Inadequacies of Death Certification in Beirut: Who Is Responsible?

By Sibai, Abla M.; Nuwayhid, Iman et al. | Bulletin of the World Health Organization, July 2002 | Go to article overview
Save to active project

Inadequacies of Death Certification in Beirut: Who Is Responsible?


Sibai, Abla M., Nuwayhid, Iman, Beydoun, May, Chaaya, Monique, Bulletin of the World Health Organization


Introduction

Death certification is a public health surveillance tool and a valuable source of information at the national and local levels. Among activities that benefit from the availability of cause-of-death statistics obtained from death certificates are the monitoring of the health of populations, the setting of priorities and the targeting of interventions (1, 2). Such statistics are also the keystone of much epidemiological study, directing the focus of research and complementing mortality data in follow-up studies (3, 4).

In order to facilitate cause-of-death documentation and to standardize reporting and coding practices among various countries, the United Nations and the International Institute for Vital Registration and Statistics periodically develop protocols and guidelines for the management, operation and maintenance of civil registration (5). Moreover, WHO and other organizations produce rules and guidelines for mortality and morbidity coding (6, 7). Nevertheless, death registration is fragmented and largely inadequate in most developing countries (8). In the Eastern Mediterranean Region, for example, only rive countries reported mortality data to WHO between 1985 and 1990. This amounted to a population coverage of only 16%, whereas in Europe and the Americas the corresponding values were 94% and 80%, respectively (9). Late registration, incomplete information and inaccurate data may also be factors in inadequate death registration. While several studies, largely conducted in the West, have focused on the validity of information (10-14) and coding practices (15-18) related to specific causes of death, only a few have examined omissions in data-reporting on death certificates (19, 20) and no information is available on the timing of registration in relation to the occurrence of death. The two latter problems remain issues of concern mainly in developing countries. Little, if anything, is known of the magnitude of these deficiencies or the reasons for them.

The present study was undertaken to evaluate death certification in Lebanon, with reference to its process, mortality documentation and registration as a first step towards identifying limitations and reducing deficiencies. The vital system in Lebanon has never been examined and its utility as a public health tool for planning and evaluation remains questionable. Lebanon is a middle-income country with a population of about 3.5 million. Data at the national level are scarce, the only census ever conducted having been in 1932. Until very recently there were no government statistical surveys or health statistics. The conflicts that ravaged the country between 1975 and 1991 exacerbated the chaotic nature of official documentation. There is virtually no information on causes of death. Even today there are no coding procedures or computerization for the information on death certificates.

The specific aims of the study were to assess the completeness of data-reporting on death certificates and to search for trends over the past 25 years, a period of transition from prewar to postwar conditions. We also investigated whether omissions in data varied with the demographic characteristics of deceased persons and with the circumstances surrounding death events.

Methods

Study sample

Data were obtained from a systematic random sample of 20% of death certificates registered in selected years between 1974 and 1998 in Beirut. The certificates were retrieved, stratified by year of registration, from the files of the Statistics Department of the Ministry of the Interior. Initially, the years 1974, 1984 and 1994 were chosen to represent deaths registered in the prewar period, the war period and the postwar period respectively. Subsequently, the years 1997 and 1998 were added. The same sampling methodology, abstract form, coding manual and data entry file were used for all registration years. The final samples of approximately 500 for each year were considered adequate (maximum error 5%) for estimating proportions of missing data.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article

Inadequacies of Death Certification in Beirut: Who Is Responsible?
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?