Improving quality of medical certification of causes of death in health facilities in Tanzania 2014–2019

Abstract Background Monitoring 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. Methods We 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. Results 9.7% 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%. Conclusion Data 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.

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Quality of cause-of-death data in Brazil: Garbage codes among registered deaths in 2000 and 2015

Revista Brasileira de Epidemiologia ◽

10.1590/1980-549720190002.supl.3 ◽

2019 ◽

Vol 22 (suppl 3) ◽

Cited By ~ 1

Author(s):

Renato Azeredo Teixeira ◽

Mohsen Naghavi ◽

Mark Drew Crosland Guimarães ◽

Lenice Harumi Ishitani ◽

Elizabeth Barboza França

Keyword(s):

Data Quality ◽

Cause Of Death ◽

Age Groups ◽

Health Assessment ◽

Mortality Data ◽

Laboratory Findings ◽

Northern Regions ◽

Icd 10 ◽

Death Data

ABSTRACT Introduction: reliability of mortality data is essential for health assessment and planning. In Brazil, a high proportion of deaths is attributed to causes that should not be considered as underlying causes of deaths, named garbage codes (GC). To tackle this issue, in 2005, the Brazilian Ministry of Health (MoH) implements the investigation of GC-R codes (codes from chapter 18 “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified, ICD-10”) to improve the quality of cause-of-death data. This study analyzes the GC cause of death, considered as the indicator of data quality, in Brazil, regions, states and municipalities in 2000 and 2015. Methods: death records from the Brazilian Mortality Information System (SIM) were used. Analysis was performed for two GC groups: R codes and non-R codes, such as J18.0-J18.9 (Pneumonia unspecified). Crude and age-standardized rates, number of deaths and proportions were considered. Results: an overall improvement in the quality of mortality data in 2015 was detected, with variations among regions, age groups and size of municipalities. The improvement in the quality of mortality data in the Northeastern and Northern regions for GC-R codes is emphasized. Higher GC rates were observed among the older adults (60+ years old). The differences among the areas observed in 2015 were smaller. Conclusion: the efforts of the MoH in implementing the investigation of GC-R codes have contributed to the progress of data quality. Investment is still necessary to improve the quality of cause-of-death statistics.

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Evaluation of neonatal mortality data completeness and accuracy in Ghana

PLoS ONE ◽

10.1371/journal.pone.0239049 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0239049

Author(s):

Dora Dadzie ◽

Richard Okyere Boadu ◽

Cyril Mark Engmann ◽

Nana Amma Yeboaa Twum-Danso

Keyword(s):

Public Sector ◽

Data Quality ◽

Neonatal Mortality ◽

Cause Of Death ◽

Health Facilities ◽

Mortality Data ◽

Death Certificates ◽

Neonatal Deaths ◽

Specific Mortality ◽

Brong Ahafo

Background Cause-specific mortality data are required to set interventions to reduce neonatal mortality. However, in many developing countries, these data are either lacking or of low quality. We assessed the completeness and accuracy of cause of death (COD) data for neonates in Ghana to assess their usability for monitoring the effectiveness of health system interventions aimed at improving neonatal survival. Methods A lot quality assurance sampling survey was conducted in 20 hospitals in the public sector across four regions of Ghana. Institutional neonatal deaths (IND) occurring from 2014 through 2017 were divided into lots, defined as neonatal deaths occurring in a selected facility in a calendar year. A total of 52 eligible lots were selected: 10 from Ashanti region, and 14 each from Brong Ahafo, Eastern and Volta region. Nine lots were from 2014, 11 from 2015 and 16 each were from 2016 and 2017. The cause of death (COD) of 20 IND per lot were abstracted from admission and discharge (A&D) registers and validated against the COD recorded in death certificates, clinician’s notes or neonatal death audit reports for consistency. With the error threshold set at 5%, ≥ 17 correctly matched diagnoses in a sample of 20 deaths would make the lot accurate for COD diagnosis. Completeness of COD data was measured by calculating the proportion of IND that had death certificates completed. Results Nineteen out of 52 eligible (36.5%) lots had accurate COD diagnoses recorded in their A&D registers. The regional distribution of lots with accurate COD data is as follows: Ashanti (4, 21.2%), Brong Ahafo (7, 36.8%), Eastern (4, 21.1%) and Volta (4, 21.1%). Majority (9, 47.4%) of lots with accurate data were from 2016, followed by 2015 and 2017 with four (21.1%) lots. Two (10.5%) lots had accurate COD data in 2014. Only 22% (239/1040) of sampled IND had completed death certificates. Conclusion Death certificates were not reliably completed for IND in a sample of health facilities in Ghana from 2014 through 2017. The accuracy of cause-specific mortality data recorded in A&D registers was also below the desired target. Thus, recorded IND data in public sector health facilities in Ghana are not valid enough for decision-making or planning. Periodic data quality assessments can determine the magnitude of the data quality concerns and guide site-specific improvements in mortality data management.

