Quality assessment of facility based medical certification of cause of death in the Department of Pediatrics and Child Health at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Abstract

Abstract Background As one of the vital events of interest death must always be certified by a person authorized by law to issue a document, stating the causes of death. In order to ensure the universal application of this principle World Health Organization has recommended an international form of medical cause of death certification that is adopted by most countries of the world. A good quality death certificate should fulfill the criteria put forth including a correct documentation of causes of death, with the correct sequence and time intervals. Objective:The purpose of the study was to assess quality of facility based documentation of death certificate in the Department of Pediatrics and Child Health at St. Paul’s Hospital Millennium Medical College from January 2022- March 2023. Methods:Ahospital based cross-sectional study was conducted with retrospective data collection by reviewing medical death certificates of deceased patients who were admitted at the Department of Pediatrics and Child health before their death with in the study period. A structured pretested questionnaire with details of the deceased, WHOformatted death certificate and Rapid Assessment Tool ware used. Medical death certificates was reviewed by the primary investigator. Errors ware identified by the rapid assessment tool and classified as Major and Minor errors. Disparities in the magnitude of errors as compared to age, sex, duration of stay, time of death; qualification of certifier and place of death was assessed. Results:From the 384 medical death certificates that were reviewed, 100% of them had errors. The commonest major error was a missing time interval. The commonest minor error was use of abbreviations. compared to daytime death, night time death was 98% less likely to ill defined UCOD under the adjusted odd‟s ratio. Those who were female had 82% less likely to have error as compared to male who were certified as dead Conclusion:As observed by the percentage of medical death certification errors, this study confirms that there was a high magnitude of error among all of the issued medical death certificates. There were a collectively similar quantity of poor quality certificates regardless of the attributes of the deceased, as well as determinant factors of certifiers. The most common error demonstrated was missing time interval followed by use of abbreviation and no error on documentation of time of death. This finding suggests that the time of death may be influence the quality of medical death certificate, with nighttime death possibly allowing more time for accurate documentation compared to emergency but need further study. In addition, it had also picked the magnitude of ill-defined Underlying Cause of Death (4.95%). These are all crucial inputs into hospital and national data.