Situation analysis of mortality in Bolivia.

Introduction The latest report on mortality in Bolivia was issued in 1990. The three leading causes of death were infectious and parasitic diseases (23.9%), diseases of the circulatory system (19.5%), and diseases of the respiratory tract (14%), followed by accidents and violence (9.8%), disorders of the digestive system (8.6%), affections originating in the perinatal period (7.4%), and tumors (4%).1 Bolivia lacks a national vital statistics information system and the process of automation and modernization of the national civil registration system, which is dependent on the National Electoral Court (Corte Nacional Electoral, CNE), is slow in coming. A recent inter-institutional coordination effort by the Ministry of Health and Social Welfare (MHSW), the National Directorate of Civil Registration (Dirección Nacional de Registro Civil, DNRC), and the National Institute of Statistics (Instituto Nacional de Estadísticas, INE) is trying to solve this problem. In 2002, a collection system for medically certified deaths has been put in place in all the hospitals of the national health system, using a standard death certificate. As part of the technical cooperation that PAHO provides to the Ministry of Health to strengthen the health information system, epidemiological surveillance, and health situation analysis in the country, a plan for the study of mortality was implemented, covering the years 2000 and 2001. This study was carried out using registries of medically certified deaths from 9 cemeteries located in departmental capital cities, representing about 43% of the Bolivian population. Current situation For 2000-2005, INE and the Latin American Demography Center (CELADE for its Spanish name) estimates Bolivia’s crude death rate to be 8.2 per 1,000 population and life expectancy 63.6 years for the same period. Table 1 presents the crude mortality rates and life expectancy at birth for Latin America, Bolivia, and the 9 departments of Bolivia in the periods 1990-1995 and 2000-2005.2 The most recent survey on demography and health, implemented in 1998, estimated the infant mortality rate in Bolivia at 67 per 1,000 live births and the under five mortality rate at 92 per 1,000 live births for the period 1993-1997.3 For the year 2002, MHSW and PAHO estimated those rates at 50 and 72 per 1,000 live births, respectively.4 Figure 1 presents the proportional distribution of mortality in the under 5 by registered cause.4 Under-registration of mortality was estimated at 63% in 1999, with variations in the departments ranging between 47% in Beni and 89% in Pando. Table 2 presents estimates provided by the DNRC of mortality under-registration by department for this same year, calculated from estimated population data, crude mortality rates, and expected and regis-