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Modal lifespan and disparity at older ages by leading causes of death: a Canada-U.S. comparison

Journal of Population Research ◽

10.1007/s12546-020-09247-9 ◽

2020 ◽

Vol 37 (4) ◽

pp. 323-344

Author(s):

Viorela Diaconu ◽

Nadine Ouellette ◽

Robert Bourbeau

Keyword(s):

Old Age ◽

Cause Of Death ◽

Causes Of Death ◽

Heart Diseases ◽

Cerebrovascular Diseases ◽

Mortality Data ◽

Age At Death ◽

Specific Mortality ◽

The U.S ◽

Country Specific

AbstractThe U.S. elderly experience shorter lifespans and greater variability in age at death than their Canadian peers. In order to gain insight on the underlying factors responsible for the Canada-U.S. old-age mortality disparities, we propose a cause-of-death analysis. Accordingly, the objective of this paper is to compare levels and trends in cause-specific modal age at death (M) and standard deviation above the mode (SD(M +)) between Canada and the U.S. since the 1970s. We focus on six broad leading causes of death, namely cerebrovascular diseases, heart diseases, and four types of cancers. Country-specific M and SD(M +) estimates for each leading cause of death are calculated from P-spline smooth age-at-death distributions obtained from detailed population and cause-specific mortality data. Our results reveal similar levels and trends in M and SD(M +) for most causes in the two countries, except for breast cancer (females) and lung cancer (males), where differences are the most noticeable. In both of these instances, modal lifespans are shorter in the U.S. than in Canada and U.S. old-age mortality inequalities are greater. These differences are explained in part by the higher stratification along socioeconomic lines in the U.S. than in Canada regarding the adoption of health risk behaviours and access to medical services.

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Evaluation of civil registration and vital statistics system in the Maldives: Focus on mortality statistics

Statistical Journal of the IAOS ◽

10.3233/sji-200748 ◽

2020 ◽

Vol 36 (4) ◽

pp. 933-941

Author(s):

Sofoora Kawsar Usman ◽

Sheena Moosa

Keyword(s):

Cause Of Death ◽

Causes Of Death ◽

Time Lag ◽

International Classification Of Diseases ◽

Vital Statistics ◽

Mortality Data ◽

Death Registration ◽

Quality Of Data ◽

Civil Registration

An efficient Civil Registration and Vital Statistics (CRVS) system is a development imperative. Data on death registration and causes of death are important for measuring health outcomes. This paper evaluates the completeness and quality of data on death registration and causes of death (CoD) based on analysis of the registration records on death and causes of death for the period 2009–2018. Using established methods and approaches, we observed that CRVS system performed well on death registration completeness, quality of age and sex reporting. However, the quality of cause of death data was poor with 50% of the International Classification of Diseases (ICD) codes classified as “major garbage codes” and significant time lag was observed in the transmission and production of vital statistics. The CRVS system in Maldives is complete with all deaths occurring within its territory registered and causes of death recorded. The two areas that require attention are the time taken for publication of vital statistics and quality of cause of death reporting. Appropriate re-engineering of the existing business process can build real-time mortality data, and regular quality assessment of death certificates with feedback to health facilities can bring sustained improvements in quality of vital statistics.

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Opportunities and Problems of Analysis of Mortality from Myocardial Infarction According to Medical Certificates of Death (on the Example of the Tula Region)

Kardiologiia ◽

10.18087/cardio.2019.7.n417 ◽

2019 ◽

Vol 59 (7) ◽

pp. 5-10

Author(s):

O. M. Drapkina ◽

I. V. Samorodskaya ◽

D. Sh. Vaisman

Keyword(s):

