Improving quality of medical certification of causes of death in health facilities in Tanzania 2014–2019

Abstract

Background Monitoring medically certified causes of death is essential to shape national health policies, track progress to Sustainable Development Goals, and gauge responses to epidemic and pandemic disease. The combination of electronic health information systems with new methods for data quality monitoring can facilitate quality assessments and help target quality improvement. Since 2015, Tanzania has been upgrading its Civil Registration and Vital Statistics system including efforts to improve the availability and quality of mortality data. Methods We used a computer application (ANACONDA v4.01) to assess the quality of medical certification of cause of death (MCCD) and ICD-10 coding for the underlying cause of death for 155,461 deaths from health facilities from 2014 to 2018. From 2018 to 2019, we continued quality analysis for 2690 deaths in one large administrative region 9 months before, and 9 months following MCCD quality improvement interventions. Interventions addressed governance, training, process, and practice. We assessed changes in the levels, distributions, and nature of unusable and insufficiently specified codes, and how these influenced estimates of the leading causes of death. Results 9.7% of expected annual deaths in Tanzania obtained a medically certified cause of death. Of these, 52% of MCCD ICD-10 codes were usable for health policy and planning, with no significant improvement over 5 years. Of certified deaths, 25% had unusable codes, 17% had insufficiently specified codes, and 6% were undetermined causes. Comparing the before and after intervention periods in one Region, codes usable for public health policy purposes improved from 48 to 65% within 1 year and the resulting distortions in the top twenty cause-specific mortality fractions due to unusable causes reduced from 27.4 to 13.5%. Conclusion Data from less than 5% of annual deaths in Tanzania are usable for informing policy. For deaths with medical certification, errors were prevalent in almost half. This constrains capacity to monitor the 15 SDG indicators that require cause-specific mortality. Sustainable quality assurance mechanisms and interventions can result in rapid improvements in the quality of medically certified causes of death. ANACONDA provides an effective means for evaluation of such changes and helps target interventions to remaining weaknesses.

Road traffic death coding quality in the WHO Mortality Database

“…Irrespective of the negative outcomes noted above, coding quality has improved in many countries and territories in recent years; despite a few exceptions (for example, Brazil and the United Republic of Tanzania) where coding quality has declined due to insufficient numbers of certified medical coders and/or increased workloads per coder. 37 , 38 …”

Patterns and trends of in-hospital mortality due to non-communicable diseases and injuries in Tanzania, 2006–2015

“…Lastly, this study used data from hospital where causes of deaths are done by health care providers, specifically physicians based on ICD-classifications. Training, routine supervision and decentralized registration systems had been done to ensure quality of medical classification of causes of death in recent years [ 68 ]. Despite these limitations, this study consolidates information on the hospital-based NCD and injuries mortality and highlights patterns and trends of major causes across Tanzania; it is our expectations that the information generated from this study will be useful to the strategies on dealing with NCD and injuries.…”

Strategy to Improve Quality of Medical Certificate of Cause of Death: An Analysis of Mortality Surveillance Data DKI Jakarta Province, Indonesia 2016-2019

“…The GC in this surveillance data tends to be the same every year, an indication that there is no evaluation or feedback to physicians regarding the results of determining the cause of death they made. evaluation of the quality of mortality data should ideally be at the facility level (Nyondo et al 2021). Routine national and sub-national (eg district/provincial) audits can be carried out with tools such as ANACONDA to comprehensively assess data quality.…”

“…Submission of GC, including codes and their effects, is expected to add to a better understanding of the accuracy of the underlying cause of death and the effect of decreasing GC. A good understanding will give positive effects on improving the quality of MCCDs and, accordingly, on the quality of country mortality statistics (Nyondo et al 2021). On the other hand, the quality of the MCCD data is also highly dependent on the physician's concern for the quality of the data.…”