Abstract
INTRODUCTION : Mortality statistics data is collected from Medical Certification of Cause of Death (MCCD) form 4 (Institutional Deaths)/4A(non-Institutional Deaths) and is a legal document which records the diseases, morbid conditions or injuries which either resulted in or contributed to death along with the timeline (3). The statistics available in the developing countries is of relatively poor quality (5-7). The errors such as missing or incorrect cause of death found in MCCD form in India is more than 90% (10). There are no studies found assessing the medical certification in Tamil Nadu. Hence it was decided to take up the MCCD data from two institutions (one government and one private) and assess the data to understand the completeness and errors noted in certification.
METHODOLOGY : It was a descriptive cross-sectional study in two Institutions (one government and one private) X & Y in a district from Tamil Nadu. One institution from government and private institution with highest number of deaths among all the institutions from the district was taken for the study and all deaths registered with MCCD was included for the study. The MCCD data from 1st June 2022 to 31st July 2022 was collected as soft copy from the two institutions. The data was analysed by State Nosologist for each record using the Bloomberg MCCD rapid assessment tool and entered and coded in a excel sheet. Demographic variables, completeness and error frequency of the records are calculated using proprotions.
RESULTS : The total number of records taken for study was 1032. The total number of records from Institution X in 280 and Institution Y is 752. The time interval in any of the illness was recorded in 161 (57.5%) records in Institution X and 21(2.8%) records in Institution Y. The Records in which multiple causes were recorded in any line of Part 1 were 130 (46.4%) records in Institution X and 428(56.9%) records in Institution Y. The Records with error (Incorrect or clinically improbably chain of events leading to death in part 1) were 174 (62.1%) records in Institution X and 483(64.2%) records in Institution Y. Overall certification in records with at least any one of the error in writing MCCD is 251(89.6%) in Institution X and 746(99.2%) in Institution Y
CONCLUSION : It was noted that there is a lacunae in completion of time intervals in any of the illness especially in Institution Y(2.8%). The major errors in MCCD form like mentioning the wrong sequence of deaths (62.1% in Institution X & 64.2% in Institution Y ), multiple cause of death recorded in a single line(46.4% in Institution X & 56.9% in Institution Y ) is found in both institutions in a considerable level. The overall certification without errors is better in Institution X (89.6%) compared to Institution Y (99.2%) but still the overall certification is poor in both Institutions which must be addressed. The only way to overcome this gap is to adopt a multifaceted approach (training of doctors (interns, postgraduate and faculty) auditing of MCCD & awareness on MCCD imprtance) which may improve the quality of MCCD data.
KEYWORDS : MCCD, Completeness, Death Certification errors