Module 1 - Overview of the cause of death (1).pptx. useful

cause of death. useful overview to have clue about what causes death,

1. Module 1 Overview of the Cause of Death Improving Cause of Death Reporting

2. By end of this session, participants will be able to: Explain what a cause of death is and be able to distinguish one from the other Able to define the process of medical certification of cause of death Explain the importance of reliable cause of death statistics Describe the common uses of cause of death data and know the main sources of cause of death information Describe the flow of information in the capturing and reporting of causes of death Learning Outcomes for this Module

3. Learning Outcomes for this Module Explain factors that affect the quality of cause of death data Describe the current status of cause of death information in your country and the African region, and know some of the issues and challenges Describe how cause of death information can be improved Explain the legal, ethical and confidentiality issues related to cause of death data generation and use

4. “Cause of death refers to all those diseases, morbid conditions or injuries which either resulted in or contributed to death and circumstances surrounding them” Does not include symptoms, signs and modes of dying Only one underlying cause should be identified and written on the death certificate What is Cause of Death?

5. The immediate cause of death: “ the final disease, injury, or complication—resulting from the underlying cause of death—that directly caused death” The antecedent or intermediary cause of death:   “ the condition(s) that led to or precipitated the immediate cause of death but occurs at the time between underlying cause of death and immediate cause of death” The underlying cause of death:  “ the disease or injury (or poisoning) that initiated the chain of events that led directly and inevitably to death” What is Cause of Death? “The cause of death may be a single disease or injury that leads to death, or a sequence of events that lead to death”

6. Medical certification of Cause of Death (MCCoD) assignment of a cause of death by an authorized medically trained clinician who fully understands the clinical sequence of disease or injury that led to death MCCoD provides a cause-of-death statement Cause-of-death statement wording written in the format used on a death notification or medical certificate of cause of death form to indicate the cause(s) of death and other significant conditions that contributed to death What is Medical Certification of Cause of Death?

7. By filling in a medical certificate of cause of death Provision of a clear sequence of events leading to death; How is Medical Certification of Cause of Death done? progressing in descending order from the immediate cause of death …. to the immediate or intermediary cause(s) of death … and then to the underlying cause of death

8. Social Purposes: Legal document for burial; processing insurance; processing inheritance and settlements Statistical Purposes: Assessment of general health status of the population Explaining levels, trends and differentials in mortality Identifying emerging diseases and their impact Importance of Cause of Death Data - the Foundation of Mortality Statistics

9. Importance of Cause of Death Data - the Foundation of Mortality Statistics Statistical Purposes cont. Monitor the impact of public health programmes Monitoring of the SDGs Guide resource allocation and prioritization of interventions Identify and contribute to epidemiological, sociomedical and biomedical research priorities Others e.g. update national database

10. SURVEILLANCE HIV / AIDS Tuberculosis Cancer Cardiovascular disease Diabetes Homicide Road traffic injuries Influenza, Malaria & Pneumonia Rare disease Tobacco use Maternal & Perinatal OUTBREAKS COVID-19 Cholera H1N1 virus Ebola Foodborne illness Listeriosis Legionnaire’s disease EMERGENCIES Surveillance & outbreaks become emergencies when severe & spreading Natural disasters Mining accidents Shack fires Pandemic influenza Epidemiological Studies

11. Clinical Research Abstract Objective:  To provide internationally comparable data on the frequencies of different causes of death. Methods:  We analysed verbal autopsies obtained during 1999 -2002 from 12 demographic surveillance sites in sub-Saharan Africa and Bangladesh to find cause-specific and age-specific mortality rates. The cause-of-death codes used by the sites were harmonized to conform to the ICD-10 system, and summarized with the classification system of the Global Burden of Disease 2000 (Version 2). Findings:  Causes of death in the African sites differ strongly from those in Bangladesh, where there is some evidence of a health transition from communicable to noncommunicable diseases, and little malaria. HIV dominates in causes of mortality in the South African sites, which contrast with those in highly malaria endemic sites elsewhere in sub-Saharan Africa (even in neighbouring Mozambique).

12. Leading 10 causes of death in Africa (2019) Health Services Planning Source: Who-int (December 2020)

13. Sources of Cause of Death Data Civil registration and vital statistics systems Sample and local demographic surveillance systems, including rapid mortality surveillance Household surveys with mortality modules Health facilities: HMIS Clinical autopsies Burial systems and verbal autopsies

14. Deaths within Health Facility Clinician complete Medical Certificate of Cause of Death (MCCoD) form Death outside health facility Letter/affidavit from police, Chief or equivalent person confirming the death MCCoD with information from:-Clinicians: paramedic, carer, clinic staff, general practitioner, and Family Autopsy reports Civil Registration Department (CRD) Family member or equivalent person brings MCCoD form or letter /affidavit to CRD CRD captures information into NPR Flow of Information on Deaths

