Medical Certification Of Cause Research Articles

Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed?

Contrary to the World Health Organization's internationally recommended medical certificate of cause of death, the South African (SA) death notification form (DNF) does not allow for the reporting of the manner of death to permit accurate coding of external causes of injury deaths. To describe the injury cause-of-death profile from forensic pathology records collected for the National Cause-of-Death Validation (NCoDV) Project and compare it with profiles from other sources of injury mortality data. In particular, the recording of firearm use in homicides is compared between sources. The NCoDV Project was a cross-sectional study of deaths that occurred during a fixed period in 2017 and 2018, from a nationally representative sample of 27 health subdistricts in SA. Trained fieldworkers scanned forensic records for all deaths investigated at the forensic mortuaries serving the sampled subdistricts during the study period. Forensic practitioners reviewed the records and completed a medical certificate of cause of death for each decedent. Causes of death were coded to the International Statistical Classification of Diseases, 10th revision (ICD-10), using Iris automated coding software. Cause-specific mortality fractions for injury deaths were compared with Injury Mortality Survey 2017 (IMS 2017) and Statistics South Africa 2017 (Stats SA 2017) datasets. The cause profile for all firearm-related deaths was compared between the three datasets. A total of 5 315 records were available for analysis. Males accounted for 77.6% of cases, and most decedents were aged between 25 and 44 years. Homicide was the leading cause of death (34.7%), followed by transport injuries (32.6%) and suicide (14.7%). This injury cause profile was similar to IMS 2017 but differed markedly from the official statistics, which showed markedly lower proportions of these three causes (15.0%, 11.6% and 0.7%, respectively), and a much higher proportion of other unintentional causes. Investigation of firearm-related deaths revealed that most were homicides in NCoDV 2017/18 (88.5%) and IMS 2017 (93.1%), while in the Stats SA 2017 data, 98.7% of firearm deaths were classified as accidental. Approximately 7% of firearm-related deaths were suicides in NCoDV 2017/18 and IMS 2017, with only 0.3% in Stats SA 2017. The official cause-of-death data for injuries in SA in 2017 differed substantially from findings from the NCoDV 2017/18 study and IMS 2017. Accurate data sources would ensure that public health interventions are designed to reduce the high injury burden. Inclusion of the manner of death on the DNF, as is recommended internationally, is critically important to enable more accurate, reliable and valid reporting of the injury profile.

Assessment of Medical Certification of Cause of Death at a Tertiary Care Center in rural region of Western Maharashtra, India

The aim of this study was to evaluate the precision and compliance with international guidelines in the medical certification of cause of death at a rural tertiary care center in Western Maharashtra, India. Additionally, we aimed to identify prevalent errors and discrepancies while investigating the factors that influence the medical certification process at the center. By conducting this research, we sought to obtain comprehensive insights into the accuracy of cause of death documentation and contribute to enhancing the adherence to standardized practices in this crucial aspect of medical practice. The Medical Certificate of Cause of Death (hereafter MCCD) is an important document issued by a doctor for which the World Health Organisation has prescribed a standard format, together with the International Classification of Diseases (hereafter ICD). In it, the doctor records the time, causes and circumstances of the deceased person's death. 615 MCCD forms were available during two years from the MAEER MIT Pune’s MIMER Medical College & BSTR Hospital, Talegaon Dabhade and Pune. All of them were scrutinized for the completeness of the certificate and tried to find out the cause of death in which underlying cause of death was written. Data was analyzed and expressed in the percentage form. Ethical clearance was obtained from the Institutional ethics committee (No. IEC/MIMER/2021/761). Main leading cause of death in the present study was disease of circulatory system 868 (29.35%), followed by Neoplasm (16.54%) and Certain infectious and parasitic disease (16.44%). The present study showed incompletely and inaccurately filled MCCD forms. Therefore, adequate training and proper sensitization of the doctors regarding the usefulness of MCCD data is required.

Cause of Death estimation from Verbal Autopsies: Is the Open Response redundant or synergistic?