Myocardial Infarction ◽

Cause Of Death ◽

Causes Of Death ◽

Professional Community ◽

Mortality Rates ◽

Electronic Database ◽

Ministry Of Health ◽

Icd 10 ◽

Underlying Cause Of Death

Aim: to analyze the quality of completion medical certificates of death (MCD) of residents of the Tula region, in which in 2017 acute and subsequent myocardial infarction (MI) was listed as the underlying cause of death (UCD) or as multiple causes of death (MC).Materials and methods. From the electronic database (DB) of MCD of residents of Tula region for 2017 we selected all MSD in which MI was written down irrespective of a section of MCD. A total of 689 MSD (43.8% men and 56.2% women) were analyzed.Results. Mean age of the deceased was 72.6±11.3 years (men 67.25±0.62; women 76.7±9.8; p<0.001). Multimorbid pathology was registered in 31.5% of the deceased. In 77.9% of cases myocardial infarction was selected as the UCD and in 22.1% – as a complication of other diseases. Among registered MI complications were hemotamponade (24.5%), cardiogenic shock (3.6%), ventricular fibrillation (0.3%), heart failure (50.2%). Complications of MI were not listed in 3.9% of MCD. Analysis of MCD showed that their completion did not comply with established ICD-10 rules and recommendations of Ministry of Health of RF; all lines were filled out only in 1% of completed MCD. Also, problems of determining the initial cause of death when myocardial infarction occurred in the presence of multimorbid pathology were revealed.Conclusion. Mortality analysis using solely UCD leads to decreasing mortality rates from MI, and unsatisfactory quality of filling the MCD decreases the ability to identify MC, that prevents the correction of priorities in the organization of medical care. The revealed problems of coding causes of death require urgent solutions from the professional community of cardiologists, pathologists, and the Ministry of Health.

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Investigation of ill-defined causes of death: assessment of a program's performance in a State from the Northeastern region of Brazil

Revista Brasileira de Epidemiologia ◽

10.1590/1415-790x201400010010eng ◽

2014 ◽

Vol 17 (1) ◽

pp. 119-134 ◽

Cited By ~ 8

Author(s):

Elisabeth Barboza França ◽

Carolina Cândida da Cunha ◽

Ana Maria Nogales Vasconcelos ◽

Juan José Cortez Escalante ◽

Daisy Xavier de Abreu ◽

...

Keyword(s):

Health Professionals ◽

Causes Of Death ◽

Family Health ◽

Completion Rate ◽

Epidemiological Surveillance ◽

Mortality Data ◽

Hospital Records ◽

Brazilian Government ◽

Probabilistic Sample

OBJECTIVE: The proportion of ill-defined causes of death (IDCD) was persistently high in some regions of Brazil in 2004. In 2005, the Brazilian government implemented a project in order to decrease this proportion, especially in higher priority states and municipalities. This study aimed to evaluate the performance of this project in Alagoas - a state from the Northeast region of Brazil. METHOD: We selected a probabilistic sample of 18 municipalities. For all IDCD identified in 2010, we collected the verbal autopsy (VA) questionnaires used for home investigation, and the Ministry of Health (MoH) form, which contains information about the final disease and cause of death taken from hospital records, autopsies, family health teams, and civil registry office records. The completion rate of the MoH form and VA was calculated using the number of deaths with specific causes assigned among investigated deaths. RESULTS: A total of 681 IDCD were recorded in 2010 in the sample, of which 26% had a MoH and/or VA3 forms completed. Although the majority of cases were attended by health professionals during the terminal disease, the completion rate was 45% using the MoH form and 80% when VA was performed. CONCLUSIONS: Our findings provide evidence that the training of the epidemiological surveillance teams in the investigation and certification of causes of death could contribute to improve the quality of mortality data.

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Garbage codes as causes of death and quality of mortality statistics in Belo Horizonte, Brazil

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.053 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

L Ishitani ◽

R Teixeira ◽

D Abreu ◽

L Paixão ◽

E França

Keyword(s):

