Abstract
BackgroundMortality data are used to conduct disease surveillance, describe health status and inform planning processes for health service provision and resource allocation. In many countries, HIV- and AIDS-related deaths are believed to be under-reported in government statistics.MethodsTo estimate the extent of under-reporting of HIV- and AIDS-related deaths in Botswana, we conducted a retrospective study of a sample of deaths reported in the government vital registration database from eight hospitals, where more than 40% of deaths in the country in 2005 occurred. We used the consensus of three physicians conducting independent reviews of medical records as the gold standard comparison. We examined the sensitivity, specificity and other validity statistics.ResultsOf the 5276 deaths registered in the eight hospitals, 29% were HIV- and AIDS-related. The percentage of HIV- and AIDS-related deaths confirmed by physician consensus (positive predictive value) was 95.4%; however, the percentage of non-HIV- and non-AIDS-related deaths confirmed (negative predictive value) was only 69.1%. The sensitivity and specificity of the vital registration system was 55.7% and 97.3%, respectively. After correcting for misclassification, the percentage of HIV- and AIDS--related deaths was estimated to be in the range of 48.8% to 54.4%, depending on the definition.ConclusionImprovements in hospitals and within government offices are necessary to strengthen the vital registration system. These should include such strategies as training physicians and coders in accurate reporting and recording of death statistics, implementing continuous quality assurance methods, and working with the government to underscore the importance of using mortality statistics in future evidence-based planning.
Highlights
Mortality data are used to conduct disease surveillance, describe health status and inform planning processes for health service provision and resource allocation
To evaluate the vital registration system for this purpose, we focus on three major objectives: (1) assessing the validity of HIV and AIDS deaths reported from hospitals; (2) characterizing the extent to which deaths related to HIV and AIDS fail to be recorded as such; and (3) providing statistics on HIVand AIDS-related deaths adjusted for under-reporting
HIV- and AIDS-related mortality prevalence estimates We used the proportion of HIV- and AIDS-related deaths, as determined by consensus of the three physicians, as the "true" mortality prevalence. We examined how this would change if we used the experts' review, with varying definitions for HIV- and AIDS-related deaths (i.e., Methods B, C, and D)
Summary
Mortality data are used to conduct disease surveillance, describe health status and inform planning processes for health service provision and resource allocation. HIV- and AIDS-related deaths are believed to be under-reported in government statistics. Accurate and standardized systems for the reporting of causes of death are essential in order to monitor the impact of public health interventions and analyze mortality trends over time [1,2]. Low-income and middle-income countries recognize the importance of timely and accurate health statistics, the death registration systems in these settings are frequently inadequate due to incomplete and delayed reporting of deaths, missing data, inaccurate reporting of the cause of death, and incorrect coding of underlying and contributory causes of death [24]. Deaths due to HIV and AIDS are underreported in low- and middle-income countries [2]. Lack of reporting of deaths outside health institutions, physician failure to report a death, the social stigma of HIV [5], missing HIV-specific documentation in the medical record, and lack of a clear primary and/or contributory causes of death are the commonly cited reasons [6]
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