Civil registration and vital statistics systems capture birth and death events to compile vital statistics and to provide legal rights to citizens. Vital statistics are a key factor in promoting public health policies and the health of the population. Medical certification of cause of death is the preferred source of cause of death information. However, two thirds of all deaths worldwide are not captured in routine mortality information systems and their cause of death is unknown. Verbal autopsy is an interim solution for estimating the cause of death distribution at the population level in the absence of medical certification. A Verbal Autopsy (VA) consists of an interview with the relative or the caregiver of the deceased. The VA includes both Closed Questions (CQs) with structured answer options, and an Open Response (OR) consisting of a free narrative of the events expressed in natural language and without any pre-determined structure. There are a number of automated systems to analyze the CQs to obtain cause specific mortality fractions with limited performance. We hypothesize that the incorporation of the text provided by the OR might convey relevant information to discern the CoD.The experimental layout compares existing Computer Coding Verbal Autopsy methods such as Tariff 2.0 with other approaches well suited to the processing of structured inputs as is the case of the CQs. Next, alternative approaches based on language models are employed to analyze the OR. Finally, we propose a new method with a bi-modal input that combines the CQs and the OR. Empirical results corroborated that the CoD prediction capability of the Tariff 2.0 algorithm is outperformed by our method taking into account the valuable information conveyed by the OR. As an added value, with this work we made available the software to enable the reproducibility of the results attained with a version implemented in R to make the comparison with Tariff 2.0 evident.

Gender differences in premature mortality for cardiovascular disease in India, 2017–18

BackgroundThe present study tries to provide a comprehensive estimate of gender differences in the years of life lost due to CVD across the major states of India during 2017–18.MethodsThe information on the CVD related data were collected from medical certification of causes of death (MCCD reports, 2018). Apart from this, information from census of India (2001, 2011), SRS (2018) were also used to estimate YLL. To understand the variation in YLL due to CVD at the state level, nine sets of covariates were chosen: share of elderly population, percentage of urban population, literacy rate, health expenditure, social sector expenditure, labour force participation, HDI Score and co-existence of other NCDs such as diabetes, & obesity. The absolute number of YLL and YLL rates were calculated. Further, Pearson’s correlation had been calculated and to understand the effect of explanatory variables on YLL due to CVD, multiple linear regression analysis had been applied.ResultsMen have a higher burden of premature mortality in terms of Years of life lost (YLL) due to CVD than women in India, with pronounced differences at adult ages of 50–54 years and over. The age pattern of YLL rate suggests that the age group 85 + makes the highest contribution to the overall YLL rate due to CVD. YLL rate showed a J-shaped relationship with age, starting high at ages below 1 years, dropping to their lowest among children aged 1–4 years, and rising again to highest levels at 85 + years among both men and women. In all the states except Bihar men had higher estimated YLL due to CVD for all ages than women. Among men the YLL due to CVD was higher in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. On the other hand, the YLL due to CVD among men was lowest in Jharkhand followed by Assam. Similarly, among women the YLL due to CVD was highest in Tamil Nadu followed by Madhya Pradesh and Chhattisgarh. While, the YLL due to CVD among women was lowest in Jharkhand. Irrespective of gender, all factors except state health expenditure were positively linked with YLL due to CVD, i.e., as state health expenditure increases, the years of life lost (YLL) due to CVDs falls. Among all the covariates, the proportion of a state's elderly population emerges as the most significant predictor variable for YLL for CVDs (r = 0.42 for men and r = 0.50 for women).ConclusionYLL due to cardiovascular disease varies among men and women across the states of India. The state-specific findings of gender differences in years of life lost due to CVD may be used to improve policies and programmes in India.

Evaluation of Medical Certification of Cause of Death in Tertiary Cancer Hospitals in Northern India.

