Improving Mortality Data in Jordan: A 10 Year review/Ameliorer Les Donnees De Mortalite En Jordanie: Analyse decennale/Mejora De Los Datos Sobre Mortalidad En Jordania: Analisis De Los Ultimos 10 Anos

By Dababneh, Faris; Nichols, Erin K. et al. | Bulletin of the World Health Organization, October 2015 | Go to article overview

Improving Mortality Data in Jordan: A 10 Year review/Ameliorer Les Donnees De Mortalite En Jordanie: Analyse decennale/Mejora De Los Datos Sobre Mortalidad En Jordania: Analisis De Los Ultimos 10 Anos


Dababneh, Faris, Nichols, Erin K., Asad, Majed, Haddad, Yousef, Notzon, Francis, Anderson, Robert, Bulletin of the World Health Organization


Problem

As in many other middle-income countries, Jordanian law mandates that all deaths be registered. However, before 2003 registration was not universal and cause of death certification was often inaccurate. A survey conducted in 1995-1996 used verbal autopsy to estimate mortality indicators and determine causes of death. (1) The death notification form did not comply with World Health Organization (WHO) recommendations (2) for mortality reporting and data were inconsistent and not comparable within Jordan or with other countries.

Assessing death notification forms from 1996 to 2000, the disease control directorate of the Ministry of Health of Jordan found underreporting of deaths, particularly infant deaths, missing information on cause of death and incomplete and inaccurate reporting of the cause of death. The crude death rate based on registered deaths was about half that estimated by the Department of Statistics (2.4-2.8 versus 5.0 per 1000 population). Over 12% of reports were missing direct cause of death, and 40% of all death notifications contained uninformative causes of death, including symptoms or ill-defined conditions. Before 2003, no cause-of-death coding was completed, inhibiting production of useful mortality statistics. Lack of coding also meant that underlying cause-of-death information could not be provided to WHO in the requested format.

Approach

The improvement of mortality data in Jordan was initiated by an inter-agency collaboration and led by a mortality surveillance unit. In March 2001, Jordan enacted a new law requiring deaths to be reported and a burial permit sought within 10 days of death. In December 2001, the ministry of health organized the first national meeting on the Jordanian mortality system with WHO, the United States Centers for Disease Control and Prevention (CDC), and the United States Agency for International Development (USAID). Approximately 40 people attended, including health sector officials, medical and paramedical syndicates, deans of medical schools, mortality statistics experts, staff from the Department of Statistics and the Civil Status and Passports Department (which is directly responsible for death notification in Jordan). The multi-agency task force proposed a five-point plan to improve mortality statistics in Jordan: (i) establishment of a cause-of-death coding unit at the ministry of health, Directorate of Information and Research; (ii) modification of death notification form; (iii) training on use of the WHO International Classification of Diseases and Related Health Problems (ICD) for cause-of-death certification and coding; (iv) appointment of focal points for supervision and quality control; and (v) tabulation and reporting.

Following these recommendations, the ministry of health initiated a project in 2003 to improve mortality statistics in collaboration with WHO, CDC and USAID. The project included a new mortality surveillance system to monitor causes of death and a unit for coding causes of death.

Modified notification form

The death notification form was modified to comply with WHO recommendations. The modified form now includes a two part medical certification section, four lines for recording cause of death and space for recording the period between onset of cause and death. These changes facilitate accurate cause-of-death certification and the application of WHO recommendations (2) for selecting the underlying cause of death. The attending physician completes the notification in duplicate, with the original sent to the Civil Status and Passports Department and the duplicate copy sent to the ministry of health. The modified form was distributed throughout Jordan in the last six months of 2003.

Certification and coding

The ministry of health developed a one-page guideline on completing the modified death notification form and distributed it to all physicians and hospitals. …

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Improving Mortality Data in Jordan: A 10 Year review/Ameliorer Les Donnees De Mortalite En Jordanie: Analyse decennale/Mejora De Los Datos Sobre Mortalidad En Jordania: Analisis De Los Ultimos 10 Anos
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