Original articles

Quality of cause of death certification at an academic hospital: Cape Town, South Africa

Beatrice Nojilana, Pam Groenewald, Debbie Bradshaw, Gavin Reagon


To investigate the quality of cause of death certification and to assess the level of under-reporting of HIV/AIDS as a cause of death at an academic hospital.
Cross-sectional descriptive retrospective review of death notification forms (DNFs) of deaths due to natural causes in an academic hospital in Cape Town during 2004. Errors in cause of death certification were assessed and ability to be coded according to International Statistical Classification of Diseases and Related Health Problems (ICD-10). The association between serious errors and age, gender, cause of death, and wards was analysed. A sample of DNFs (N=243) was assessed for level of underreporting of HIV/AIDS.
A total of 983 death certificates were evaluated. Almost every DNF had a minor error; serious errors were found in 32.2% (95% CI: 29.3-35.1). Errors increased with age, and cause of death was the most important factor associated with serious errors. Compared with neoplasms, which had the lowest error rate, the odds ratio for errors in endocrine and metabolic diseases and genitourinary diseases were 17.2 (95% CI: 8.7-34.0) and 17.3 (95% CI: 7.8-38.2) respectively. Based on the sub-sample, the minimum prevalence of HIV among the deceased patients was 15.7% (95% CI: 11.1-20.3) and the underreporting of deaths due to AIDS was 53.1% (95% CI: 35.8-70.4).
This study demonstrates that in almost a third of the DNFs, the errors were serious enough to affect identification of underlying cause of death, confirming the need to improve the quality of medical certification.

Authors' affiliations

Beatrice Nojilana, Burden of Disease Unit, Medical Research Council

Pam Groenewald, Burden of Disease Unit, Medical Research Council

Debbie Bradshaw, Burden of Disease Unit, Medical Research Council

Gavin Reagon, School of Public Health, University of Western Cape, Bellville, Cape Town

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cause of death, certification, accuracy, underlying cause, death notification form, AIDS related deaths, underreporting

Cite this article

South African Medical Journal 2009;99(9):648.

Article History

Date submitted: 2009-06-08
Date published: 2009-09-02

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