Medical certification of cause of death (MCCD) provides valuable data regarding disease burden in a community and for formulating health policy. Inaccurate MCCDs can significantly impair the precision of national health information. To evaluate the accuracy of cause of death certificates prepared at two tertiary cancer care hospitals in Northern India during the study period (May 2018 to December 2020). A retrospective observational study at two tertiary cancer care hospitals in Varanasi, India, over a period of two and a half years. Medical records and cause of death certificates of all decedents were examined. Demographic characteristics, administrative details and cause of death data were collected using the WHO recommended death certificates. Accuracy of death certification was validated by electronic medical records and errors were graded. A total of 778 deaths occurred in the two centres during the study period. Of these, only 30 (3.9%) certificates were error-free; 591 (75.9%) certificates had an inappropriate immediate cause of death; 231 (29.7%) certificates had incorrectly labelled modes of death as the immediate cause of death; and 585 (75.2%) certificates had an incorrect underlying cause of death. The majority of certificates were prepared by junior doctors and were significantly associated with higher certification errors. A high rate of errors was identified in death certification at the cancer care hospitals during the study period. Inaccurate MCCDs related to cancers can potentially influence cancer statistics and thereby affect policy making for cancer control. This study has identified the pressing need for appropriate interventions to improve quality of certification through training of doctors.

Physician’s Knowledge and Skill to Complete the Certificate of Cause of Death According to who Guidelines A Survey Among the Doctors of A Tertiary Care Hospital at Lahore\

Background: The medical document certifying the cause of death provides vital data to develop health policies. In spite of very comprehensive guidelines issued by the WHO for thecompletion of death certificates; very few certificate arefound errorfree which might be due to lack of knowledge and practice on the part of physicians issuing that certificate.Purpose of this study is to assess the knowledge and competencies of a doctor in completing a death certificate. Methods: This study was cross-sectional. The population of this study was physicians of a tertiary care hospital of Lahore. A structured questionnaire along with a case scenario was given to 137 physicians having variable working experiences, performing in different clinical departments of a tertiary care hospital of Lahore.The participants were asked to complete the component of cause of death of the certificateonly. The percentage of omissions done by the doctors during the completion of said section was analyzed using the chi square test to establish the association between participant’s characteristics and their relevant responses. Results: Among 137participants working in different clinical departments of a Tertiary Care Hospital at Lahore, 89% were having less than 5 years’ experience and 11% having more than 5 years’ experience. 53% were qualified from public sector, 24% from private sector and 23% from foreign institutes. 77% doctors identified immediate cause of death incorrectly, 83 % did not identify and interpret underlying cause of death correctly; 90 % did notidentify contributory cause of death correctly. In46 % cases mechanism/mode of death was confused with the cause of death. Practical Implication: The correct completion of death certificates would provide an accurate and genuine mortality index essential for framing a national health policy. Conclusion: Physician’s knowledge and skill of completing the death certificates is very deficient and alarming which necessitate periodical and regular training of the physicians on completing the death certificates as per guidelines of the WHO to get an appropriate and valid health statistics effective for future public national health policies and strategies. Keywords (MeSH): Death certificate completion, Medical certification of cause of death, Physician’s knowledge, skill to complete death certificate, Mortality index

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

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.

Death certification errors in medical certificates of cause of death related to COVID-19 disease

Background: In the case of public health emergency scenarios, mortality surveillance done by analyzing medical certificates of cause of death (MCCDs) provides accurate morbidity and mortality data. Precise death certification in the novel coronavirus disease 2019 deaths is critical to understanding the magnitude and advancement of the pandemic. Inaccurate death certificates may cause underreporting or overwhelming reporting of COVID-19 deaths.Methods: The aim of the study was to analyse the MCCDs issued by the institute where the cause of death was attributed to or associated with the COVID-19 infection for certification errors. 729 MCCDs issued in COVID-19 deaths were audited primarily for their formal correctness and completeness and errors, using categories previously reported with some minor modifications. The study did not include analyzing the medical and hospital records of the deceased for the factual correctness of these MCCDs.Results: All types of major and minor certification errors were observed. Incomplete MCCDs were observed in 697 (95.61%) cases. 691 MCCDs (94.8%) were having either major or minor or both types of errors. Abbreviations were used in the MCCDs in 65.29% of cases while improper sequencing of the causes of death was observed in 52.92% of cases. Wrong terminologies like “COVID”, “COVID pneumonia”, “COVID +ve”, and “coronavirus” were used instead of the standard terminology.Conclusions: The lack of completeness and accuracy in writing the causes of death related to COVID-19 indicates a problem faced by the certifying doctors in analyzing them, especially in the early days of the pandemic.

