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. 2020 Jul:73:101993.
doi: 10.1016/j.jflm.2020.101993. Epub 2020 Jun 2.

A review of completeness, correctness, and order of cause of death statements among decedents with documented causes of death and HIV status at two major mortuaries in Kenya, 2015

Emily A Rogena  1 , Anthony Waruru  2 , Peter W Young  3 , Pheena Abade  4 , Lilly M Nyagah  5 , Edwin O Walong  6
Affiliations

A review of completeness, correctness, and order of cause of death statements among decedents with documented causes of death and HIV status at two major mortuaries in Kenya, 2015

Emily A Rogena et al. J Forensic Leg Med. 2020 Jul.

Abstract

Background: The cause of death (COD) statement is a vital statistic that refers to the disease(s) and process(es) that lead to death. Obtaining accurate COD is valuable for mortality prevention priorities. The statements are formulated using International Classification of Diseases and related health problems, version 10 (ICD-10) system. However, physicians may be unfamiliar with these standards or fail to use them and instead refer to mechanisms or manner of death when stating COD. We present results of an of assessment of quality of COD statements in decedent cases reviewed during a one-month mortuary-based surveillance at Kenyatta National Hospital (KNH) and the City mortuaries in Nairobi, Kenya in 2015.

Methods: Quality elements reviewed were completeness, correctness and order of stating the immediate (ICOD), antecedent, underlying (UCOD), and other significant causes (OSCs) as per the ICD 10 standards, in all deaths reported among adolescents and adults aged 15 years or older at the two mortuaries. COD were assessed for correct sequencing from immediate, antecedent, to underlying compared with autopsy pathology and clinical findings where available. Errors in COD statements were classified as missing or containing incomplete information such as: lack of underlying cause of an injury; incorrect words or statements; presence of more than one competing COD; use of the mechanism of death or anatomic and physiologic processes or signs and symptoms, and or laboratory results as CODs. Pearson's χ-squared test was used to compare proportions.

Results: Out of 810, 610 (75.3%) deaths having HIV statuses were abstracted and 356 had at least one COD documented; 114 (32%) females and 242 (68%) males; 239 (67.1%) from KNH and 117 (32.9%) City mortuary. The cases from City mortuary had higher rates of correct statements on 116 (99.1%) ICOD, 90 (89.1%) UCOD, and 40 (81.6%) OSCs, compared to KNH Mortuary; 50 (20.9%), 200 (90.1%) and 62 (76.5%) respectively, p < 0.001. The most common type of errors was incomplete information and citing mechanisms of death as the COD.

Conclusions: In addition to revising national forms to conform to ICD-10, there is a need for periodic training of individuals responsible for completing death certificates. This will improve correctness and completeness of COD in order to provide reliable mortality data in Kenya.

Keywords: Cause of death (COD); Death certificate (DC); Errors for COD statements; ICD-10; Mortuary surveillance.

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Conflict of interest statement

Declaration of competing interest The authors declare that there are no conflicts of interests. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies.

Figures

Fig. 1.
Fig. 1.. Number of cases with causes of death at City Mortuary and Kenyatta National Hospital Mortuary, Kenya, 2015, n = 356.
The figure shows the number of records with at least one cause of death reviewed at city and Kenyatta National Hospital mortuaries.
See this image and copyright information in PMC

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