1. EMR burden of Diseases
Operation of Civil Registration, Vital Statistics and Identity Management Systems and the Production of Vital Statistics Reports, EMRO countries,
Casablanca, Morocco
19-23 March 2018
Dr. Eman Aly MD PhD
Dr. Eman Aly MD PhD

2. Introduction:
Mortality data are the most relevant medical data to describe trend of diseases in the community
Accurate and complete causes of death registration are required to represent the true burden of diseases
CRVS – program in EMRO, is focusing on improving death/cause of death registration coverage and accurate identification of underlying cause of death, through; building capacity, close monitoring and evaluation of death registration systems at MS and provide technical support to overcome system issues
Dr. Eman Aly MD PhD

3. Objective:
Provide examples of cause specific mortality data analysis, including the Global burden of disease list, using the actual national resisted data
Introduce output analysis of one of cause of death and data quality analysis software (ANACONDA)
Identify the main data quality parameters (completeness and accuracy)
Dr. Eman Aly MD PhD

4. Methodology:
Calculation of proportion of causes of death using, the most recent mortality data available at, WHO global mortality data base, where data are cleaned in consultation with MS and uploaded
The plan of analysis followed the classification of Global burden of disease list (20 causes), Analysis is done using STATA – 13
ANACONDA “Analysis of Cause of Death and data quality check tool”, is used to visualize the proportion of deaths and death rate per 100,000 by age group and sex
Dr. Eman Aly MD PhD

5. Bahrain 2014 Completeness =83%
GBD Cause category
Freq. %
Diabetes mellitus
474
17.59
Malignant neoplasms
279
10.36
Ill-defined diseases
265
9.84
Unintentional injuries
160
5.94
Endocrine disorders 93
3.45
Perinatal conditions 77
2.86
Congenital anomalies 65
2.41
Infectious and parasitic diseases 62
2.3
Neuropsychiatric conditions
Genitourinary diseases 56
2.08
Respiratory diseases 54 2
Digestive diseases 53
1.97
Ill-defined injuries/accident 34
1.26
Respiratory infections 29
1.08
Intentional injuries 16
0.59
Musculoskeletal diseases 14
0.52
Other neoplasms 13
0.48
Skin diseases
Nutritional deficiencies 9
0.33
Maternal conditions
0.07
Total
2,694
Dr. Eman Aly MD PhD

6. Bahrain 2014
Dr. Eman Aly MD PhD

7. Egypt 2014 Completeness =95% GBD Cause category Freq. %
Cardiovascular diseases
253,152
47.66
Digestive diseases
58,460
11.01
Malignant neoplasms
32,864
6.19
Ill-defined diseases
30,736
5.79
Respiratory diseases
23,295
4.39
Genitourinary diseases
20,681
3.89
Diabetes mellitus
19,838
3.74
Unintentional injuries
19,515
3.67
Infectious and parasitic diseases
19,249
3.62
Respiratory infections
17,375
3.27
Endocrine disorders
9,335
1.76
Congenital anomalies
8,654
1.63
Neuropsychiatric conditions
6,240
1.17
Perinatal conditions
4,833
0.91
Other neoplasms
2,471
0.47
Nutritional deficiencies
1,258
0.24
Ill-defined injuries/accident
1,252
Intentional injuries
608
0.11
Maternal conditions
501
0.09
Skin diseases
409
0.08
Musculoskeletal diseases
314
0.06
Sense organ diseases 45
0.01
Oral conditions 30
Total
531,115
Dr. Eman Aly MD PhD

