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Medical certification of cause of death

Medical certification of cause of death (COD) | World Health Organization International Form of Medical Certificate of Cause of Death (MCCOD)

In principle, hospitals with physicians should routinely record deaths by date and place of occurrence, age and sex of the decedent, and cause of death (COD). COD should be certified by a physician using the World Health Organization International Form of Medical Certificate of Cause of Death. The COD should be coded according to International Classification of Diseases (ICD) standards. 

For this to be possible, the quality of medical records should be such that the routine system can collect:

  • Individual patient data: including sex, age, date of admission, date of discharge, death, pregnancy, accident, treatment, and diagnosis (including reason for admission and comorbid conditions)
  • Individual cause(s) of death: collected on the International Form of Medical Certificate of Cause of Death, the standard data collection form for COD in routine health facility settings. 

The diagram below shows, in a simplified form, the sequence followed from the admission of a patient to a health facility when a clinical diagnosis is made and therapeutic decisions taken, to the issuance (should the patient die) of a medical certificate of cause of death, to the statistical coding of the COD and the eventual aggregation of the information on each individual patient into health statistics.

Use of cause of death data at individual and aggregated levels

The information on the individual death certificate may be given to the family for use for administrative and legal purposes and is subsequently incorporated into the civil registry of deaths. However, in some settings, information on individual COD is not shared with the family on the grounds of confidentiality. Subsequently, the COD is coded according to the ICD, and aggregated into vital statistics on causes of death that are used to inform public health policy. 

It is clear from this figure that the quality of COD statistics is critically dependent on the accurate completion of the medical record and on the ability of physicians to correctly assign the COD. This group of modules under Topic 4 describes how to ensure maximum quality from the start to the end of the process.


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