Trend of ill-defined causes of death in Egypt (2000–2013) in comparison to selected Eastern Mediterranean Countries, and an intervention study to improve the accuracy of death certification in one district in Cairo,

Abstract

Vital statistics is the core of a country’s health information system as it provides estimates of the prevalence and distribution of mortality due to diseases and injuries guiding the health policies, reallocation of resources and evaluating the impact of health programs. A complete and accurate death certification is necessary in order to reflect and gain actual data. Most developing countries face the challenges of data quality, analysis of trends regarding the main causes of death since reliable data are restricted to either areas with a high socioeconomic level or metropolitan cities. Thus, the trend and pattern of ill-defined causes of death were studied in Egypt to be compared with other EMR countries. Secondary data generated from the civil registration system is utilized for the time series 2000-2013 to identify prevalence of the ill-defined causes of death with regard to cause, sex and age group, calculating the linear regression, mortality ratios with standardization for causes of death, temporal ratios and the correction factor for ill-defined causes. Pre- and post-intervention evaluations were performed to identify the change in the major and minor errors in death certification. A total of 3385965 ill-defined causes of death out of 6478279 deaths (~52%, ranged from 43% in 2012 to 55% in 2007) were identified between 2000-2013 (y=0.1552x+363.62, R2 0.0395) mostly associated with coded symptoms and signs (chapter XVIII) followed by heart failures 8.5-23% and 10-17% respectively (death due to circulatory causes was 0.16 whereas its corrected proportion reached 0.32), these were more likely to be found in males (p<0.05) reached 54% in 2011 (Egyptian revolution event), a directly proportional relationship between age and ill-defined cause of death (p<0.05) with the highest proportions in elderly aged 65 years and above (63-66%). A reduction in the overall ill-defined causes of death from 0.41 before intervention to 0.22, minor errors reduced by 20% for using abbreviation and recording of inappropriate information, 70% for absence in time interval and significant reduction in reporting error of the primary hypertension and ill-defined cancer sites 0.33 to 0.25 and 0.02 to zero respectively. Death certification completing skills should be revised to interns, medical officers and residents as a part of their continuous medical education and raising awareness on the consequences of a poorly filled out death certification because the errors that have the highest impact on the data quality could be eliminated by the implementation of even the simplest form of educational intervention.