8. Egypt 2014
Completeness =95%

9. Iran 2014 Completeness =90% GBD Cause category Freq. %
Cardiovascular diseases
114,013
41.99
Malignant neoplasms
35,882
13.21
Unintentional injuries
24,710
9.1
Ill-defined diseases
18,505
6.82
Respiratory diseases
10,317
3.8
Perinatal conditions
10,198
3.76
Diabetes mellitus
9,989
3.68
Neuropsychiatric conditions
6,731
2.48
Digestive diseases
6,622
2.44
Respiratory infections
5,572
2.05
Congenital anomalies
5,148
1.9
Genitourinary diseases
5,115
1.88
Infectious and parasitic diseases
4,973
1.83
Intentional injuries
4,822
1.78
Other neoplasms
2,450
0.9
Ill-defined injuries/accident
2,402
0.88
Endocrine disorders
2,046
0.75
Musculoskeletal diseases
807
0.3
Skin diseases
581
0.21
Nutritional deficiencies
373
0.14
Sense organ diseases
146
0.05
Maternal conditions
104
0.04
Oral conditions 26
Total
271,532
No data in age >75y
Dr. Eman Aly MD PhD

10. Iran 2014
Dr. Eman Aly MD PhD

11. Iraq 2008 Completeness =75% GBD Cause category Freq. %
Cardiovascular diseases
43,130
40.59
Unintentional injuries
11,020
10.37
Malignant neoplasms
7,907
7.44
Infectious and parasitic diseases
6,833
6.43
Ill-defined diseases
6,353
5.98
Perinatal conditions
5,651
5.32
Genitourinary diseases
5,197
4.89
Ill-defined injuries/accident
4,246 4
Diabetes mellitus
3,474
3.27
Intentional injuries
3,093
2.91
Respiratory infections
2,062
1.94
Respiratory diseases
1,866
1.76
Congenital anomalies
1,754
1.65
Neuropsychiatric conditions
1,460
1.37
Digestive diseases
1,214
1.14
Nutritional deficiencies
371
0.35
Endocrine disorders
323
0.3
Other neoplasms
114
0.11
Maternal conditions 63
0.06
Sense organ diseases 48
0.05
Musculoskeletal diseases 47
0.04
Skin diseases 27
0.03
Oral conditions 3
Total
106,256
No data in age >75y
Dr. Eman Aly MD PhD

12. Iraq 2008
Dr. Eman Aly MD PhD

13. Jordan 2012 Completeness =65%
GBD Cause category
Freq. %
Cardiovascular diseases
6,434
37.13
Malignant neoplasms
2,490
14.37
Diabetes mellitus
1,272
7.34
Unintentional injuries
1,042
6.01
Perinatal conditions
958
5.53
Congenital anomalies
747
4.31
Genitourinary diseases
544
3.14
Respiratory infections
535
3.09
Ill-defined diseases
512
2.95
Digestive diseases
499
2.88
Respiratory diseases
494
2.85
Ill-defined injuries/accident
456
2.63
Infectious and parasitic diseases
410
2.37
Neuropsychiatric conditions
303
1.75
Other neoplasms
194
1.12
Endocrine disorders
185
1.07
Intentional injuries
147
0.85
Musculoskeletal diseases 49
0.28
Maternal conditions 44
0.25
Nutritional deficiencies 7
0.04
Skin diseases
Total
17,329
Dr. Eman Aly MD PhD

14. Jordan 2012
Dr. Eman Aly MD PhD

15. Kuwait 2014 Completeness =65%
GBD Cause category
Freq. %
Cardiovascular diseases
2,273
38.32
Unintentional injuries
755
12.73
Malignant neoplasms
743
12.53
Respiratory infections
497
8.38
Infectious and parasitic diseases
383
6.46
Perinatal conditions
235
3.96
Congenital anomalies
221
3.73
Diabetes mellitus
127
2.14
Digestive diseases
107
1.8
Intentional injuries
103
1.74
Genitourinary diseases 93
1.57
Respiratory diseases 76
1.28
Ill-defined diseases 73
1.23
Neuropsychiatric conditions 63
1.06
Endocrine disorders 56
0.94
Ill-defined injuries/accident
Other neoplasms 50
0.84
Musculoskeletal diseases 10
0.17
Maternal conditions 7
0.12
Skin diseases 3
0.05
Nutritional deficiencies 1
0.02
Total
5,932
Dr. Eman Aly MD PhD

