# Updated estimates of infant mortality in Venezuela

Jenny Garcia, Stéphane Helleringer, Gerardo Correa, Maria Di Brienza

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Jenny Garcia, Stéphane Helleringer, Gerardo Correa, Maria Di Brienza. Updated estimates of infant mortality in Venezuela. The Lancet global health, 2024, 12 (1), pp.e25-e27. 10.1016/S2214-109X(23)00520-X. hal-04357450

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Submitted on 21 Dec 2023

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<figure><img src="image_1.png" /></figure>

Distributed under a Creative Commons CC BY 4.0 - Attribution - International License
Updated estimates of
infant mortality in
Venezuela

We recently highlighted the rapidly
deteriorating circumstances faced by

young children in Venezuela between
2008 and 2016.¹ This reversal of a
decades-long trend towards better
health in the country occurred in the
middle of a sharp economic downturn
and a collapsing health system.² Since
then, the socioeconomic crisis affecting

Venezuela has continued, leading to
the greatest population displacements
in the recent history of the Americas.
Several vaccine-preventable diseases
have also re-emerged,³ and multiple
waves of the COVID-19 pandemic have
further disrupted health services over

<figure><img src="image_2.png" /></figure>

<figure><img src="image_3.png" /><figcaption>Scenario 2 (NDB 56% completeness)</figcaption></figure>

<figure><img src="image_4.png" /><figcaption>Figure: Venezuelan infant mortality rate estimations between 1985 and 2022</figcaption></figure>

International models and projections includes UNIGME 2022, WPP 2022, IHME 2019, and ECLAC 2016. IMoH (MPPS)=Venezuelan Ministry of Health (Ministerio del Poder Popular para la Salud). NSO (INE)=Venezuelan National Statistics Office (Instituto Nacional de Estadisticas). NDBs (56% completeness)=Notifiable Diseases Bulletins published by Venezuelan Ministry of Health, minimum historical completeness (2005: 56%). NDBs (80% completeness)=Notifiable Diseases Bulletins published by Venezuelan Ministry of Health, predicted completeness due to historical trend (2003-16). ENCOVI data=National Survey of Living Conditions of the Venezuelan Population, 2019 and 2021, published by Universidad Catolica Andres Bello. UNIGME 2022=UN Inter-Agency Group for Child Mortality Estimation, Revision 2022. WPP 2022=World Population Prospects, UN Department of Economic and Social Affairs, Population Division, Revision 2022. ECLAC 2016=UN Economic Commission for Latin America and the Caribbean, Population Division, revision 2016. IHME 2019=The Institute for Health Metrics and Evaluation, Global Burden of Disease Study, 2019.
See Online for appendix

the past 3 years.⁴ How infants have fared in this adverse context remains largely unknown because official vital statistics about mortality have not been made public in Venezuela since 2018.

To produce annual estimates of the infant mortality rate (IMR) for the period beginning in 2019, we adapted methods used in our earlier paper.¹ We estimated the annual number of births (ie, the denominator of the IMR) by combining census data on the number of women by age in 2011, with survey estimates of age-specific out-migration and fertility rates covering the period until 2022 (appendix pp 3-4).⁵ We used records collected in hospitals and other health facilities to obtain annual counts of infant deaths (ie, the numerator of the IMR). These data on hospital deaths were reported by the Venezuelan Ministry of Health in 2022, after several years of hiatus,⁶ but it is unclear what percentage of all infant deaths they represent (appendix p 4). We thus formulated two scenarios, on the basis of an analysis of trends in the ratio of hospital deaths to total deaths for the period when both indicators were reported every year (ie, 2003-16). In the first scenario we considered that this ratio continued to increase linearly after 2016. In the second scenario, we considered that the ratio of hospital to total deaths recently declined, because the socioeconomic crisis and the COVID-19 pandemic might have reduced health-care use or the completeness of health records, or both. Finally, we used indirect demographic techniques⁷ to generate two independent IMR estimates from the Encuesta Nacional de Condiciones de Vida (ENCOVI) nationally representative survey of living conditions done in 2019-21 (appendix p 5).⁵

Our analyses of these multiple data sources indicate that the health of Venezuelan infants has probably continued to deteriorate since 2016. In the first of our scenarios, the IMR reached 23.2 deaths per

1000 livebirths (95% CI 22.1-24.2) in 2017, before declining to 20.2 deaths per 1000 livebirths in 2022, a 12.9% decline relative to the estimated peak (figure A). In the second scenario, the IMR continued to increase, albeit at a slower rate, until 2022 (figure B). In both scenarios, however, infant mortality remained at levels similar to those experienced in the country in the 1990s or early 2000s.