Causes Of Death ◽

Health Planning ◽

Age Groups ◽

International Classification Of Diseases ◽

Mortality Statistics ◽

Classification Of Diseases ◽

Icd 10 ◽

Hospital Deaths ◽

Belo Horizonte

Abstract Background Quality of cause-of-death information is fundamental for health planning. Traditionally, this quality has been assessed by the analysis of ill-defined causes from chapter XVIII of the International Classification of Diseases - 10th revision (ICD-10). However, studies have considered other useless diagnoses for public health purposes, defined, in conjunction with ill-defined causes, as garbage codes (GC). In Brazil, despite the high completeness of the Mortality Information System, approximately 30% of deaths are attributable to GCs. This study aims to analyze the frequency of GCs in Belo Horizonte municipality, the capital of Minas Gerais state, Brazil. Methods Data of deaths from 2011 to 2013 in Belo Horizonte were analyzed. GCs were classified according to the GBD 2015 study list. These codes were classified in: a) GCs from chapter XVIII of ICD-10 (GC-R), and b) GC from other chapters of ICD-10 (GC-nonR). Proportions of GC were calculated by sex, age, and place of occurrence. Results In Belo Horizonte, from the total of 44,123 deaths, 5.5% were classified as GC-R. The majority of GCs were GC-nonR (25% of total deaths). We observed a higher proportion of GC in children (1 to 4 years) and in people aged over 60 years. GC proportion was also higher in females, except in the age-groups under 1 year and 30-59 years. Home deaths (n = 7,760) had higher proportions of GCs compared with hospital deaths (n = 30,182), 36.9% and 28.7%, respectively. The leading GCs were the GC-R other ill-defined and unspecified causes of death (ICD-10 code R99)), and the GCs-nonR unspecified pneumonia (J18.9), unspecified stroke (I64), and unspecified septicemia (A41.9). Conclusions Analysis of GCs is essential to evaluate the quality of mortality information. Key messages Analysis of ill-defined causes (GC-R) is not sufficient to evaluate the quality of information on causes of death. Causes of death analysis should consider the total GC, in order to advance the discussion and promote adequate intervention on the quality of mortality statistics.

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The decomposition of life expectancy for age and cause of death in Tuscany, Italy

European Journal of Public Health ◽

10.1093/eurpub/ckz185.638 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

N Nante ◽

L Kundisova ◽

F Gori ◽

A Martini ◽

F Battisti ◽

...

Keyword(s):

Life Expectancy ◽

Causes Of Death ◽

National Level ◽

Age Groups ◽

Resistant Bacteria ◽

Mortality Data ◽

Life Expectancy At Birth ◽

Icd 10 ◽

Reduction Of Mortality ◽

The Impact

Abstract Introduction Changing of life expectancy at birth (LE) over time reflects variations of mortality rates of a certain population. Italy is amongst the countries with the highest LE, Tuscany ranks fifth at the national level. The aim of the present work was to evaluate the impact of various causes of death in different age groups on the change in LE in the Tuscany region (Italy) during period 1987-2015. Material and methods Mortality data relative to residents that died during the period between 1987/1989 and 2013/2015 were provided by the Tuscan Regional Mortality Registry. The causes of death taken into consideration were cardiovascular (CVS), respiratory (RESP) and infective (INF) diseases and cancer (TUM). The decomposition of LE gain was realized with software Epidat, using the Pollard’s method. Results The overall LE gain during the period between two three-years periods was 6.7 years for males, with a major gain between 65-89, and 4.5 years for females, mainly improved between 75-89, <1 year for both sexes. The major gain (2.6 years) was attributable to the reduction of mortality for CVS, followed by TUM (1.76 in males and 0.83 in females) and RESP (0.4 in males; 0.1 in females). The major loss of years of LE was attributable to INF (-0.15 in females; -0.07 in males) and lung cancer in females (-0.13), for which the opposite result was observed for males (gain of 0.62 years of LE). Conclusions During the study period (1987-2015) the gain in LE was major for males. To the reduction of mortality for CVS have contributed to the tempestuous treatment of acute CVS events and secondary CVS prevention. For TUM the result is attributable to the adherence of population to oncologic screening programmes. The excess of mortality for INF that lead to the loss of LE can be attributed to the passage from ICD-9 to ICD-10 in 2003 (higher sensibility of ICD-10) and to the diffusion of multi-drug resistant bacteria, which lead to elevated mortality in these years. Key messages The gain in LE during the period the 1987-2015 was higher in males. The major contribution to gain in LE was due to a reduction of mortality for CVS diseases.

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Causes of Mortality in Older People With Intellectual Disability: Results From the HA-ID Study

American Journal on Intellectual and Developmental Disabilities ◽

10.1352/1944-7558-123.1.61 ◽

2018 ◽

Vol 123 (1) ◽

pp. 61-71 ◽

Cited By ~ 11

Author(s):

Alyt Oppewal ◽

Josje D. Schoufour ◽

Hanne J.K. van der Maarl ◽

Heleen M. Evenhuis ◽

Thessa I.M. Hilgenkamp ◽

...

