Improving quality of medical certification of causes of death in health facilities in Tanzania 2014-2019

被引：9

作者：

Nyondo, Trust ^{[1
]}

Msigwa, Gisbert ^{[1
,2
]}

Cobos, Daniel ^{[3
]}

Kabadi, Gregory ^{[1
,2
]}

Macha, Tumaniel ^{[1
]}

Karugendo, Emilian ^{[4
]}

Mugasa, Joyce ^{[5
]}

Semu, Geofrey ^{[5
]}

Levira, Francis ^{[6
]}

Fruchtman, Carmen Sant ^{[3
]}

Mwanza, James ^{[2
]}

Lyatuu, Isaac ^{[3
,6
,7
]}

Bratschi, Martin ^{[2
]}

Kumalija, Claud J. ^{[1
]}

Setel, Philip ^{[2
]}

de Savigny, Don ^{[2
,3
]}

机构：

[1] Minist Hlth, Community Dev Gender Elderly & Children, Dodoma, Tanzania

[2] Bloomberg Philanthropies Data Hlth Initiat, Vital Strateg, New York, NY USA

[3] Univ Basel, Swiss Trop & Publ Hlth Inst, Basel, Switzerland

[4] Nat Bur Stat, Dodoma, Tanzania

[5] Muhimbili Natl Hosp, Dar Es Salaam, Tanzania

[6] Ifakara Hlth Inst, Dar Es Salaam, Tanzania

[7] Afr Acad Publ Hlth, Dar Es Salaam, Tanzania

来源：

BMC HEALTH SERVICES RESEARCH | 2021年 / 21卷 / SUPPL 1期

关键词：

Data quality assessment; Mortality data; Causes of death; ICD-10; Start-up mortality list; DHIS2; Continuing professional development; Medical certification; eHealth; Civil Registration and vital statistics; Tanzania; CIVIL REGISTRATION; STATISTICS;

D O I：

10.1186/s12913-021-06189-7

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background Monitoring medically certified causes of death is essential to shape national health policies, track progress to Sustainable Development Goals, and gauge responses to epidemic and pandemic disease. The combination of electronic health information systems with new methods for data quality monitoring can facilitate quality assessments and help target quality improvement. Since 2015, Tanzania has been upgrading its Civil Registration and Vital Statistics system including efforts to improve the availability and quality of mortality data. Methods We used a computer application (ANACONDA v4.01) to assess the quality of medical certification of cause of death (MCCD) and ICD-10 coding for the underlying cause of death for 155,461 deaths from health facilities from 2014 to 2018. From 2018 to 2019, we continued quality analysis for 2690 deaths in one large administrative region 9 months before, and 9 months following MCCD quality improvement interventions. Interventions addressed governance, training, process, and practice. We assessed changes in the levels, distributions, and nature of unusable and insufficiently specified codes, and how these influenced estimates of the leading causes of death. Results 9.7% of expected annual deaths in Tanzania obtained a medically certified cause of death. Of these, 52% of MCCD ICD-10 codes were usable for health policy and planning, with no significant improvement over 5 years. Of certified deaths, 25% had unusable codes, 17% had insufficiently specified codes, and 6% were undetermined causes. Comparing the before and after intervention periods in one Region, codes usable for public health policy purposes improved from 48 to 65% within 1 year and the resulting distortions in the top twenty cause-specific mortality fractions due to unusable causes reduced from 27.4 to 13.5%. Conclusion Data from less than 5% of annual deaths in Tanzania are usable for informing policy. For deaths with medical certification, errors were prevalent in almost half. This constrains capacity to monitor the 15 SDG indicators that require cause-specific mortality. Sustainable quality assurance mechanisms and interventions can result in rapid improvements in the quality of medically certified causes of death. ANACONDA provides an effective means for evaluation of such changes and helps target interventions to remaining weaknesses.

引用

页数：14