Compared with global series of IMR estimates routinely produced by the UN or the Institute for Health Metrics and Evaluation (IHME), our analyses highlight a later and higher peak of the IMR, and more uncertainty about the most recent trends in infant mortality (appendix p 8). Estimates from the Global Burden of Disease 2019 study suggest that the IMR has steadily declined since 2010, reaching its lowest point at 12.8 deaths per 1000 livebirths in 2019. In contrast, the UN's Inter-Agency Group for Child Mortality Estimation (UN-IGME) reported that the IMR started plateauing in 2016 at 21.1 deaths per 1000 livebirths,⁸ whereas the World Population Prospects (WPP) indicated that the IMR peaked at approximately 15.7 deaths per 1000 livebirths.⁹ Contrary to our own estimates, these three IMR series do not use data from hospitals and health facilities, nor do they consider results from the ENCOVI survey.

To estimate how many more infant deaths have occurred than would have been expected if the long-term decline in IMR observed in the 1990s and 2000s had continued, we compared our results to IMR projections formulated by the UN's Economic commission for Latin America and the Caribbean (ECLAC-CELADE), and data that covered a period not affected by the socioeconomic upheaval.¹⁰ ECLAC-CELADE projected that IMR levels in Venezuela would continue to fall after 2010, similar to those of neighbouring countries (appendix p 10). In the scenario where the IMR recently started declining (figure A), we found

that an excess of 40 101 (95% CI 34 479-45 724) infant deaths might have occurred between 2011 and 2022 (appendix p 9), relative to the ECLAC-CELADE scenario. However, cumulative excess mortality might be even higher if recent data on infant deaths in hospitals included a smaller proportion of all infant deaths (figure B). By comparison, recent WPP estimates only imply less than half as many excess infant deaths in Venezuela between 2011 and 2022.

Even though the IMR appears not to have reached thresholds defining humanitarian emergencies (ie, a doubling of mortality over baseline rates), the protracted nature of the crisis has led to large numbers of excess infant deaths. The situation of young children in Venezuela warrants increased attention.

JG received funding from the EU's Horizon 2020 Excellent Science, Marie Skłodowska-Curie, individual fellowship program 2019 (grant agreement number 892134). All other authors declare no competing interests.

Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

*Jenny Garcia, Stephane Helleringer, Gerardo Correa, Maria Di Brienza
jenny.garcia@ined.fr

Institut National d'Etudes Démographiques, Paris, France (JG); New York University Abu Dhabi, Abu Dhabi, United Arab Emirates (SH); Instituto de Investigaciones Económicas y Sociales IIES, Universidad Católica Andrés Bello, Caracas, Venezuela (GC, MDB)

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5. Instituto de Investigaciones Económicas y Sociales de la Universidad Católica Andrés Bello. Encuesta Nacional sobre Condiciones de Vida (ENCOVI) 2014-2022. https://www.proyectoencovi.com/sobre-encovi (accessed Oct 10, 2022).
6 Venezuelan Ministry of Health. Boletín Epidemiológico: Semanal Epidemiológica No. 41 (09 de octubre al 15 de octubre del 2022) Año de edición LXIII. https://drive.google.com/file/d/1f1zB3MJe3ndT_zgdBen3KEwTGiVwzLBn/view (accessed Jan 8, 2023).

7 Hill K, Lopez AD, Shibuya K, Jha P. Interim measures for meeting needs for health sector data: births, deaths, and causes of death. *Lancet* 2007; **370**: 1726–35.

8 United Nations Inter-agency Group for Child Mortality Estimation. Child mortality, stillbirth, and causes of death estimates. 2023. https://childmortality.org/data/Venezuela%20(Bolivarian%20Republic%20of (accessed May 4, 2023).

9 UN Department of Economic and Social Affairs, Population Division. World population prospects 2022. 2022. https://population.un.org/wpp/Download/Standard/MostUsed/ (accessed May 2, 2023).

10 Economic Commission for Latin America and the Caribbean (ECLAC), Demographic Observatory. Population projections. 2016. https://repositorio.cepal.org/bitstream/handle/11362/41018/1/S1600734_en.pdf (accessed May 2, 2023).