * Latin Cariean Cua Dominican Repulic French Guiana Guadeloupe Haiti Martinique Puerto Rico a..3.3 c, o.2 d 2.7 o d, q 2. q k Andean Area Bolivia Colomia Ecuador Peru Venezuela a a 3.4 o d c., q q. q 2. d, r c, q * * * Brazil.4. 3., n 3., q * 00 * Southern Cone Argentina Chile Paraguay Uruguay a 4., m, m 2. c, m, n, q 2., q q 3. c, q c 9.0 e * NonLatin Cariean Anguilla Antigua & Baruda Arua Bahamas Barados Cayman Islands Dominica Grenada Guyana Jamaica Montserrat Netherlands Antilles Saint Kitts & Nevis Saint Lucia Saint Vincent & the Grenadines Suriname Trinidad & Toago Turks & Caicos Islands Virgin Islands (UK) Virgin Islands (US) c, o 3.4 c d c p.0 p c, q c, p. d, p p s. s, q. p p. p.4 p 0. p c, q c * 5 00 * 00 g * * 5 00 * 00 g * * * g 00 * a 4 3 BI 4 49: (a) value pulic sector; () value 200; (c) value ; (d) value ; (e) value ; (f) value ; (g) value St. Maarten; (h) < 2 years; (k) < year; (l) data under country review. BI 42 AB: (m) incl. 'Oras Sociales' (ARG), ISAPRES and FONASA (CHL), IAMC (URY); (n) institutional expenditure; (o) expenditure y activities or udgetary program; (p) medical care and expenses; (q) health; (r) health care and health conservation; (s) personal care and health. BI 45 4: (*) reported coverage >00%.

10 socioeconomic indicators 50T 50M 50F literate population (5+years old) (%) male female 5 calories availaility (Kcal/pc/day) 52A 52B gross national income (US$ per capita) 200 current value ppp value 53 annual GDP growth (%) 0 54 highest 20%/ lowest 20% income ratio , lay 55T 55U 55R 5T 5U population with access (%) to improved sources of drinking water, 200 uran rural uran 5R improved sanitation 200 rural The Americas 3,205 20,040, North America Bermuda Canada United States of America 3,739 2,235 3,05 3,754, a 3,50 44,70,34 3,20 44, Latin America & the Cariean ,75 4,2, Latin America , 4,, Mexico ,7 7,30, c Central American Isthmus Belize Costa Rica El Salvador Guatemala Honduras Nicaragua Panama ,39 2,7 2,3 2,55 2,7 2,373 2,29 2,27 2,4 3,740 4, 2,0 2,5, ,000 5,330 7,00 9,0 5,0 5,20 3,420 2,720, c e 4 79 e 9 0e e 4 74 e e Latin Cariean Cua Dominican Repulic French Guiana Guadeloupe Haiti Martinique Puerto Rico ,5 3,2 2,2 2,09 2, 0 a 5,500, Andean Area Bolivia Colomia Ecuador Peru Venezuela ,45 2,29 2,57 2,4 2,579 2,272 3,5,00 3,20 2, 2,,070 7,3 3,0,30,0,4 0, c Brazil ,4 4,70, Southern Cone Argentina Chile Paraguay Uruguay , 2,9 2,72 2,524 2,3 5,7 5,50,0,40 5,30 0,,70,300 4,040 9, d d NonLatin Cariean Anguilla Antigua & Baruda Arua Bahamas Barados Cayman Islands Dominica Grenada Guyana Jamaica Montserrat Netherlands Antilles Saint Kitts & Nevis Saint Lucia Saint Vincent & the Grenadines Suriname Trinidad & Toago Turks & Caicos Islands Virgin Islands (UK) Virgin Islands (US) ,75 2,33 2,709 3,23 2,75 2,0 2,74 2, 2,5 2, 2,7 5,544,050 a a a a 4,0 4,50,50 3,50 a,40 5,00 3,320 4,20 2,500 a 9,39 5,30 5,50 7,70,0 3,40 7,050 2,440,500,0 7,720, c BI 52A 54: (a) estimated to e US$, and more; () estimated to e US$ 3,5; (c) ased on expenditure shares; (d) uran data. BI 55 5: (e) value 2002 and provided y country.

