Why correct death records matter to us

How accurate are hospital death records in Tanzania? This is the question that researchers have attempted to answer in a recent study involving 39 hospitals across the country.

The researchers from the National Institute for Medical Research (NIMR) found that reports on deaths in many hospitals were not kept properly.

Data on hospital deaths, according to the study coordinator Dr Leonard Mboera, are important for planning and preparation of healthcare policies.

But what the study found out in many hospitals, including Muhimbili National Hospital (MNH), is that death reports are not properly preserved and there are no clear guidelines for the keeping records.

Dr Mboera says the details relating to death, such as causes of death are help in making follow-ups and evaluating the quality of health services provided and clarifying the priorities of health care services.

The study, which was carried out from July to December 2016 centered on how death reports were collected and preserved from 2006 to 2015.

“We aimed at establishing the causes/diseases causing deaths of of hospitalized patients and one of the challenges we faced were on getting accurate names of patients who died, the symptoms of diseases that led to their death...,” says Dr Mboera.

“Another reason of carrying out the study was to evaluate the care and the keeping of death statistics in our country’s hospitals,” he says further.

“It’s important to know why people die…” says the researcher, explaining that the statistics were obtained from the hospitals’ registers and permits from the Registration Insolvency and Trusteeship Agency (Rita) in district hospitals.

“This is the first time for Tanzania to carry out such a study that involved many hospitals since independence.

So, it is important to conduct regular studies so as to find out the trend of deaths and the quality of healthcare services provided by hospitals in the country,” he explains.

He says their study found out that 247,976 death reports were obtained in a period from 2006 to 2015 with more deaths occurring to men than women.

“The gathered reports were about a patient’s gender, date of hospitalisation, date of death and causes of deaths were classified into 45 categories, depending on the World Health Organization (WHO)’S procedures of grouping patients,” he says.

What hospitals say about inaccurate records

In an interview with the head of record-keeping and medical information department at MNH, Geofrey Semi, it was revealed that misleading death reporting was a big problem facing various hospitals including MNH.

“After the release of the study findings, we sat down and asked ourselves what the causes were…,” says Semu.

“We had to carry out a study of our own as its findings showed that the subject on how to write the cause of the death of a patient by many doctors was not given its due weight during their medical training courses,” he explains.

He clarifies that even new doctors on their job were not instructed on how to write causes of deaths.

Symptoms written as causes of death

“Another thing that we found out was that we did not check death record books regularly,” he points out.

He says the WHO guidelines require to know the cause of death so that it can help prevent more deaths, but in that study it was found that some symptoms of diseases were being written as causes of death.

“For example, when a person has had an accident, we do not want to read the death of that person was caused by that accident. We want to know the cause of death that occurred there so we can help prevent it from happening again,” he clarifies.

The study found out that Aids, Tuberculosis and road accident injuries were the main causes of deaths of many youths in a period from 2006 to 2015.

“In a period from 2006 to 2015 the study findings showed that malaria-related deaths decreased by 47 per cent, HIV/Aids (28 per cent) and TB by (26 per cent),’’ he says.

However, the same study findings showed that deaths caused by diseases affecting under-one-month-old babies increased by 128 per cent,” he clarifies.

However, he says many deaths occurred in hospitals of Dar es Salaam, Morogoro and Mwanza regions while deaths of the under-five contributed by 20 per cent of all the deaths.

“Many deaths, according to the study, occurred to groups of people aged 30 to 45 as on average many people died at the age of 31.

Their study, according to Semu, also found out that malaria and anemia were the major causes of many deaths of the under-five children during the period.

The study challenges

Record keeping in many hospitals faced major challenges as some statistics were missing in some hospitals or for several years.

The required use of names of patients by observing the international guidelines was weak while the symptom of some disease being recorded as the cause of death.

The leading killer diseases

The leading killer diseases were malaria by 12.8 per cent, respiratory diseases (10.1 per cent), HIV/Aids (8 per cent), anemia (7.8 percent), heart and blood system diseases (6.3 per cent).

The study also found out that hospitals in Dar es Salaam Region had a big number of patients that died from malaria, HIV/Aids, injuries from motorized vessel accidents, blood bacterial infections, anemia, cancer and TB.

Communicable diseases

The study found out that Coast, Geita and Katavi regions were more affected by infectious diseases and malnutrition with deaths and injuries caused by road accidents affecting more Rukwa, Tabora, Singida and Kigoma regions.

The regions affected more by non-communicable diseases were Ruvuma, Manyara, Dar es Salaam and Mwanza.

The central zone regions (Dodoma, Singida and Manyara) and the northern regions, (Arusha and Moshi) were affected by many deaths caused by respiratory diseases with anemia affecting more Dodoma, Simiyu and Mtwara regions.

Recommendations

Various stakeholders have given their recommendations to the government to prepare effective guidelines for correct use of collecting, caring and the record-keeping of health and death statistics.

Prof Daudi Simba of the Muhimbili University of Health and Allied Sciences (MUHAS) says there is need for capacity building among health workers in terms of analyzing the use of death statistics.

“Hospital managements are supposed to improve their statistic systems electronically without forgetting to improve training for doctors in use of the international guideline on clarifying causes of diseases and deaths,” he says.

Government strategies

The Chief Medical Officer, Prof Mohamed Bakari says the government has already put in place guidelines that had been incorporated into the curricula of medical training colleges and those of medical practitioners in the country.

For his part, MNH’s records manager Semu, again, says they had started offering training on how to write death recording reports to students of the health profession and newly employed doctors.

Top 10 causes of death globally

According to 2016 World Health Organisation’s report on top causes of death, globally, or his part, Of the 56.9 million deaths worldwide in 2016, more than half (54 per cent) were due to the top 10 causes. Ischaemic heart disease and stroke are the world’s biggest killers, accounting for a combined 15.2 million deaths in 2016.

These diseases have remained the leading causes of death globally in the last 15 years.

Chronic obstructive pulmonary disease claimed 3.0 million lives in 2016, while lung cancer (along with trachea and bronchus cancers) caused 1.7 million deaths.

Diabetes killed 1.6 million people in 2016, up from less than 1 million in 2000.

Deaths due to dementias more than doubled between 2000 and 2016, making it the 5th leading cause of global deaths in 2016 compared to 14th in 2000.

Lower respiratory infections remained the most deadly communicable disease, causing 3.0 million deaths worldwide in 2016. The death rate from diarrhoeal diseases decreased by almost 1 million between 2000 and 2016, but still caused 1.4 million deaths in 2016. Similarly, the number of tuberculosis deaths decreased during the same period, but is still among the top 10 causes with a death toll of 1.3 million.

HIV/AIDS is no longer among the world’s top 10 causes of death, having killed 1.0 million people in 2016 compared with 1.5 million in 2000.

Road injuries killed 1.4 million people in 2016, about three-quarters (74 per cent) of whom were men and boys.

The report further added that more than half of all deaths in low-income countries in 2016 were caused by the so-called “Group I” conditions, which include communicable diseases, maternal causes, conditions arising during pregnancy and childbirth, and nutritional deficiencies.

This story first appeared in the Mwananchi Newspaper.