Registration and medical certification of deaths in the Indian States: a comparative analysis of data of CRS and MCCD reports (2010–2019)

Abstract

The medical certification of cause of death under Civil Registration System has been implemented in the States/UTs to provide data on cause of death but use of this data is compromised due to incomplete coverage and inadequate quality. The completeness of registration of death (CoRD) and completeness of medically certified deaths (CoMeRD) were assessed to understand the trend over time and also to identify gaps in data to improve data quality. CoRD and CoMeRD for each year for each state was calculated from the CRS reports and MCCD reports, respectively, for the period 2010–2019. Data were analyzed nationally as per geographical region and individual state. The CoRD in India have increased in the CRS from 66.9% in 2010 to 92% in 2019, a significant increase of 37.7% over 9 years (P < 0.001), whereas India has not witnessed a substantial increase in the CoMeRD in MCCD which has increased from 17.1% in 2010 to only 20.6% in 2019. Among the 29 States, 18 (62%) had CoRD > 95% in 2019, with 15 states recording 100% of CoRD however just 3 states (10.3%) have CoMeRD more than 50%. Despite the significant progress made in CoRD, importance of medical certification cannot be undermined; critical differences between the States within the CRS and MCCD remain a cause of concern. Concentrated efforts to assess the strengths and weaknesses at the State level of the MCCD and CRS processes, quality of data, and plausibility of information generated are needed.