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What is CRVS and why does every country need it?
Introduction

Why do CRVS systems underperform?
Global CRVS systems

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What is CRVS and why does every country need it?

Cause of death

The civil registration system collects information on the occurrence of each death and key characteristics such as the age and sex of the decedent and other socioeconomic and demographic variables. In addition, CRVS systems, especially when working closely with the health sector, can produce statistics on cause of death for all deaths – essential data for health decision making. For this to happen, the physician attending the death is required to complete a medical certificate of cause of death (MCCOD) using the international form of the death certificate. If the civil registration law requires information on cause of death, the physician in attendance is generally required to forward the information to the registrar. The information in the MCCOD is subsequently coded to a statistical category according to the World Health Organization International Classification of Diseases 10th Revision

Time series data on causes of death, produced in the same way for different countries, are of enormous value in understanding evolving patters of mortality and alerting health authorities of the need for interventions to combat rises in preventable mortality. The charts show trends in mortality due to ischaemic heart disease (see below, lung and stomach cancer (see below) and motor vehicle accidents (see below) in five countries between 1950 and 1999. Faced with such trends, country health authorities introduced preventive interventions such as dietary and physical activity advice, tobacco control, seatbelt legislation and speed reductions, among others, designed to avert such premature mortality. Mortality reductions have occurred in all five countries subsequently. 

The example from Australia shows the rapid decline in motor vehicle accident mortality following the introduction of seatbelt legislation in 1970 (see below).

Examples:

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One of the most striking examples of the use of data from well-functioning CRVS systems is the use of time series data on lung cancer mortality in the USA, showing how rising mortality rates mirrored the upsurge in smoking prevalence some 20 years earlier (figure below).

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For some types of deaths (generally deaths under suspicious circumstances), a medical examiner or coroner may be designated to determine and report cause of death. In some areas, if the person dies in a hospital or other medical facility, the cause of death may be obtained from the hospital.

Information on cause of death may be collected separately from the fact-of-death information for civil registration. Some countries collect cause-of-death information as part of the registration of death. In other countries, cause-of-death information is collected separately and is forwarded to the civil registration agency or to the national vital statistics office tabulation. 

Some countries do not collect cause of death through the civil registration process, and other methods such as verbal autopsy are used to obtain information for statistical tabulations.



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Cause of death in CRVS


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