Strengthening local-level cause of death surveillance: a case study of Western Cape Province, South Africa

Abstract

BackgroundThe Western Cape Province has a local-level mortality surveillance system that has been upgraded to do automated cause of death coding using IRIS software, in concordance with the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes. This paper reviews the achievements in providing district-level and subdistrict-level mortality data, and describes the lessons learnt and the challenges for sustaining such a system. MethodsCause of death coding was upgraded from a shortlist to full ICD-10 coding for natural causes of death in a customised data capture system. We manually coded injury deaths information obtained from mortuaries. We continuously reviewed the development of the project to identify the progress, challenges, and lessons learnt. FindingsA total of 33 564 deaths from natural causes were coded for 2009, with 9·4% (95% CI 9·1–9·7) due to ill-defined causes. We estimated that completeness was 83·7% (95% CI 76·9–90·4) and provided mortality profiles for all health districts for the first time, highlighting district variations in age-standardised mortality rates, although HIV and tuberculosis were the leading causes of premature mortality across all districts. We learned of the necessity of training data capturers in medical terminology and doctors in death certification, as well as building quality assurance measures into the system. Local cause of death coding enables quality issues to be identified and addressed directly at source. IRIS makes it possible to standardise coding across districts for routine cases. Dissemination of local mortality information creates a demand for updated results, which are sometimes difficult to meet. Challenges include securing the appropriate resource allocation, integrating into a fragmented health system, and ensuring co-operation between government departments. Utilisation of information technology opportunities (eg, electronic registration of death) remains a challenge. InterpretationIRIS-automated coding software has made it possible to provide routine ICD-10 cause of death coding at local level in South Africa, providing opportunities for improving the quality and use of mortality data at both local and national levels. FundingSouth African Medical Research Council, Provincial Government of Western Cape.