Immediate and antecedent causes of mortality in hospitalised Indian patients with COVID-19.

It is of interest to assess the immediate and antecedent causes of mortality amongst adult COVID-19 infected patients with or without comorbidities admitted in an exclusive COVID-19 hospital was conducted the between August 2020 to May 2021. The immediate and antecedent causes were collected from the medical certificate of cause of death (MCCD). Remaining data was extracted from the hospital's record. ICMR protocol was used to grade severity of illness at admission into mild, moderate and severe categories. Clinical status during hospitalisation and most recent radiographic and laboratory data were used to assess disease progression and outcome. This study includes data from 571 people, who died at our centre between August 2020 and May 2021. Patients registered without any co-morbidity were 146 with mean age of 57.53 years; (33/146) were females and (110/46) males. Hypertension (274, 47.99%) was found in a moderately large number of patients followed by diabetes (225, 39.4%) and anaemia (199, 34.6%). Increase in risk of mortality of COVID-19 was found maximum in patients with acute respiratory distress syndrome (72.33%), followed by secondary infections (6.83%). Mortality recorded in this study was mainly in males of older age (50 years and above) with at least one co-morbidity. Anaemia was also prevalent amongst these patients and considered as an independent factor for mortality. Hence, recording of comorbidities and haemoglobin levels may help as a guideline to develop risk stratification and management of patients with COVID-19 to reduce overall mortality.

Ischemic heart disease: medical certificate of cause of death analysis

Aim. According to data from the Moscow Oblast civil registry office in 2020, to analyze medical certificates of cause of death (MCCD), where the code from “Ischemic heart disease” (IHD) (I20-I25) group is indicated as underlying cause of death (UCD).Material and methods. A total of 23193 deaths with I20-I25 codes (UCDs) were included. We assessed the prevalence of individual IHD types, the frequency and patterns of complications, the average age of deceased persons, the proportion of women and men, place of death registration.Results. The average age of the deceased was 73,6±12,5 (men, 68,8±10,5; women, 78,4±12,5; p&lt;0,0001). The proportion of women who died under the age of 70 was &lt;20%, men — &gt;50%. Half of the deaths were registered at home, a third in a hospital, and the rest elsewhere. Taking into account age and sex, inhospital death from myocardial infarction (MI) is recorded 12 times more often than in “other forms of acute IHD”. Chronic forms of IHD were registered in 76,9% of cases; in 47,3%, such IHD form as “Atherosclerotic heart disease” was noted. The proportion of deaths from acute MI and deaths after MI was 37,3%. In 92,1% of MCCDs of “other forms of acute IHD”, “acute coronary insufficiency” is indicated. Differences in the prevalence of various IHD forms between men and women were significant (p&lt;0,0001). In female mortality pattern, there are 3 times less deaths from other (non-MI) acute forms of IHD and almost 2 times less deaths from old myocardial infarction and cardiac aneurysm. As the immediate cause of death, heart failure was indicated in 78,9%, while among those with prior MI — in 91%. In other acute forms of IHD, acute coronary insufficiency was indicated in 89%.Conclusion. A high proportion of deaths with unspecified acute and chronic forms of IHD as the cause of death, especially in young men, requires a comprehensive study and development by the Russian Society of Cardiology of criteria for death from various IHD forms.

The knowledge assessment and reducing the errors of medical certificate of cause of death with sensitization training of physicians: A quality improvement intervention study.

