Abstract
BackgroundMortality statistics derived from cause of death data are an important source of information for population health monitoring, priority setting and planning. In Perú, almost all death certificates are issued by doctors because it is a legal requirement. However, the quality of cause of death data is poor. In August 2016, the Ministry of Health of Perú decided to make two specific interventions to improve cause of death data: to introduce an online death certification system and to train doctors in standard death certification practices.MethodsThe study comprised a random sample of 300 pre-intervention death certificates, 900 death certificates that were part of the online intervention, and 900 death certificates that were part of both the online and training interventions. All the deaths had occurred between January and September 2017. We used the Assessing the quality of death certification tool from the University of Melbourne for the assessment. We examined the frequency of common errors in death certificates, the frequency of any error and the average error score for each category of: age group, sex, doctor’s seniority, doctor’s speciality, level of health facility and broad cause of death.ResultsThe average error score declined by 38% due to the online intervention and by a further 26% due to the training intervention. Improved certification practices remained after controlling for potentially confounding factors. Main improvements were reductions in the absence of a time interval (66% of certificates), incorrect sequence of causes (22%), and ill-defined conditions (13%).ConclusionsThis study demonstrates how the two interventions introduced by the Ministry of Health in Perú improved the correctness of death certificates. The study also provides evidence on necessary changes to the training program to address the poor certification practices that have remained after implementation of the online system.
Highlights
Mortality statistics derived from cause of death data are an important source of information for population health monitoring, priority setting and planning
This study has clearly demonstrated the effect of the two interventions introduced by the Ministry of Health in Perú to improve the correctness of cause of death data
The study has demonstrated the significant impact that an online system can have on the quality of death certification, which in Perú will result in improved mortality statistics as the system is rolled out through the country
Summary
Mortality statistics derived from cause of death data are an important source of information for population health monitoring, priority setting and planning. Routine cause of death data from civil registration and vital statistics (CRVS) systems are an important source of information and evidence for monitoring population health, identifying health priorities, and planning public health interventions [1,2,3,4]. While 95% of medical certificates of cause of death (‘death certificates’) are certified by doctors [16], international studies have shown that cause of death data from certificates are of limited use for country policy due to their poor quality [6, 17, 18] Such findings are supported by Perú’s low Vital Statistics Performance Index (VSPI) score (50%). The VSPI scores the quality of data on mortality and cause of death by assessing several components within a CRVS system, including the extent to which age and/or sex are missing in the data, and the number of biologically implausible underlying causes of death recorded on death certificates [19]
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