Hazard Riley H, Chowdhury Hafizur Rahman, Adair Tim, Ansar Adnan, Quaiyum Rahman A M, Alam Saidul, Alam Nurul, Rampatige Rasika, Streatfield Peter Kim, Riley Ian Douglas, Lopez Alan D
School of Population and Global Health, University of Melbourne, Level 5, Building 379, 207 Bouverie St, Carlton, VIC, 3010, Australia.
Maternal and Child health Division, icddr,b, Mohakhali, Dhaka, 1212, Bangladesh.
BMC Health Serv Res. 2017 Oct 2;17(1):688. doi: 10.1186/s12913-017-2628-y.
Accurate and timely data on cause of death are critically important for guiding health programs and policies. Deaths certified by doctors are implicitly considered to be reliable and accurate, yet the quality of information provided in the international Medical Certificate of Cause of Death (MCCD) usually varies according to the personnel involved in certification, the diagnostic capacity of the hospital, and the category of hospitals. There are no published studies that have analysed how certifying doctors in Bangladesh adhere to international rules when completing the MCCD or have assessed the quality of clinical record keeping.
The study took place between January 2011 and April 2014 in the Chandpur and Comilla districts of Bangladesh. We introduced the international MCCD to all study hospitals. Trained project physicians assigned an underlying cause of death, assessed the quality of the death certificate, and reported the degree of certainty of the medical records provided for a given cause. We examined the frequency of common errors in completing the MCCD, the leading causes of in-hospital deaths, and the degree of certainty in the cause of death data.
The study included 4914 death certificates. 72.9% of medical records were of too poor quality to assign a cause of death, with little difference by age, hospital, and cause of death. 95.6% of death certificates did not indicate the time interval between onset and death, 31.6% required a change in sequence, 13.9% required to include a new diagnosis, 50.7% used abbreviations, 41.5% used multiple causes per line, and 33.2% used an ill-defined condition as the underlying cause of death. 99.1% of death certificates had at least one error. The leading cause of death among adults was stroke (15.8%), among children was pneumonia (31.7%), and among neonates was birth asphyxia (52.8%).
Physicians in Bangladeshi hospitals had difficulties in completing the MCCD correctly. Physicians routinely made errors in death certification practices and medical record quality was poor. There is an urgent need to improve death certification practices and the quality of hospital data in Bangladesh if these data are to be useful for policy.
准确及时的死因数据对于指导卫生项目和政策至关重要。医生开具证明的死亡情况被默认认为是可靠且准确的，然而国际死亡医学证明书（MCCD）所提供信息的质量通常会因参与认证的人员、医院的诊断能力以及医院类别而有所不同。目前尚无已发表的研究分析孟加拉国的认证医生在填写MCCD时如何遵循国际规则，也没有对临床记录保存质量进行评估。
该研究于2011年1月至2014年4月在孟加拉国的钱德布尔和科米拉地区开展。我们向所有研究医院引入了国际MCCD。经过培训的项目医生确定根本死因，评估死亡证明的质量，并报告给定死因所提供病历的确定程度。我们检查了填写MCCD时常见错误的频率、医院内死亡的主要原因以及死因数据的确定程度。
该研究纳入了4914份死亡证明。72.9%的病历质量太差，无法确定死因，在年龄、医院和死因方面差异不大。95.6%的死亡证明未注明发病与死亡之间的时间间隔，31.6%需要更改顺序，13.9%需要纳入新诊断，50.7%使用了缩写，41.5%每行使用了多个死因，33.2%将定义不明确的情况用作根本死因。99.1%的死亡证明至少有一处错误。成年人中主要死因是中风（15.8%），儿童中是肺炎（31.7%），新生儿中是出生窒息（52.8%）。
孟加拉国医院的医生在正确填写MCCD方面存在困难。医生在死亡认证实践中经常出错，病历质量较差。如果这些数据要对政策有用，孟加拉国迫切需要改进死亡认证实践和医院数据质量。
