Azerbaijan. Healthcare statistics
As standard, the Health Systems in Transition reports use data available through the European Health for All database; this, in turn, is compiled from data supplied to the World Health Organization (WHO) by national governments using standardized reporting procedures. Where such data are available they have been included below, but there are certain caveats to using data based on official statistics in Azerbaijan, and where necessary, complementary data sources have also been used. The main source of mortality data is through the civil registration system, which records the vital statistics for the country.
In theory, the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) (World Health Organization, 1992) is applied as standard in recording the cause of death, but there is some problems with the full implementation of ICD-10 nationwide as health providers and health statistics offices often lack adequate training or the relevant manuals for classification and coding of cases (Katsaga and Kehler, 2008). There are significant discrepancies between data collected through the civil registration system (which captures 70–89% of all deaths occurring) and data collected through the Ministry of Health Department of Information and Statistics, such as the annual number of births and deaths (Katsaga and Kehler, 2008).
The Azerbaijan Demographic and Health Survey of 2006 is a nationally representative population-based sur vey conducted according to the internationally accepted methodology for such surveys. The findings in 2006 on infant mortality differed significantly from official rates. While discrepancies in data collected from different sources is not unusual, the size of differences between population-based survey data and those collected through routine reporting channels do call into question the reliability of routine statistical data.
There is evidence to suggest that the managers of health facilities are under pressure to avoid reporting ‘negative’ statistics, particularly those relating to maternal and child health, which could account for this discrepancy; in addition, WHO criteria for defining a live birth have not been fully implemented nationwide (Katsaga and Kehler, 2008). Officially, infant mortality fell in the period from 1995 to 2007, from 24.3 to 9.8 deaths per 1000 live births, which is relatively low compared with the CIS average of 12.8 in 2006 (WHO Regional Office for Europe, 2009). However, the Azerbaijan Demographic and Health Survey 2006 found infant mortality to be 43 per 1000 births based on the international classification of live births and 23 per 1000 live births if the ‘Soviet classification’ was applied (State Statistical Committee of the Republic of Azerbaijan and Macro International, 2008).
Improving the reliability of health data has been widely recognized as central to the development of priority health programmes (such as those targeting mother and child health). Consequently, the Ministry of Health has
been focusing on a number of efforts to improve vital statistics and mortality data, and ongoing efforts to improve the situation will be combined with other plans in a National Integrated Health Information System Concept, which was under development at the time of writing. Data included in the Health for All database show that the three main causes of mortality in Azerbaijan in 2007 were circulatory diseases (551.6 per 100 000 population), cancer (87.4) and digestive diseases (60.4); unlike other countries of the CIS, deaths from external causes were not shown to be a major cause of mortality.
However, it is not clear how the unprecedented reduction in deaths from transport accidents, to 1.1 per 100 000 population in 2007, the lowest in the WHO European Region in that year, was achieved. Hence it raises questions on the quality of mortality data.
The Azerbaijan Demographic and Health Survey of 2006 included blood pressure readings for the representative study sample and found 16% of women aged 15–49 and 17% of men aged 15–49 were hypertensive. Nearly one-third of men and women over 40 years of age were found to be hypertensive, which would indicate that it is a serious health issue in Azerbaijan, although most respondents with high blood pressure were unaware that they were hypertensive (State Statistical Committee of the Republic of Azerbaijan and Macro International, 2008). The same survey found that almost half of the men aged 15–59 years were smokers; women were not asked about their tobacco consumption.
Officially, Azerbaijan has comparatively high vaccination coverage rates for measles, with 97.3% coverage in 2008. In 2008, the rates were similarly high for tuberculosis (TB; 98.2%), Diphtheria-tetanus-pertussis vaccine (DTP; 95%) and polio (97.5%) (WHO Regional Office for Europe, 2009); however, such high rates may reflect that the number of neonates in the denominator is underestimated. The 2006 Azerbaijan Demographic and Health Survey found that just 60% of children aged 18–29 months had received all the basic WHO-recommended vaccinations at the date of interview, while 13% had not received any vaccinations (State Statistical Committee of the Republic of Azerbaijan and Macro International, 2008). A dropout rate of 10% between the first and third doses was found for both DTP and polio vaccination (State
Statistical Committee of the Republic of Azerbaijan and Macro International, 2008).
Although the main causes of mortality in Azerbaijan are essentially noncommunicable, prevention of communicable diseases is a significant health issue, particularly in relation to TB as rates of multiple drug resistant TB (MDR-TB) are among the highest in Europe.