BACKGROUND:A Medical Certificate of Cause of Death (MCCD) is a vital document issued by a doctor and has a prescribed format published by the World Health Organization. It is an essential tool to obtain scientific and reliable information in terms of the cause of mortality. The aim of this study is to assess the knowledge about MCCD and to evaluate the impact of sensitization training on the MCCD among the physicians working in the trauma and emergency department in a Tertiary Care Centre.MATERIALS AND METHODS:A quasi-experimental quality improvement hospital-based study executed in Trauma and Emergency Department of Tertiary Care Hospital in Chhattisgarh State, India. The physicians posted in the Trauma and Emergency Department were participated in the study and attended the sensitization training session on MCCD. Statistical analysis used; the data were entered in Microsoft Excel and analyzed with SPSS version 20 statistical software. Mean scores and standard deviation (SD) were used for pre and posttest data while statistical significance was tested using the paired t-test. P < 0.05 was considered as significant. The technical and medical errors in MCCD forms were depicted in percentages.RESULTS:A total of 54 physicians completed the study, including 42 junior resident doctors, 6 senior resident doctors, and 6 faculties. There was a significant difference in the scores before (M = 4.39, SD = 1.571) and after (M = 7.5, SD = 0.885) the training (t = 17.6, P < 0.0001). The participants showed substantial improvement by reduction in technical errors from 28% to 14% while the medical error also slashed down from 42% to 16%.CONCLUSIONS:Sensitization and educational training should be carried out consistently on regular intervals to improve the knowledge of physicians regarding the appropriate filling of MCCD and minimize the errors in MCCD, ultimately this will enhance usability and comparability of mortality statistics generated from International Classification of Diseases data.

A PRECEDE-PROCEED Approach in the Advocacy for Computer-based Education on Correct Medical Certification of Cause of Death among Physician-Learners

Objective. Mortality data is a critical input to public health decision-making and planning. Yet, about 36% of underlying causes of death reported by physicians in 2018 are considered garbage codes, not useful in analyzing public health and mortality (PSA, 2018). We used the PRECEDE-PROCEED approach to develop, implement, and report an advocacy and education Project to improve training on medical certification of cause of death (MCCOD) among senior medical students and interns. Methods. An MCCOD Instructional Design and eLearning course was introduced and validated in 33 medical education institutions. Lessons enhanced these education materials and are proposed for nationwide adoption. In the middle of the COVID-19 pandemic, the Project fast-tracked the training of physician-learners on the correct cause of death reporting and certification. Results. Awareness of correct MCCOD and its personal and public health value reached at least 4000 learners, over a hundred medical faculty, and all deans of medical colleges in the Philippines. Conclusion. The PRECEDE-PROCEED Model provided a clear and practicable framework for the advocacy and education efforts to train senior medical students and interns on MCCOD. It can similarly guide other medical education innovations by defining predisposing, enabling, and reinforcing factors then considering these factors for intervention strategies, implementation, process evaluation, outcome evaluations, and impact evaluations.

What Percentage of Mortality were Medically Certified among Total Registered Mortality in 36 States &amp; UTs of India During 2018-2020 and COVID-19 Mortality Age-Sex Distribution Pattern in India: A Cross Sectional Observational Research Study

