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The value of cause of death data

Medical certification of cause of death

Coding causes of death to statistical categories
The International Classification of Diseases

Cause of death: where there is no physician
Verbal autopsy diagnostic algorithms

Automated verbal autopsy
What is automated verbal autopsy and how does it differ from medical certification of cause of death?

Incorporating verbal autopsy into the civil registration and vital statistics system

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Medical certification of cause of death

Strategies to improve certification of cause of death

A strategy for improving the quality of COD certification involves a series of steps that are summarised below. These should be adapted to local circumstances and needs and endorsed by key stakeholders including medical associations, the ministry of health, the department of the registrar-general, the national statistics office, and other relevant entities such as ministries of education, justice, finance and planning. 

A central assumption throughout is that COD be certified only by a physician or other medically trained person. 

Step 1: Form a national or hospital mortality committee with senior representation from physicians, medical educators and trainers, health practitioners, health statisticians, legal and ethical experts and civil-society representatives. The function of the committee is to:

  • Gather information on the status of COD certification
  • Identify priority actions needed, prepare a work plan and schedule of activities
  • Identify resources needed and sources of technical and financial support
  • Report regularly on progress to relevant agencies and institutions.

Step 2: Review existing death certificates and related forms and modify as required to ensure alignment with international standards. Review available guidance materials and manuals and revise and/or improve as necessary – ensuring that this addresses not only the technical aspects of COD certification but also its legal and ethical aspects. Ensure that the updated guidance materials are widely distributed and disseminated to all medical professionals.

Step 3: Through discussions with hospital administrators and physicians, draw up an action plan with timelines for the ongoing training of physicians in medical certification of COD. Training should also cover the business process for data collection. Physicians, administrators, nursing staff and health information officers should be trained in legal regulation, data flows and reporting responsibilities.

Step 4: Through discussions with universities and medical training establishments, draw up a plan for incorporating information on the purposes and content of the medical certification of cause of death in medical curricula.

Step 5: Establish quality assurance processes to foster the integrity of COD certification – for example, introduce University of Melbourne death certificate assessment tool for periodic evaluation of death certification accuracy. Feedback should be provided to physician certifiers as an incentive for good-quality certification.

Step 6: Discuss with health researchers and the medical establishment the possibility of introducing verbal autopsies for deaths occurring outside health facilities.


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Action guide on training and education on medical certification of cause of death

Outlines an approach to training and education on medical certification of cause of death based on three key stages in a physician's career: during medical school, as an intern or junior physician, and as senior practicing clinicians.

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Publication date: August 2018 (update)

Resource type: CRVS action guide

Related resources: Training and education on medical certification: Effective strategies and approaches


Assessing the quality of death certificates: Guidance for the rapid tool
Assessing the quality of death certificates: Guidance for the rapid tool

This document provides guidance on how to use the rapid assessment tool. Information generated from the assessment would be helpful for ministry of health staff, hospital administrators, health information officers or medical record officers to determine the quality of death certificates. The tool can be used by a doctor who is trained in death certification practices and understands the ICD-10 death certification rules.

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Authors: Rampatige R, Gamage S, Richards N, Riley I, Wijesekera N.

Publication date: February 2019 (update)

Resource type: CRVS resources and tools

Related resources: Assessing the quality of death certificates: Rapid tool


Promoting the periodic assessment of the quality of medical records and cause-of-death data
Promoting the periodic assessment of the quality of medical records and cause-of-death data

A rare look into the validation of cause of death information from routine reporting systems.

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Authors: Rampatige R, Mikkelsen L, Gamage S, Peiris S

Publication date: November 2009

Resource type: CRVS technical outcome series

Related resources: Assessing the production, quality and use of national vital statistics: a case study of the Philippines


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Strategies for improving the quality of cause of death data in hospitals

This paper outlines the importance of accurate medical certification of cause of death, and provides eight strategies that hospitals can implement to improve the accuracy and consistency of cause of death data drawn from medical records.

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Author: University of Melbourne

Publication date: April 2018 (update)

Resource type: CRVS development series

Related resources: Action guide on improving the quality of cause of death data in hospitals


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Training and education on medical certification: Effective strategies and approaches

This document outlines a best-practice plan for the timing and content of education and training on medical certification for physicians at three career stages.

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Author: University of Melbourne

Publication date: July 2018 (updated)

Resource type: CRVS development series

Related resources: Summary: Effective strategies and approaches to training in medical certification

Godfrey M Semu MCCOD3

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