Assessment of quality of facility based medical certifications of death and its associated factors in Saint Paul’s Hospital Millennium Medical College and Ras Desta Damtew Memorial Hospital

Abstract

Abstract Background: In many countries medical certificates of cause of death (referred to as ‘death certificate’) are often of poor quality, even when the cause of death has been certified by a doctor. There is limited information concerning the validity of death certificate given in most of the developing countries. In Ethiopia, however, the internationally recommended death certificate guidelines have not been utilized until now. So this research try to analyze the gap in filling the death certificate and put the possible solutions in improving the quality and accuracy of medical certifications of death and also can be a source of information which can be very valuable for others in conducting similar studies in the subject matter. Objectives: Assessment of quality of facility based medical certifications of death and its associated factors in Saint Paul’s Hospital Millennium Medical College and Ras Desta Damtew Memorial Hospital. Methods: A cross-sectional retrospective record review was conducted at Saint Paul’s Hospital Millennium Medical College and Ras Desta Damtew Memorial Hospital. Randomly selected records of patients died after admission to the hospital during the study period was included. The total calculated sample size was 620. The data was entered into a mobile using ODKversion 1.26.2 and was exported to statistical package for social science (SPSS) version 25 for analysis. Binary logistic regression analysis was performed to estimate the association between outcome and explanatory variables. Result: A cross-sectional study was done to assess the quality of medical certification of cause of death and associated factors by assessment tool of University of Melbourne and WHOrecommended International form of medical certificate of cause of death. During the period under study, a total number of 595 death certificates of Saint Paul’s Hospital Millennium Medical College and Ras Desta Damtew Memorial Hospital were reviewed. Of the 595 death certificates, 71.6% were from SPHMMC and 58.2% of them were male. Most deaths were in the age group between 25-65 years and most stayed for 1-7 days. 1 Most of the deaths occurred at the emergency. More than half (57.1%) of the deaths occurred at night. Majority of the death certificates (66.7%) were certified by a Resident. Almost for all the issued death certificate, the manner of death was Natural. All death certificates were not filled correctly. The most common error was missing time interval between onset and death followed by ill-defined underlying cause of death. The death certifiers usually make three errors in filling medical certificates of cause of death. At least one major and one minor error seen in 50.9% and 34.1% of the death certificates respectively. A significant association was seen between type of health facility and quality of death certificate documentation. Conclusion: In this study, substantial shortcomings in the death certification practices are seen; all death certificates were not filled correctly. The most common error was missing time interval between onset and death followed by ill-defined underlying cause of death. The death certifiers usually make three errors in filling medical certificates of cause of death. A significant association was seen between type of health facility and quality of death certificate documentation. Key Words: Cause of Death, Accuracy, MCC