11 infant and maternal mortality: WHO estimates vs. country figures Infant Mortality Rate country figures Maternal Mortality Ratio country figures Figure : Infant Mortality Rate WHO vs. country figures VCT ATG PER BRA ECU BHS BLZ PRY LCA BRB COL VEN PAN USA CHL CRI URYARG GRD CAN CUB DOM Figure 2: Maternal Mortality Ratio WHO vs. country figures BOL GTM GUY MEX VEN PRY PAN DOM JAM BRA COL NIC ECU CAN USA CUB ARG CHL SLV BRB NIC SUR MEX TTO Infant Mortality Rate WHO Maternal Mortality Ratio WHO GUY BOL HTI HTI Tale : Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) country ARG ATG BHS BLZ BOL BRA BRB CAN CHL COL CRI CUB DOM ECU GRD GTM GUY HND HTI JAM LCA MEX NIC PAN PER PRY SLV SUR TTO URY USA VCT VEN IMR, WHO, IMR, country year MMR WHO, MMR country year Figures and 2 show the difference etween WHO estimates and the numers reported y the country for oth the maternal mortality ratio (per 00,000 l) and the infant mortality rate (per,000 l). Deviances from the straight line reflect the differences etween rates/ratios reported y the countries and WHO estimates. Tale shows maternal and infant mortality reported y countries and estimated y WHO. Infant Mortality Rate (IMR): Four countries (GUY, MEX, SUR, TTO) report infant mortality rates lower than the WHO estimates. The relative difference etween the reported and estimated mortality in these countries is greater than 50%. Two countries (ATG, VCT) show reported rates higher than the estimated rate, with a relative difference of over 30% (Figure ). In general, the differences oserved may stem from the assumptions used in the WHO estimation methodology or from possile underregistration of irths and/or infant deaths. In Mexico, for example, we oserve a large difference etween the rate reported y the country and the estimated rate although Mexico has a good vital statistics system. Additionally, it can e oserved that countries with higher reported rates than estimated tend to have smaller populations and the estimation error is larger. Maternal Mortality Ratio (MMR): Figure 2 shows the comparison etween the maternal mortality ratio in the two different sources where the estimates are in most cases higher than the figures reported y the countries. In four countries, the estimates are more than 00% higher than the figures reported (ECU, SLV, GUY, DOM). The estimates for ARG, COL, GTM, JAM, NIC, and PAN are 50% to 00% higher than the country reported figures. The estimates for BRA and CUB are approximately 50% higher than their reported figures. Oserved differences etween the estimated and reported maternal mortality ratio are higher than those for the infant mortality rate. Conclusion: Since monitoring of maternal and infant mortality is part of the Millennium Development Goals, having methodologies that allow the validation of reported indicators is essential. The analysis of the data has shown that estimation does not always provide reliale indicators for certain countries. For example, estimation of infant mortality in Mexico shows: a) a rate different to the national reality and ) a rate not consistent to other countries. It is therefore necessary to work with the countries in the identification of methodologies that will lead to an improvement in the quality of mortality data, and to develop correction methods for immediate use in areas such as monitoring and health situation analysis. Limitations: Estimates of WHO correspond to the year (MMR) and 200 (IMR). The data reported y the countries does not necessarily correspond to the year of the estimates. The magnitude of some differences etween reported and estimated is very large and cannot e explained solely due to the difference in years. The following countries have een excluded from the analysis for lack of uptodate information ( or most recent year): MMR: ANT, GUF, HON, PER; IMR: ANT, GTM, JAM. Furthermore, countries with few events were not included, owing to the fluctuation in the rate/ratio over time. Source: Technical reports from the PAHO/WHO Representative Office in the countries of the Region of the Americas;. WHO, World Health Statistics, Geneva, WHO,. Country codes according to ISO 3: Arua (ABW), Anguilla (AIA), Netherlands Antilles (ANT), Argentina (ARG), Antigua and Baruda (ATG), Bahamas (BHS), Belize (BLZ), Bermuda (BMU), Bolivia (BOL), Brazil (BRA), Barados (BRB), Canada (CAN), Chile (CHL), Colomia (COL), Costa Rica (CRI), Cua (CUB), Cayman Islands (CYM), Dominica (DMA), Dominican Repulic (DOM), Ecuador (ECU), Guadeloupe (GLP), Grenada (GRD), Guatemala (GTM), French Guiana (GUF), Guyana (GUY), Honduras (HND), Haiti (HTI), Jamaica (JAM), Saint Kitts & Nevis (KNA), Saint Lucia (LCA), Mexico (MEX), Montserrat (MSR), Martinique (MTQ), Nicaragua (NIC), Panama (PAN), Peru (PER), Puerto Rico (PRI), Paraguay (PRY), El Salvador (SLV), Suriname (SUR), Turks and Caicos Islands (TCA), Trinidad & Toago (TTO), Uruguay (URY), United States of America (USA), Saint Vincent & the Grenadines (VCT), Venezuela (VEN), Virgin Islands UK (VGB) and Virgin Islands US (VIR).

