Sant Fruchtman Carmen, Kallis Natasha, Govender Sudarshan, Bradshaw Debbie, Cobos Daniel, Morof Diane, Groenewald Pamela
University of Basel, Basel, Switzerland.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
Health Res Policy Syst. 2024 Dec 30;22(1):177. doi: 10.1186/s12961-024-01275-8.
Despite South Africa's well-established Civil Registration and Vital Statistics system (CRVS) and good completeness of death registration, challenges persist in terms of the quality of cause of death information and the delayed availability of mortality statistics. The introduction of an electronic medical certification of cause of death (eMCCD) system may offer opportunities to improve both the quality and timeliness of this information.
This study used an exploratory mixed methods design to investigate perceptions surrounding an electronic solution for registering deaths in South Africa. We conducted 14 key informant interviews from 23 key informants invited, surveyed 208 out of 250 targeted health workers and engaged with more than 500 South African health professionals in a participatory workshop about the acceptability of introducing an eMCCD. Mentimeter was used to obtain feedback from the participants. Rapid qualitative analysis methods were used to analyse the key informant interviews and descriptive statistics for the survey and workshop data. During the interpretation phase, qualitative and quantitative data were integrated according to key themes that emerged from the data.
During the qualitative interviews, the underlying factors mentioned as contributing to inadequate mortality data quality included insufficient MCCD training, diseases subjected to stigma, limited access to and quality of patient health information, and a significant proportion of deaths occurring outside medical facilities. More than 80.8% of the surveyed health professionals (168/208) rated the importance of mortality statistics as high, but the current quality was rated as low or very low by 29.3% (61/208). An eMCCD appeared to be acceptable to most workshop participants who registered on Mentimeter and was perceived as a means to strengthen the timeliness of mortality information. However, 43.0% (68/158) of the workshop participants who responded to this question on Mentimeter saw poor internet use as the main barrier to introducing an online system.
Our results shed light on critical aspects surrounding cause of death information in South Africa, as well as the challenges faced in maintaining the quality of such data. The findings suggest that the implementation of an eMCCD system could provide opportunities to strengthen the cause of death information in South Africa if it is designed to integrate into the current system and provide supplementary functionalities.
尽管南非拥有完善的民事登记和人口动态统计系统（CRVS），且死亡登记的完整性良好，但在死因信息质量和死亡率统计数据延迟提供方面仍存在挑战。引入电子死因医学证明（eMCCD）系统可能为提高这些信息的质量和及时性提供机会。
本研究采用探索性混合方法设计，以调查围绕南非死亡登记电子解决方案的看法。我们邀请了23名关键信息提供者，进行了14次关键信息提供者访谈，在250名目标卫生工作者中调查了208名，并在一个关于引入eMCCD可接受性的参与式研讨会上与500多名南非卫生专业人员进行了交流。使用Mentimeter从参与者那里获得反馈。采用快速定性分析方法分析关键信息提供者访谈，并对调查和研讨会数据进行描述性统计。在解释阶段，根据数据中出现的关键主题对定性和定量数据进行整合。
在定性访谈中，提到导致死亡率数据质量不足的潜在因素包括MCCD培训不足、受污名化的疾病、获取患者健康信息的机会有限和质量不佳，以及很大一部分死亡发生在医疗机构之外。超过80.8%的受访卫生专业人员（168/208）认为死亡率统计很重要，但29.3%（61/208）的人认为当前质量低或非常低。对于大多数在Mentimeter上注册的研讨会参与者来说，eMCCD似乎是可以接受的，并且被视为加强死亡率信息及时性的一种手段。然而，在Mentimeter上回答这个问题的研讨会参与者中，43.0%（68/158）认为互联网使用不佳是引入在线系统的主要障碍。
我们的结果揭示了南非死因信息周围的关键方面，以及在维持此类数据质量方面面临的挑战。研究结果表明，如果设计成融入当前系统并提供补充功能，实施eMCCD系统可为加强南非的死因信息提供机会。