16. Kuwait 2014 Completeness =65%
Dr. Eman Aly MD PhD

17. Morocco 2012 Completeness =22%
GBD Cause category
Freq. %
Ill-defined diseases
14,228
30.44
Cardiovascular diseases
9,103
19.47
Malignant neoplasms
4,041
8.64
Perinatal conditions
3,796
8.12
Diabetes mellitus
2,558
5.47
Ill-defined injuries/accident
2,062
4.41
Infectious and parasitic diseases
1,849
3.96
Unintentional injuries
1,609
3.44
Respiratory diseases
1,409
3.01
Genitourinary diseases
1,176
2.52
Digestive diseases
1,146
2.45
Neuropsychiatric conditions
1,032
2.21
Respiratory infections
921
1.97
Congenital anomalies
551
1.18
Endocrine disorders
366
0.78
Intentional injuries
270
0.58
Other neoplasms
213
0.46
Nutritional deficiencies
199
0.43
Maternal conditions 92
0.2
Musculoskeletal diseases 77
0.16
Skin diseases 42
0.09
Oral conditions 4
0.01
Total
46,744
Available Pop. data = 0-4
Dr. Eman Aly MD PhD

18. Morocco 2012
Dr. Eman Aly MD PhD

19. OPT 2014 GBD Cause category Freq. % Cardiovascular diseases 2,736
40.86
Malignant neoplasms
954
14.25
Diabetes mellitus
599
8.95
Perinatal conditions
346
5.17
Ill-defined diseases
306
4.57
Genitourinary diseases
264
3.94
Infectious and parasitic diseases
233
3.48
Respiratory diseases
221
3.3
Congenital anomalies
200
2.99
Digestive diseases
166
2.48
Unintentional injuries
157
2.34
Respiratory infections
140
2.09
Neuropsychiatric conditions
123
1.84
Ill-defined injuries/accident
100
1.49
Intentional injuries 79
1.18
Endocrine disorders 62
0.93
Maternal conditions 5
0.07
Musculoskeletal diseases 2
0.03
Nutritional deficiencies
Other neoplasms 1
0.01
Total
6,696
Dr. Eman Aly MD PhD

20. OPT 2014
Dr. Eman Aly MD PhD

21. Oman 2012 Completeness=81% GBD Cause category Freq. %
Ill-defined diseases
2,642
37.98
Cardiovascular diseases
1,398
20.1
Unintentional injuries
437
6.28
Infectious and parasitic diseases
386
5.55
Malignant neoplasms
313
4.5
Ill-defined injuries/accident
228
3.28
Respiratory diseases
217
3.12
Perinatal conditions
208
2.99
Diabetes mellitus
196
2.82
Respiratory infections
177
2.54
Congenital anomalies
155
2.23
Digestive diseases
154
2.21
Genitourinary diseases
152
2.19
Neuropsychiatric conditions 95
1.37
Endocrine disorders 94
1.35
Other neoplasms 26
0.37
Musculoskeletal diseases 21
0.3
Intentional injuries 19
0.27
Nutritional deficiencies 16
0.23
Skin diseases 13
0.19
Maternal conditions 6
0.09
Sense organ diseases 3
0.04
Total
6,956
Dr. Eman Aly MD PhD

22. Oman 2012
Dr. Eman Aly MD PhD

23. Qatar 2014 Completeness=67% GBD Cause category Freq. Percent
Ill-defined diseases
666
28.18
Unintentional injuries
390
16.5
Cardiovascular diseases
372
15.74
Malignant neoplasms
250
10.58
Diabetes mellitus
135
5.71
Respiratory infections 75
3.17
Congenital anomalies 67
2.84
Intentional injuries
Genitourinary diseases 65
2.75
Digestive diseases 60
2.54
Perinatal conditions 52
2.2
Infectious and parasitic diseases 47
1.99
Respiratory diseases 37
1.57
Endocrine disorders 32
1.35
Neuropsychiatric conditions 27
1.14
Ill-defined injuries/accident 11
0.47
Other neoplasms 4
0.17
Nutritional deficiencies 3
0.13
Skin diseases 2
0.08
Maternal conditions 1
0.04
Total
2,363
Dr. Eman Aly MD PhD