Azerbaijan was also one of the countries affected by the virulent H5N1 strain of avian influenza in 2006, which was introduced via migrating wild birds. The outbreak was successfully contained, but there were eight confirmed cases and five of these were fatal (World Health Organization, 2006).
In theory, the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) (World Health Organization, 1992) is applied as standard in recording the cause of death, but there is some problems with the full implementation of ICD-10 nationwide as health providers and health statistics offices often lack adequate training or the relevant manuals for classification and coding of cases (Katsaga and Kehler, 2008). There are significant discrepancies between data collected through the civil registration system (which captures 70–89% of all deaths occurring) and data collected through the Ministry of Health Department of Information and Statistics, such as the annual number of births and deaths (Katsaga and Kehler, 2008).
The Azerbaijan Demographic and Health Survey of 2006 is a nationally representative population-based sur vey conducted according to the internationally accepted methodology for such surveys. The findings in 2006 on infant mortality differed significantly from official rates. While discrepancies in data collected from different sources is not unusual, the size of differences between population-based survey data and those collected through routine reporting channels do call into question the reliability of routine statistical data.
There is evidence to suggest that the managers of health facilities are under pressure to avoid reporting ‘negative’ statistics, particularly those relating to maternal and child health, which could account for this discrepancy; in addition, WHO criteria for defining a live birth have not been fully implemented nationwide (Katsaga and Kehler, 2008). Officially, infant mortality fell in the period from 1995 to 2007, from 24.3 to 9.8 deaths per 1000 live births, which is relatively low compared with the CIS average of 12.8 in 2006 (WHO Regional Office for Europe, 2009). However, the Azerbaijan Demographic and Health Survey 2006 found infant mortality to be 43 per 1000 births based on the international classification of live births and 23 per 1000 live births if the ‘Soviet classification’ was applied (State Statistical Committee of the Republic of Azerbaijan and Macro International, 2008).
Improving the reliability of health data has been widely recognized as central to the development of priority health programmes (such as those targeting mother and child health). Consequently, the Ministry of Health has
been focusing on a number of efforts to improve vital statistics and mortality data, and ongoing efforts to improve the situation will be combined with other plans in a National Integrated Health Information System Concept, which was under development at the time of writing. Data included in the Health for All database show that the three main causes of mortality in Azerbaijan in 2007 were circulatory diseases (551.6 per 100 000 population), cancer (87.4) and digestive diseases (60.4); unlike other countries of the CIS, deaths from external causes were not shown to be a major cause of mortality.
However, it is not clear how the unprecedented reduction in deaths from transport accidents, to 1.1 per 100 000 population in 2007, the lowest in the WHO European Region in that year, was achieved. Hence it raises questions on the quality of mortality data.
The Azerbaijan Demographic and Health Survey of 2006 included blood pressure readings for the representative study sample and found 16% of women aged 15–49 and 17% of men aged 15–49 were hypertensive. Nearly one-third of men and women over 40 years of age were found to be hypertensive, which would indicate that it is a serious health issue in Azerbaijan, although most respondents with high blood pressure were unaware that they were hypertensive (State Statistical Committee of the Republic of Azerbaijan and Macro International, 2008). The same survey found that almost half of the men aged 15–59 years were smokers; women were not asked about their tobacco consumption.
Officially, Azerbaijan has comparatively high vaccination coverage rates for measles, with 97.3% coverage in 2008. In 2008, the rates were similarly high for tuberculosis (TB; 98.2%), Diphtheria-tetanus-pertussis vaccine (DTP; 95%) and polio (97.5%) (WHO Regional Office for Europe, 2009); however, such high rates may reflect that the number of neonates in the denominator is underestimated. The 2006 Azerbaijan Demographic and Health Survey found that just 60% of children aged 18–29 months had received all the basic WHO-recommended vaccinations at the date of interview, while 13% had not received any vaccinations (State Statistical Committee of the Republic of Azerbaijan and Macro International, 2008). A dropout rate of 10% between the first and third doses was found for both DTP and polio vaccination (State
Statistical Committee of the Republic of Azerbaijan and Macro International, 2008).
Although the main causes of mortality in Azerbaijan are essentially noncommunicable, prevention of communicable diseases is a significant health issue, particularly in relation to TB as rates of multiple drug resistant TB (MDR-TB) are among the highest in Europe.
Azerbaijan was also one of the countries affected by the virulent H5N1 strain of avian influenza in 2006, which was introduced via migrating wild birds. The outbreak was successfully contained, but there were eight confirmed cases and five of these were fatal (World Health Organization, 2006).
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