Quality of cause of death certification at an academic hospital in Cape Town, South Africa

Abstract

Objectives: To investigate the quality of cause of death certification and assess the level of under-reporting of HIV/AIDS as a cause of death at an academic hospital.

Design: Cross-sectional descriptive retrospective review of death notification forms (DNFs) of deaths due to natural causes in an academic hospital in Cape Town during 2004. Errors in cause of death certification and ability to code causes of death according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) were assessed. The association between serious errors and age, gender, cause of death and hospital ward was analysed. A sample of DNFs (N=243) was assessed for level of under-reporting of HIV/AIDS.

Results: A total of 983 death certificates were evaluated. Almost every DNF had a minor error; serious errors were found in 32.2% (95% confidence interval (CI) 29.3-35.1%). Errors increased with patient age, and cause of death was the most important factor associated with serious errors. Compared with neoplasms, which had the lowest error rate, the odds ratios for errors in endocrine and metabolic diseases and genito-urinary diseases were 17.2 (95% CI 8.7-34.0) and 17.3 (95% CI 7.8-38.2), respectively. Based on the sub-sample, the minimum prevalence of HIV among the deceased patients was 15.7% (95% CI 11.1-20.3%) and the under-reporting of deaths due to AIDS was 53.1% (95% CI 35.8-70.4%).

Conclusion: Errors were sufficiently serious to affect identification of underlying cause of death in almost a third of the DNFs, confirming the need to improve the quality of medical certification.