What is the cause? Certification of deaths in sub-Saharan Africa

Brazzaville – About two-thirds of the countries in the African region do not have reliable data on births, deaths and causes of death, a recent assessment by the World Health Organization (WHO) found. The absence of this important information complicates effective health responses and policy-making in the region.

It also indicates that countries cannot provide timely insight into the population growth and patterns in the regions of a country, as well as when, where and why people die. Only four countries in the region register more than 90% of deaths, according to the study.

“The cause of death is critical because it defines our public health interventions,” said Dr Benson Droti, who heads the Health Information Systems Team at the World Health Organization’s Regional Office for Africa. “If these statistics are not available, the effectiveness of health interventions across the region will be jeopardized,” points out Dr. Droti op.

WHO recently held virtual trainings for more than 500 health professionals from 42 African countries on medical certification of cause of death and the eleventh revision of the International Classification of Diseases (ICD-11). The training also outlined methods for reporting deaths in the community, how to perform oral autopsies, and rapid death surveillance. The International Classification of Diseases is the global standard for reporting diseases and related health conditions. This ensures that data is comparable within and across countries.

“[In South Africa] we are trying to assess the effect of COVID-19. If you do not count [deaths] accurate, then you do not know what is going on and it is difficult to plan and more difficult to respond, “said Dr Lyn Hamner, co-head of the WHO Family of International Classification Collaborating Center in South Africa, who attended the training. .

Mauritius is the only country in the region that fully documents causes of death. Its civilian registration system systematically monitored deaths during the COVID-19 pandemic. Nasser Jeeanody, the chief health statistician at the country’s health ministry, said no deaths were reported during the pandemic, in which ten people died and 467 were infected with the virus.

The civil registration system of Mauritius was introduced in 1957 and digitized in 2005 and has been continuously strengthened and made prominent, says Jeeanody. Important statistics are required by law. A certificate of death showing the cause of death is a requirement before burial or cremation.

Sooneeraz Manohur, the chief health record officer, also at the Mauritius Ministry of Health, explains that the country’s 1.3 million people live mostly in the capital, making it possible to detect deaths and issue death certificates.

In most African countries, about 70% of deaths occur in communities where there are no structures to confirm and report deaths and their causes. Even for deaths that occur in health care facilities, their causes are poorly certified or not certified at all.

“It is likely that countries in the African region are seriously underreporting their deaths and are also unaware of the major causes of death in their countries because they cannot count or certify every death,” says Dr Droti.

WHO in the African region has now prioritized support to countries to improve cause of death by international standards. It plans to hold further training to help countries accurately certify causes of death and develop strategies and policies that are consistent with the country’s national health information system.

In May 2019, the World Health Assembly endorsed the eleventh revision of the International Classification of Diseases and recommended that all countries adopt it by January 2022.

“The African region has largely lagged far behind in implementing the earlier versions of the International Classification of Diseases. We will ensure that this is not the case this time around,” said Dr Droti.


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