15. Capturing and Reporting Causes of Death at Facility Wired-Network Enabled Environment Forms are collected from the wards to a single point for data capturing Gov. Computer Service Facility B Facility D Facility C Facility A   Facility data handlers capturing ICD11 forms into HMIS Portal Doctor / Clinician Completes ICD11 form at ward Data flowing from facility A to central service (GCS) Facility data handlers capturing ICD11 forms into HMIS Portal Doctor / Clinician Completes ICD11 form at ward Facility E   Data flowing from facility E to central service (GCS)

16. Capturing and Reporting Causes of Death at Facility Wireless-Network Enabled Environment MCCoD data is captured in the wards Wireless PC Wireless PC Wireless Access Point Table B or Gov. Computer Service

17. Quality of Cause of Death Data Correct COD certification Death registration completeness Quality of cause of death data Flow of information occurring in the community Deaths in a community A facility

18. Source: Strengthening civil registration and vital statistics for births, deaths and causes of death, Resource Kit. WHO 2012 Factors Affecting Quality of Death Certification and Mortality Data

19. High numbers of unreported community deaths Poor registration of community deaths Lack of training of medical certifiers High proportion of deaths with ill-defined causes Inaccurate injury mortality profiles Under-reporting of deaths (e.g. HIV related and COVID-19 deaths) Current Challenges in Cause of Death data in Africa

20. Unusable codes classification Number of deaths with unusable codes % of total causes Category 1 Symptoms, signs and ill-defined conditions 58,342 12.3 Category 2 Impossible as underlying cause of death 5,282 1.1 Category 3 Intermediate cause of death 47,544 10.0 Category 4 Immediate cause of death 4,560 1.0 Category 5 Insufficiently specified causes within ICD chapters 92,853 19.6 Total unusable and insufficiently specified causes 208,581 44.1 Unusable cause of death data categories used in 2014 Current Challenges in Cause of Death Data – An Example

21. Key Considerations for Improving Cause of Death Reporting Mortality Statistics National / Central Registry District Health Information system (DHIS 2) or Similar System Medical Certification and Coding of Cause of Death Health Facility Death Sub-national Repository Community-based Certification of Cause of Death (including Verbal Autopsy) Community Death ICD-based system for reporting of facility deaths Verbal autopsy system(s) for reporting of community deaths: Local administration Community health workers Religious and traditional institutions Overarching and Supportive Policy and Legislative Environment

22. Key Consideration Improving Cause of Death Reporting

23. A legal document needed: In some countries, to proceed with burial or cremation of the body To execute the deceased person’s will In certain situations, for the police or the pathologist to access the body By clinician or hospital to report details of the death to national authorities To enter details of death and circumstances into a database for reporting of national morbidity and mortality statistics. The Death Certificate – a Legal Document

24. What laws govern death notification and death certification ? Who certifies deaths at facility and community level? Who notifies deaths at facility and community level? What is the legal time period within which deaths should be certified and notified? Laws Governing Reporting of Deaths and Cause of Death

25. INTERNATIONAL The United Nations describes civil registration as “ the continuous, permanent, compulsory and universal recording of the occurrence and characteristics of vital events pertaining to the population as provided through decree or regulation in accordance with the legal requirements of a country” Laws Governing Reporting of Deaths and Cause of Death

26. Ethiopia : Proclamation (No.760/2012) “Registration of Vital Events and National Identity Card Proclamation).” Amended in 2017 (Proclamation no.1049/2017 ). It declares “ Any vital event shall be registered with necessary detailed information that can be used for legal, administrative and statistical purposes.” Ethiopian Laws Governing Reporting of Deaths and Cause of Death

27. “The registration has to be “within 30 days following the date of its occurrence unless there is sufficient “cause for delay ” Regarding death registration, Articles 39 to 43 of the Proclamation put an obligation to declare death for registration by I ndividuals who used to live together with the deceased or know about the event . relevant authorities in several institutes ( such as health facilities, police common dwelling places ,..) Ethiopian Laws Governing Reporting of Deaths and Cause of Death

28. What ethical issues you might think concerning MCCoD ? ETHICAL Issues

29. Certifiers should observe confidentiality , ethics and honesty about the cause of death the patient's privacy and confidentiality of the information should always be maintained The disclosure is permissible only when: There is expressed or implied consent of the next-of-kin An order of court The clinician or hospital interest cannot otherwise be safeguarded There exists a higher duty ( i.e. Public interest issue ) Legal Issues – Privacy & Confidentiality

30. The clinician is not to reveal the details of a certificate of cause of death to a third party unless: are legally required to do so have obtained prior consent from the next of kin of the deceased May be used for research purposes, if the deceased is not identified by name or other means Legal Issues – Privacy & Confidentiality