24. Qatar 2014
Dr. Eman Aly MD PhD

25. Saudi Arabia 2012 Completeness=36%
GBD Cause category
Freq. %
Ill-defined diseases
13,681
29.99
*******************************
Cardiovascular diseases
8,216
18.01
*******************
Ill-defined injuries/accident
5,609
12.3
*************
Perinatal conditions
3,622
7.94
********
Unintentional injuries
3,175
6.96
*******
Malignant neoplasms
2,026
4.44
*****
Genitourinary diseases
1,558
3.42
****
Infectious and parasitic diseases
1,488
3.26
***
Congenital anomalies
1,244
2.73
Respiratory infections
1,074
2.35 **
Diabetes mellitus
950
2.08
Digestive diseases
842
1.85
Respiratory diseases
833
1.83
Neuropsychiatric conditions
452
0.99 *
Endocrine disorders
429
0.94
Skin diseases
179
0.39
Nutritional deficiencies 88
0.19
Intentional injuries 76
0.17
Maternal conditions 45
0.1
Musculoskeletal diseases 24
0.05
Other neoplasms 4
0.01
Sense organ diseases 2
Total
45,617
Dr. Eman Aly MD PhD

26. Syria 2010 GBD Cause category Freq. Percent Cardiovascular diseases
33,780
50.4
*******************************
Respiratory infections
9,185
13.7
********
Malignant neoplasms
4,036
6.02
****
Respiratory diseases
3,008
4.49
***
Ill-defined diseases
2,828
4.22
Perinatal conditions
2,560
3.82 **
Unintentional injuries
2,049
3.06
Congenital anomalies
1,947
2.9
Digestive diseases
1,811
2.7
Infectious and parasitic diseases
1,777
2.65
Genitourinary diseases
982
1.47 *
Ill-defined injuries/accident
808
1.21
Diabetes mellitus
751
1.12
Neuropsychiatric conditions
508
0.76
Endocrine disorders
489
0.73
Intentional injuries
245
0.37
Other neoplasms
132
0.2
Nutritional deficiencies 91
0.14
Maternal conditions 23
0.03
Skin diseases 11
0.02
Musculoskeletal diseases 6
0.01
Total
67,027
Dr. Eman Aly MD PhD

27. Tunisia 2013 Completeness=28%
GBD Cause category
Freq. %
Cardiovascular diseases
5,670
26.46
Ill-defined diseases
3,822
17.83
Malignant neoplasms
3,109
14.51
Diabetes mellitus
1,705
7.96
Perinatal conditions
1,171
5.46
Respiratory diseases
858 4
Ill-defined injuries/accident
769
3.59
Infectious and parasitic diseases
691
3.22
Digestive diseases
594
2.77
Neuropsychiatric conditions
555
2.59
Congenital anomalies
519
2.42
Genitourinary diseases
467
2.18
Respiratory infections
452
2.11
Unintentional injuries
407
1.9
Endocrine disorders
333
1.55
Other neoplasms
145
0.68
Musculoskeletal diseases 50
0.23
Nutritional deficiencies 45
0.21
Maternal conditions 28
0.13
Intentional injuries 21
0.1
Skin diseases 20
0.09
Sense organ diseases 1
Total
21,432
Dr. Eman Aly MD PhD

28. Tunisia 2013
Dr. Eman Aly MD PhD

29. Key Findings!
Using standardized data distribution for age group and the use of accurate ICD codes, reflect the actual burden of diseases and their epidemiological trends
Cardiovascular disease comes on the top of the list, reflect the true epidemiologic evolution of NCDs and, also due the use of non specific diagnosis heart diseases (heart failure, cardiac arrest …etc)
Ill-defined cause of death, which is representing the use of chapter IIIVX in ICD 10, also comes on the top of the list, indicating limited data quality and underlying cause of death identification
Limited death and cause of death registration coverage, lower the confidence of the data analysis results
Dr. Eman Aly MD PhD
Dr. Eman Aly MD PhD