A study of ill-defined causes of death in Bahrain. Determinants and health policy issues

OBJECTIVE: To find the actual cause of death in death certificates that had ‘ill-defined’ causes in 2006, evaluate the correctness of the completion of those certificates, and recommend ways to decrease the proportion of ‘ill-defined’ causes of death in Bahrain.

METHODS: This was a retrospective review of all death certificates that had ‘ill-defined’ as a cause of death (International Classification of Diseases-10 codes R0-R99) from January through December 2006 in Bahrain.

RESULTS: Of the decedents with ‘ill-defined causes’ of death in 2006, 76.7% were Bahraini, 70.6% males, 37% older than 70 years, and 62.7% died in their homes. The underlying causes of death of 92% were recorded as ‘brought dead’ and ‘cardiopulmonary failure.’ Of those whose place of death was recorded as ‘brought dead'', 86% had died in their homes. Sixty percent of the death certificates were signed by Salmaniya Medical Complex (SMC) physicians and the remaining by forensic doctors and over half by senior residents. Of the death certificates retrieved at SMC, 60% were corrected, 47.4% of which were certified by doctors from the accident and emergency department, 31.5% from medical, and 21.1% from surgical departments.

CONCLUSION: Death certification in Bahrain should be reevaluated by all stakeholders to improve the quality of mortality data. The revised policy should stress upon increasing the awareness of the physicians on the implications of inaccurate death certification.