Hospital mortality statistics in Tanzania: availability, accessibility, and quality 2006-2015

Abstract

Background: Accurate and reliable hospital information on the pattern and causes of death is important to monitor and evaluate the effectiveness of health policies and programs. The objective of this study was to assess the availability, accessibility, and quality of hospital mortality data in Tanzania.

Methods: This cross-sectional study involved selected hospitals of Tanzania and was carried out from July to October 2016. Review of hospital death registers and forms was carried out to cover a period of 10 years (2006-2015). Interviews with hospital staff were conducted to seek information as regards to tools used to record mortality data, staff involved in recording and availability of data storage and archiving facilities.

Results: A total of 247,976 death records were reviewed. The death register was the most (92.3%) common source of mortality data. Other sources included the International Classification of Diseases (ICD) report forms, Inpatient registers, and hospital administrative reports. Death registers were available throughout the 10-year period while ICD-10 forms were available for the period of 2013-2015. In the years between 2006 and 2010 and 2011-2015, the use of death register increased from 82 to 94.9%. Three years after the introduction of ICD-10 procedure, the forms were available and used in 28% (11/39) hospitals. The level of acceptable data increased from 69% in 2006 to 97% in 2015. Inconsistency in the language used, use of non-standard nomenclature for causes of death, use of abbreviations, poorly and unreadable handwriting, and missing variables were common data quality challenges. About 6.3% (n = 15,719) of the records had no patient age, 3.5% (n = 8790) had no cause of death and ~ 1% had no sex indicated. The frequency of missing sex variable was most common among under-5 children. Data storage and archiving in most hospitals was generally poor. Registers and forms were stored in several different locations, making accessibility difficult.

Conclusion: Overall, this study demonstrates gaps in hospital mortality data availability, accessibility, and quality, and highlights the need for capacity strengthening in data management and periodic record reviews. Policy guidelines on the data management including archiving are necessary to improve data.

Keywords: Availability; Cause of death; Data quality; Hospital; Mortality; Tanzania.

Fig. 1

Map of Tanzania showing the hospitals in the study

Fig. 2

Pattern of hospital mortality data availability in Tanzania, 2006–2015

Fig. 3

Quality challenges in hospital mortality data

Fig. 4

Percentage of records with missing variables in collected hospital mortality data

Fig. 5

Pattern of records without sex by different categories of age

Fig. 6

Storage of registers and forms in some of the hospitals in Tanzania. a Different types of registers compiled from different places kept in a plastic container; b One stop point designed for data storage; c Inpatient register that was destructed by ants; d, e Searching for death registers in a hospital store; f, g Storage of used registers with disposed equipment; h, i, j Sorting of death report forms