The most significant event of birth and death must be certified medically / non-medically to prove or support the evidence of existence of birth and death of a particular person legal existence between the certified date / timings of birth and death. Apart from this legal significance, footage of births and mortality is central basic data required for policy and planning about a population group / country such as provisioning of fundamental requirements like food, cloth, housing, health care, transportation, education etc. The national / state programmes planning, management, implementation can be effectual and triumphant only if this statistical information of birth and death is specific, reliable, timely and correct. Hence, the certification / registration of births and mortality are significant as well as necessity of modern era. We aimed to assess percentage of mortality medically certified among total registered mortality in 36 States &amp; UTs of India during 2018-2020 and COVID-19 mortality age-sex distribution pattern in India during 2020 medically certified due to pandemic in India with available data resources. The mortality data for this cross sectional retrospective observational study were obtained through Civil Registration System of India under the RBD Act, 1969. The data available were obtained on medically certified cause of deaths from States/UTs has been collected, tabulated, analysed in compliance with the ICD - Tenth Revision (1993). The total registered death during 2018 was 6911197 for 2019 it was 7596849 and in 2020 8062070. The figure increased continuously during successive years but there is a question mark on this data. The total RD increased by 685652 numbers in 2019 compared to 2018 whereas despite the COVID-19 PANDEMIC impact the increase in figures during 2020 was 240148 only which are highly questionable? The researcher found that this controversy is also raised by several global highly accredited international organizations like WHO etc. This research study revealed that Bihar which is second most populous state in India ranked lowest in medical certification of cause of death, 2020 which is amazing. Bihar ranked lowest with only 3.4 percent medically certified deaths during 2020 the COVID-19 pandemic era. Hence a large number of mortality during COVID-19 era remains uncertified till date in states like Bihar. This observational research study revealed that the majority of COVID-19 mortality was found in the age group of 45 years and above accounting for 82.7 per cent of total deaths in the group. The percentage of female mortality aged 34 years and below as well as for 55-64 years age group and 65-69 years age group, to total female deaths are greater in comparison to corresponding age groups mortality for male while in other groups male mortality were more than females. Particularly in poor states like Bihar in India the lower socio-economic strata of population may be more affected by low MCCD which is chiefly due to failure of Public Health Management related largely to corruption, posting and other scams. Bihar ranked lowest with only 3.4 percent medically certified deaths during 2020 the COVID-19 pandemic era. Hence a large number of mortality during COVID-19 era remains uncertified till date in states like Bihar. The researcher has found that in states like Bihar the total registered deaths have increased continuously during study period while MCCD decreased continuously during the study period which is due to failure of public health management and corruption, posting scams etc., by which such states are putting highly incapable / untrained person on state programme officer etc vital posts. These irregularities or ignorance have put India’s data credibility in doubt at international level bringing shame to the nation.

Heart failure in coronary artery disease: review of medical certificates of cause of death

The role of heart failure (HF) in mortality rates is ambiguous, and much depends on assessment criteria and accounting potential.Aim. Using medical certificates of cause of death (MCCD), to assess rates of HF, taking into account different types of coronary artery disease (CAD), sex, age and place of death.Material and methods. Data on deceased persons for 2020 were obtained from the electronic database of the Main Department of Civil Registry Office of Moscow Oblast, using the 4-digit codes of the International Classification of Diseases, Tenth Revision (ICD-10). All deaths with CAD codes (I20-25) were selected. A total of 23193 deaths were included in the analysis. The codes and verbal descriptions of complications were assessed and 3 groups were formed: without indication of heart failure (HF), with indication of HF (without chronic HF) and CHF in MCCD. Comparison of the average age of deceased, the proportion of women and men, the detection rates of certain CAD types and the place of death was carried out. Using logistic regression, the probability of chronic HF/HF as a death cause was determined, taking into account other factors.Results. Any HF was indicated in 78,9% of the MCCD (acute CAD — 44,5%, chronic CAD — in 89,1%). Chronic HF was indicated in 27% of the MCCD (men, 30,9%; women, 22,9%; p&lt;0,0001). The highest values were obtained in heart aneurysm — 47%; in other chronic CAD forms — slightly more than a third of the MCCD. HF was not indicated in men in 23,3% of deaths, in women — in 19%; maximum — 90% in “other acute CADs”; minimum — 11% in heart aneurysm. Average age of deceased was 73,6±12,5 years (men, 68,8±10,5; women, 78,4±12,5) (p&lt;0,0001). In all CAD forms, the average age of deceased was significantly higher in subgroups with chronic HF than in groups with (not chronic HF) or without HF. Age, sex, CAD type, place of death (in-hospital deaths were ~2 times less common).Conclusion. According to the MCCD data, chronic HF is not the dominant complication leading to death. The results obtained require clarification in studies based on primary medical documentation.

