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Medical certification of cause of death

Understanding the underlying cause of death

A 50-year-old woman was admitted to hospital vomiting blood and was diagnosed as having bleeding oesophageal varices. Investigations revealed portal hypertension. The woman had liver cirrhosis, due to hepatitis B. Three days later, she died. The figure below outlines the chain (or sequence) of events that led to her death.

It is very important that the UCOD is correctly determined and accurately recorded for each death, since this is the information that determines the importance and urgency of prevention strategies. In this case, bleeding oesophageal varices was the immediate (or direct) COD and hepatitis B was the UCOD. Therefore, the critical message for public health is to prevent infection with the hepatitis B virus. 
Knowing this, the public health response is to implement immunisation programs against the hepatitis B virus to prevent such deaths in the future.

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