12 technical notes & sources Technical notes: Infant mortality rate (IMR) and maternal mortality ratio (MMR) (BI 0, ) are reported or estimated y countries. Data are presented when the variation coefficient (relative standard error) is less than 23%; otherwise the numer of deaths is shown. An increase of MMR or IMR may reflect an improvement in data coverage and quality. Certified deaths due to illdefined and unknown conditions (BI ) refers to death certificates issued in a given year for which the underlying cause of death was symptoms, signs, and illdefined and unknown conditions (ICD9 codes 707; ICD0 codes R00R). Mortality underregistration (BI 7) is determined y sutracting from the cumulative deaths registered in a countryperiod divided y the corresponding cumulative estimated deaths, otained after applying the UN estimated crude death rates to the corresponding population estimates y the UN. Corrected mortality rates (BI Tc/Mc/Fc IB 2Tc/Mc/Fc) were computed ased on registered mortality data, applying a correction algorithm for mortality underregistration and a redistriution algorithm for deaths from illdefined causes. The methodology used is presented in Health Statistics from the Americas, 200 edition ( The rates represent the average mortality for three years. General corrected mortality rates for Bolivia and Honduras were determined with UN lifetales and UN population estimates. Ageadjusted mortality rates (BI Ta/Ma/Fa BI 2Ta/Ma/Fa) were computed y direct standardization to the World Standard Population (2,400 under year; 9,00 from to 4 years; 9,000 from 5 to 4 years;,000 from 5 to 44 years; 9,000 from 45 to 4 years; and 7,000 5 years and older) (WHO, World Health Statistics Annual; Edition; Geneva, ). Malaria risk areas population (BI 3) shows the proportion of the population in a country living in high and moderate malaria transmission risk areas. Moderate risk: API etween to 0/,000 pop; high risk: API > 0/,000 pop. Data from previous years were used to calculate the estimated APIs. National Health Expenditure (BI 42A) corresponds to expenditure in the function health (Division 07) of the Functional Classification of the Government Expenditure y Functions of the International Family of Classifications of the United Nations. It includes expenditures y general government, from social security funds and other pulic health insurance systems (mandatory). Data come from the International Monetary Fund s Government Finance Statistics dataase (Printed version 200 and CD, ) and from pulic health insurance institutions financial reports. ( Denominator for rates of BI 29, 30, 3, 35 y 4: UN WPP 200 Revision; US Census Bureau. Suregional aggregates express average values weighted y respective denominator. The sum of the is presented for asolute numers. Values from different years are included in this. Data sources: Technical reports from PAHO/WHO Country Representatives; Region of the Americas;, (BI 0, 37, 4, 44, 49). As of 20 June. Technical reports from PAHO/WHO Regional Units; (BI 2, 340, 42AB, 454). As of 3 June. United Nations Population Division. World Population Prospects: The 200 Revision, New York; (BI, 9THM, 2). U.S. Bureau of the Census. International Data Base (BI,, 9THM). Accessed May at: World Health Organization. World Health Statistics. Geneva, WHO; (BI 3). United Nations Population Division. World Uranization Prospects: The Revision, New York; 200 (BI 7). PAHO/WHO. Technical Information System: Regional Mortality Dataase, HDM/HA; Washington, D.C.; (BI 42). As of August. UNESCO. Institute for Statistics (UIS). Data Centre, UIS Estimates (BI 50THM). Accessed June at: United Nations. Food and Agriculture Organization (FAO), FAOSTAT Statistical Dataase. Rome, (BI 5). Accessed August at: The World Bank World Development Indicators. Washington DC; (BI 52AB 54). WHO/UNICEF. Joint Monitoring Programme for Water Supply and Sanitation (JMP),. With data of 200. In press. (IB555). Suggested citation: Pan American Health Organization, Health Information and Analysis. Health Situation in the Americas: Basic Indicators. Washington, D.C.,. Areviations: () magnitude zero; (0) magnitude less than half the measurement unit; (...) data not availale; (c) circa; (pop) population; (l) live irths; (lay) latest availale year; (ppp) purchasing power parity; (GDP) gross domestic product; (ADD) acute diarrheal diseases: CIE9 (00009); CIE0 (A00A09); (ARI) acute respiratory infections: CIE9 (404; 4047); CIE0 (J00J); (SS+) sputum smear positive; (API) annual parasite index; (aids) acquired immunodeficiency syndrome; (DPT3) diphtheriapertussistetanus, third dose; (Polio 3) oral polio vaccine or inactivated polio vaccine, third dose; (BCG) antituerculosis vaccine (acille CalmetteGuerin); (MMR) measles, mumps and ruella; () not applicale; (IB) asic indicator. PAHO/HSD/HA/0.0 Quality of mortality data in the Americas, or most recent year The quality of mortality data was measured y means of a composite index that is composed of Proportion of underregistered deaths and the Proportion of deaths due to illdefined and unknown conditions. The index has four categories: good quality data ( 0%), medium quality (20%), poor quality (240%) and very poor quality (>4%). DATA QUALITY INDEX good medium poor very poor no data COUNTRIES ARG, CAN, CHL, CRI, CUB, GLP, GRD, GTM, GUF, MEX, MTQ, PRI, SUR, TTO, URY, USA, VCT, VEN, VIR BRA, COL, ECU, GUY, PAN, SLV ABW, DOM, NIC, PER, PRY BOL, HTI AIA, ANT, ATG, BHS, BLZ, BMU, BRB, CYM, DMA, HND, JAM, KNA, LCA, MSR, TCA, VGB Index: * Proportion of underregistered deaths (%) * Proportion of certified deaths due to illdefined and unknown conditions (%) Source: PAHO/WHO; Technical Information System: Regional Mortality Dataase; PAHO,. As of August. Information presented in this pulication supersedes that of previous editions and is under ongoing review. Users are advised not to compare data series etween different editions. Data sources were defined to ensure comparaility; therefore, statistics can differ from national statistics. For more information, contact: Health Surveillance, Disease Prevention and Control (HSD) Health Information and Analysis (HA) Pan American Health Organization 525 Twentythird St., N.W. Washington, D.C., 7, USA ha@paho.org