Improving mortality data in South Africa: review of next of kin statements to determine cause of death in police certification.

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STUDY OBJECTIVE--The study aimed to improve mortality data by finding ways of reducing the large number of deaths certified as being from "ill-defined" causes (ICD 780-798) in South Africa. This problem is attributable to the absence of cause of death information in many cases where the police issue the death certificate. DESIGN AND SETTING--A total of 600 consecutive death certification records at the Salt River State Mortuary, Cape Town were reviewed. MEASUREMENTS AND MAIN RESULTS--Altogether 347 (58%) deaths were from unnatural causes, 111 (18%) were certified by a doctor, 83 (14%) were certified as being the result of natural causes after a necropsy, and 59 (10%) were certified by the police as being from natural causes. Analysis of sworn statements obtained from the next of kin of all those certified dead by the police rather than a doctor provided a clear cause of death in 72.9%, and a history of recent contact with health services (less than one week previously) in 47.5%. All infants certified dead by the police had a history consistent with diarrhoeal disease. CONCLUSIONS--The method of death certification may be an indicator of access to health care and reviewing sworn statements to determine the cause of death should improve the quality of mortality data in the developing world.

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