Generating cause of death information to inform health policy: implementation of an automated verbal autopsy system in the Solomon Islands

BackgroundGood quality cause of death (COD) information is fundamental for formulating and evaluating public health policy; yet most deaths in developing countries, including the Solomon Islands, occur at home without medical certification of cause of death (MCCOD). As a result, COD data in such contexts are often of limited use for policy and planning. Verbal autopsies (VAs) are a cost-effective way of generating reliable COD information in populations lacking comprehensive MCCOD coverage, but this method has not previously been applied in the Solomon Islands. This study describes the establishment of a VA system to estimate the cause specific mortality fractions (CSMFs) for community deaths that are not medically certified in the Solomon Islands.MethodsAutomated VA methods (SmartVA) were introduced into the Solomon Islands in 2016. Trained data collectors (nurses) conducted VAs on eligible deaths to December 2020 using electronic tablet devices and VA responses were analysed using the Tariff 2.0 automated diagnostic algorithm. CSMFs were generated for both non-inpatient deaths in hospitals (i.e. ‘dead on/by arrival’) and community deaths.ResultsVA was applied to 914 adolescent-and-adult deaths with a median (IQR) age of 62 (45–75) years, 61% of whom were males. A specific COD could be diagnosed for more than 85% of deaths. The leading causes of death for both sexes combined were: ischemic heart disease (16.3%), stroke (13.5%), diabetes (8.1%), pneumonia (5.7%) and chronic-respiratory disease (4.8%). Stroke was the top-ranked cause for females, and ischaemic heart disease the leading cause for males. The CSMFs from the VAs were similar to Global Burden of Disease (GBD) estimates. Overall, non-communicable diseases (NCDs) accounted for 73% of adult deaths; communicable, maternal and nutritional conditions 15%, and injuries 12%. Six of the ten leading causes reported for facility deaths in the Solomon Islands were also identified as leading causes of community deaths based on the VA diagnoses.ConclusionsNCDs are the leading cause of adult deaths in the Solomon Islands. Automated VA methods are an effective means of generating reliable COD information for community deaths in the Solomon Islands and should be routinely incorporated into the national mortality surveillance system.

The impact of errors in medical certification on the accuracy of the underlying cause of death.

Correct certification of cause of death by physicians (i.e. completing the medical certificate of cause of death or MCCOD) and correct coding according to International Classification of Diseases (ICD) rules are essential to produce quality mortality statistics to inform health policy. Despite clear guidelines, errors in medical certification are common. This study objectively measures the impact of different medical certification errors upon the selection of the underlying cause of death. A sample of 1592 error-free MCCODs were selected from the 2017 United States multiple cause of death data. The ten most common types of errors in completing the MCCOD (according to published studies) were individually simulated on the error-free MCCODs. After each simulation, the MCCODs were coded using Iris automated mortality coding software. Chance-corrected concordance (CCC) was used to measure the impact of certification errors on the underlying cause of death. Weights for each error type and Socio-demographic Index (SDI) group (representing different mortality conditions) were calculated from the CCC and categorised (very high, high, medium and low) to describe their effect on cause of death accuracy. The only very high impact error type was reporting an ill-defined condition as the underlying cause of death. High impact errors were found to be reporting competing causes in Part 1 [of the death certificate] and illegibility, with medium impact errors being reporting underlying cause in Part 2 [of the death certificate], incorrect or absent time intervals and reporting contributory causes in Part 1, and low impact errors comprising multiple causes per line and incorrect sequence. There was only small difference in error importance between SDI groups. Reporting an ill-defined condition as the underlying cause of death can seriously affect the coding outcome, while other certification errors were mitigated through the correct application of mortality coding rules. Training of physicians in not reporting ill-defined conditions on the MCCOD and mortality coders in correct coding practices and using Iris should be important components of national strategies to improve cause of death data quality.

