Dr Wijesekera trains participants from Bangladesh and Myanmar in morality coding.

Building mortality coding expertise in Bangladesh and Myanmar

One hundred and forty countries with 80 per cent of the world’s population do not have reliable cause of death data, which makes it difficult for policy makers to identify mortality trends and make informed decisions for the benefit of the population.

Melbourne’s Bloomberg Data for Health Initiative (BD4H) organised mortality coding training this September for non-clinical staff (statisticians, data entry clerks and existing coders) from Myanmar and Bangladesh. Dr Nandalal Wijesekera – a physician and specialist in health information systems and a consultant to Bloomberg Data for Health Initiative – delivered the training in the regional centre of Colombo, Sri Lanka.

Mortality coding
Death certificates record the chain of events or illnesses leading to death, from immediate causes to the underlying cause of death. Mortality coding involves selecting the underlying cause of death and translating the data into alpha-numeric codes that allow for tabulation and aggregation for national statistics. (To expand, an immediate cause of death may be trauma due to head injuries sustained in a car accident; however, it may eventuate that the driver was partially blind due to diabetes. In this example, the underlying cause of death is diabetes, not the car accident.)

Statistics allow countries to monitor and evaluate disease and injury trends in the population; measure the effectiveness of programs and policies to prevent deaths; identify emerging challenges to health; provide insights into neglected health problems; understand how causes of death are changing; and monitor progress with national health development goals.

As part of the training, Dr Wijesekera introduced participants to the International Classification of Diseases (ICD 10) – a diagnostic tool published by the World Health Organization (WHO) used to classify diseases and other health problems.

Building expertise in-country
Both Bangladesh and Myanmar have prioritised coding in their Civil Registration and Vital Statistics (CRVS) Country Work Plans. Bangladesh has a new CRVS system (law introduced in 2004) and is in the process of establishing a functioning registration office. The country does not have a team of coders so the training has helped build the expertise in-country. 

Myanmar has had an established system of vital registration since the nineteenth century but has no overall law or act that brings civil registration and vital statistics into one system and this has led to confusion over roles and responsibilities. The Central Statistics Office has only six coders and this has resulted in backlogs of up to three years in document processing. 

Increasing the number and skill levels of coders for both countries will improve the speed, accuracy, efficiency and consistency of coding, resulting in quality civil registration and vital statistics. The training participants can now act as ‘master trainers’ to help facilitate ongoing training and support for coders in their countries.

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