Updated estimates of infant mortality in Venezuela
Authors: Jenny Garcia, Stephane Helleringer, Gerardo Correa, Maria Di Brienza
Journal: The Lancet Global Health (2023)

We recently highlighted the rapidly deteriorating circumstances faced by young children in Venezuela between 2008 and 2016.1García J Correa G Rousset B Trends in infant mortality in Venezuela between 1985 and 2016: a systematic analysis of demographic data.Lancet Glob Health. 2019; 7: e331-e336Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar 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.2Page KR Doocy S Reyna Ganteaume F Castro JS Spiegel P Beyrer C Venezuela's public health crisis: a regional emergency.Lancet. 2019; 393: 1254-1260Summary Full Text Full Text PDF PubMed Scopus (81) Google Scholar 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,3Paniz-Mondolfi AE Tami A Grillet ME et al.Resurgence of vaccine-preventable diseases in Venezuela as a regional public health threat in the Americas.Emerg Infect Dis. 2019; 25: 625-632Crossref PubMed Scopus (0) Google Scholar and multiple waves of the COVID-19 pandemic have further disrupted health services over the past 3 years.4Correa-Salazar C Amon JJ Cross-border COVID-19 spread amidst malaria re-emergence in Venezuela: a human rights analysis.Global Health. 2020; 16: 118Crossref Scopus (6) Google Scholar 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.1García J Correa G Rousset B Trends in infant mortality in Venezuela between 1985 and 2016: a systematic analysis of demographic data.Lancet Glob Health. 2019; 7: e331-e336Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar 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).5Instituto de Investigaciones Económicas y Sociales de la Universidad Católica Andrés BelloEncuesta Nacional sobre Condiciones de Vida (ENCOVI) 2014–2022.https://www.proyectoencovi.com/sobre-encoviDate accessed: October 10, 2022Google Scholar 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,6Venezuelan Ministry of HealthBoletín 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/viewDate accessed: January 8, 2023Google Scholar 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 techniques7Hill 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: 1726-1735Summary Full Text Full Text PDF PubMed Scopus (116) Google Scholar 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).5Instituto de Investigaciones Económicas y Sociales de la Universidad Católica Andrés BelloEncuesta Nacional sobre Condiciones de Vida (ENCOVI) 2014–2022.https://www.proyectoencovi.com/sobre-encoviDate accessed: October 10, 2022Google Scholar 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,8United Nations Inter-agency Group for Child Mortality EstimationChild mortality, stillbirth, and causes of death estimates.https://childmortality.org/data/Venezuela%20(Bolivarian%20Republic%20ofDate: 2023Date accessed: May 4, 2023Google Scholar whereas the World Population Prospects (WPP) indicated that the IMR peaked at approximately 15·7 deaths per 1000 livebirths.9UN Department of Economic and Social AffairsPopulation DivisionWorld population prospects 2022.https://population.un.org/wpp/Download/Standard/MostUsed/Date: 2022Date accessed: May 2, 2023Google Scholar 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.10Economic Commission for Latin America and the Caribbean (ECLAC)Demographic ObservatoryPopulation projections.https://repositorio.cepal.org/bitstream/handle/11362/41018/1/S1600734_en.pdfDate: 2016Date accessed: May 2, 2023Google Scholar 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. Download .pdf (.32 MB) Help with pdf files Supplementary appendix