Are there sex differences in completeness of death registration and quality of cause of death statistics? Results from a global analysis

IntroductionRecent studies suggest that more male than female deaths are registered and a higher proportion of female deaths are certified as ‘garbage’ causes (ie, vague or ill-defined causes of limited...

An assessment of the quality of mortality and cause of death statistics produced by the civil registration and vital statistics system in Maldives

The civil registration and vital statistics system is the most comprehensive source of data on mortality used to inform health policy in Maldives. The objective of this study is to assess the quality of the civil registration and vital statistics data and recommend improvements. The electronic tool ANACONDA was used to evaluate completeness of death registration, plausibility of age-specific death rates, quality of cause of death reporting and generate the Vital Statistics Performance Index for Quality for the period 2010–2017. The quality of physicians’ practices in completing the medical certificate of cause of death was evaluated using a standardized assessment tool. Death registration completeness was estimated to be 95.4 per cent for males and 97.0 per cent for females for the 2014–2017 period. Life expectancy estimates using the civil registration and vital statistics system data varied by three to four years, depending on the population data source used. About half of all deaths were assigned a cause of death that was unclear or not an underlying cause. The Vital Statistics Performance Index was 48.8 for the period 2014–2017, which is rated as being low quality. Poor medical certification practices were common; for example, more than half (56 per cent) of medical certificates of cause of death had an incorrect or clinically improbable chain of events leading to death. In conclusion, improvement in medical certification practices is necessary to attain more reliable mortality indicators to aid policy and planning.

Improving quality of medical certification of causes of death in health facilities in Tanzania 2014\u20132019

BackgroundMonitoring medically certified causes of death is essential to shape national health policies, track progress to Sustainable Development Goals, and gauge responses to epidemic and pandemic disease. The combination of electronic health information systems with new methods for data quality monitoring can facilitate quality assessments and help target quality improvement. Since 2015, Tanzania has been upgrading its Civil Registration and Vital Statistics system including efforts to improve the availability and quality of mortality data.MethodsWe used a computer application (ANACONDA v4.01) to assess the quality of medical certification of cause of death (MCCD) and ICD-10 coding for the underlying cause of death for 155,461 deaths from health facilities from 2014 to 2018. From 2018 to 2019, we continued quality analysis for 2690 deaths in one large administrative region 9 months before, and 9 months following MCCD quality improvement interventions. Interventions addressed governance, training, process, and practice. We assessed changes in the levels, distributions, and nature of unusable and insufficiently specified codes, and how these influenced estimates of the leading causes of death.Results9.7% of expected annual deaths in Tanzania obtained a medically certified cause of death. Of these, 52% of MCCD ICD-10 codes were usable for health policy and planning, with no significant improvement over 5 years. Of certified deaths, 25% had unusable codes, 17% had insufficiently specified codes, and 6% were undetermined causes. Comparing the before and after intervention periods in one Region, codes usable for public health policy purposes improved from 48 to 65% within 1 year and the resulting distortions in the top twenty cause-specific mortality fractions due to unusable causes reduced from 27.4 to 13.5%.ConclusionData from less than 5% of annual deaths in Tanzania are usable for informing policy. For deaths with medical certification, errors were prevalent in almost half. This constrains capacity to monitor the 15 SDG indicators that require cause-specific mortality. Sustainable quality assurance mechanisms and interventions can result in rapid improvements in the quality of medically certified causes of death. ANACONDA provides an effective means for evaluation of such changes and helps target interventions to remaining weaknesses.

Is it appropriate to link ‘old age’ to certain causes of death on the medical certificate of cause of death?

In the current list of acceptable causes of death in the medical certificate of cause of death, some causes are either linked to old age or could be used for all people over the age of 80 years. Notable ones include 'frailty of old age', 'debility of old age' and 'senility'. It is best to avoid these terms as they provide an erroneous impression that these conditions occurred because a person was old; we recommend that the list of acceptable causes of death is revised by engaging all stakeholders.