Issuing and appropriate completion of medical certification of cause-of-death forms by physicians at a tertiary teaching hospital in Nigeria

Abstract

Background: Medical certificates of cause-of-death are essential public health documents needed in proof of death, crime prevention, health planning, setting of priorities, monitoring of the health of the population, outcome review studies and others. When cause-of-death forms are filled out erroneously, they provide misleading and inaccurate information; and thus not useful in cause-of-death statistics.

Objective: This retrospective study was to answer the following questions: how frequent is death certificates issued for deaths occurring at a tertiary hospital in Nigeria, and are death certificate forms completed correctly by physicians?

Methods: All deaths occurring at the hospital over a 5-year-period were stratified by ward and sex. Errors in death certificate’s completion were grouped into 4 categories according to the classification system adopted by Tsung-Hsueh Lu et al. We also extracted other information such as decedents’ ages and qualifications of the certifiers from the reviewed forms.

Results: A total of 5,392 deaths were recorded, 53.3% of whom were males; only 350 (6.5%) death certificates were issued - 299 (85.4%) in males and 51 (14.6%) in females - out of which only 125 (35.7%) were completed correctly as regards the section on cause of death. Less than 1% of these certificates were issued in decedents less than 20 years of age. The most common type of error was Minor Error, 2 (41.3%). A total of 321 (91.7%) of the certifiers included their qualifications in the forms. Consultants in charge of the cases directly completed the cause-of-death forms in only 3.1% of the cases. Also, very insignificant proportion (0.6%) of the certificates was issued following autopsies.

Conclusion: Death certification forms are not routinely issued by physicians; more than half of the issued certificates completed by both the lowest and highest echelons of medical professionals contained no useful information for epidemiological studies. Thus, there is a strong reason for a continuous medical education on the need for a vigorous and systematic documentation of causes of deaths in Nigeria.

Keywords: Death, Certificate, Request, Accuracy, Clinicians, Hospital-based