Keyword(s):

Older Adults ◽

Intellectual Disability ◽

Cause Of Death ◽

Causes Of Death ◽

Circulatory System ◽

Bacterial Diseases ◽

Specific Mortality ◽

Causes Of Mortality ◽

Insight Into

Abstract We aim to provide insight into the cause-specific mortality of older adults with intellectual disability (ID), with and without Down syndrome (DS), and compare this to the general population. Immediate and primary cause of death were collected through medical files of 1,050 older adults with ID, 5 years after the start of the Healthy Ageing and Intellectual Disabilities (HA-ID) study. During the follow-up period, 207 (19.7%) participants died, of whom 54 (26.1%) had DS. Respiratory failure was the most common immediate cause of death (43.4%), followed by dehydration/malnutrition (20.8%), and cardiovascular diseases (9.4%). In adults with DS, the most common cause was respiratory disease (73.3%), infectious and bacterial diseases (4.4%), and diseases of the digestive system (4.4%). Diseases of the respiratory system also formed the largest group of primary causes of death (32.1%; 80.4% was due to pneumonia), followed by neoplasms (17.6%), and diseases of the circulatory system (8.2%). In adults with DS, the main primary cause was also respiratory diseases (51.1%), followed by dementia (22.2%).

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2372Causes of death and effect of co-morbidities on mortality in young patients with heart failure. Data from the Swedish Heart Failure, Cause of Death and National Patient Registers

European Heart Journal ◽

10.1093/eurheartj/ehz748.0139 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Basic ◽

A Rosengren ◽

U Dahlstrom ◽

M Edner ◽

T Zverkova Sandstrom ◽

...

Keyword(s):

Heart Failure ◽

Cause Of Death ◽

Causes Of Death ◽

Young Patients ◽

Mortality Data ◽

Quality Register ◽

Co Morbidity ◽

National Patient ◽

Age And Sex ◽

Observation Period

Abstract Background The last two decades incidence and prevalence of heart failure (HF) among young patients have increased in Sweden. Up to the beginning of the 21st century mortality in patients with HF has decreased but causes of death and the effects of co-morbidity on mortality in young patients with HF are not well studied. Purpose To address causes of death and the effect of co-morbidity at baseline on mortality during the last decade in young patients with HF. Methods The Swedish Heart Failure Register (SwedeHF,) a nationwide quality register, was introduced in Sweden in 2003. All hospital discharge diagnoses are recorded in the National Patient Register (NPR) and deaths are registered in the Cause of Death Register. All patients ≥18 and <55 years with a HF diagnosis in SwedeHF were included and linked to the Cause of Death Register and NPR with the personal identification number. ICD 10-codes for all comorbidities and principal cause of death were identified during the observation period from 2003 to 2016. Besides, comorbidity and mortality data were compared with age and sex matched controls from the general population, database from Statistics Sweden (SCB). Results We identified 3752 (6.2%) patients <55 years from the total SwedeHF population (n=60,962) and added 7573 age and sex matched controls. There were 971 (25.9%) women and 2781 (74.1%) men mean age 44.9 (8.4) and 46.4 (7.3) years respectively. Among the young 604 (16.1%) patients died vs. 162 (2.2%) among matched controls (p<0.001) during the observation period. Principal cause of death was HF in 2.7% of the young patients (in men 3% vs. 1.4% in women (p=0.221)), other cardiovascular diseases 48.7% (27.7% in men vs. 20% in women (p=0.05)), congenital heart disease 4% (3% in men vs. 6.9% in women (p=0.077)), cancer 12.9% (9.6% in men vs. 23.6% in women (p=0.003)), neurologic disease 4.5% (5.4% in men vs. 1.4% in women (p=0.028)) suicide 0.8% (0.7% in men vs 1.4% in women (p=0.47)) and other causes 15.1% (15.9% in men vs 12.5% in women (p=0.179)) vs. 0, 26.5%, 1.2%, 32.7%, 1.2%, 9.9% and 18.5% in matched controls (all p<0.0001). The effect of co-morbidity at baseline on mortality in young patients with HF is presented in Figure 1. Effect of co-morbidity on mortality Conclusion Compared to matched controls young patients with HF had worse survival. Almost one quarter of women with HF had cancer as a principal cause of death. Men with AF, obesity and depression at baseline had higher risk to die than women. Women with HF and hypertension, PAH or kidney disease at baseline had higher risk to die than men with HF and the same co-morbidities. Acknowledgement/Funding Swedish state under the agreement concerning research and education of doctors, The Swedish Heart and Lung Foundation, Västra Götaland Region grants

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