Motivations and barriers to death registration in Dakar, Senegal

Spatial disparities in death registration across states and districts of India, 2019-21

BACKGROUND

The persistent issue of incomplete death registration in India, with a significant number of deaths going unrecorded, underscores the critical need for a granular understanding of spatial variations. Given the nation's vast geographic and demographic diversity, this granular understanding, particularly at the district level, is crucial for effective interventions. This analysis, therefore, aims to examine spatial disparities in death registration at both the state and district levels across India.

DATA AND METHODS

Using data from the fifth round of the National Family Health Survey (NFHS-5) conducted in 2019-21, this study analyzed information on 79,449 deaths occurring in the three years preceding the survey, across 707 districts in India. The study explored spatial patterns and identified clusters of death registration using Moran's I and univariate Local Indicators of Spatial Association (LISA) maps. Additionally, spatial regression models were employed to examine the factors influencing death registration at the district level.

RESULTS

In 2019-21, only 71% of deaths in India were registered, with significant variations across states and districts. The univariate Moran's I value of 0.69 (p < 0.001) indicated strong spatial clustering in death registration at the district level. Two notable 'cold spots'-districts with low death registration rates surrounded by other low-registration districts-were identified across 152 districts, primarily in the eastern states of Uttar Pradesh, Jharkhand, Bihar, and the northeastern regions of Arunachal Pradesh, Nagaland, and parts of Manipur. Results from regression models revealed that factors such as the proportion of poor households, rural households, Muslim and Scheduled Tribe (ST) households, and households with at least one uneducated member were negatively associated with death registration at the district level.

CONCLUSIONS

The findings suggest the necessity for region-specific focused interventions to improve death registration in India, taking the social determinants of death registration into consideration and raising societal awareness about it.

"Do we register our deaths?": Motivations and barriers to death registration in Ghana

Death registration is generally low in sub-Saharan African countries, including Ghana. This study investigated the factors that motivate and serve as barriers in registering for a death certificate. A cross-sectional qualitative study design was used to interview twelve birth and death registration officers in Ghana. The interviews were analysed using Atlas.ti version 7.5. The results show that death registration in Ghana is generally low. Processing of a deceased person's estate emerged as the main motivation for the registration of death. Other motivators included the obligation to register deaths and the requirement of death certificates for burial. The barriers to death registration included the governance system at the cemetery, the hastiness in burying the dead, the perception of cost of death certificates, and less importance attached to death registration. Policymakers should consider these factors in the design of interventions to increase the rate of death registration in Ghana.

Enhancing the value of death registration with verbal autopsy data: a pilot study in the Senegalese urban population in 2019

BACKGROUND

There is no source of data on causes of death in Senegal that covers both community and hospital deaths. Yet the death registration system in the Dakar region is relatively complete (>80%) and could be expanded to provide information on the diseases and injuries that led to death.

METHODS

In this pilot study, we recorded all deaths that occurred over 2 months and were reported in the 72 civil registration offices in the Dakar region. We selected the deaths of residents of the region and administered a verbal autopsy to a relative of the deceased to identify the underlying causes of death. Causes of death were assigned using the InterVA5 model.

RESULTS

The age structure of deaths registered at the civil registry differed from that of the census, with a proportion of infant deaths about twice as high as in the census. The main causes of death were prematurity and obstetric asphyxia in newborns. Meningitis and encephalitis, severe malnutrition, and acute respiratory infections were the leading causes from 1 month to 15 years of age. Cardiovascular diseases accounted for 27% of deaths in adults aged 15-64 and 45% of deaths among adults above age 65, while neoplasms accounted for 20% and 12% of deaths in these two age groups, respectively.

CONCLUSIONS

This study demonstrates that the epidemiological transition is at an advanced stage in urban areas of Dakar, and underlines the importance of conducting regular studies based on verbal autopsies of deaths reported in civil registration offices.

Performance barriers of Civil Registration System in Bihar: An exploratory study

Objectives

Vital statistics generated by the Civil Registration System (CRS) are essential for developing healthcare interventions at all administrative levels. Bihar had one of the lowest levels of mortality registration among India’s states. This study investigates CRS’s performance barriers from the perspective of CRS staff and community members in Bihar.

Methods

We conducted a primary qualitative survey in the two districts of Bihar during February-March 2020 with CRS staff (n = 15) and community members (n = 90). We purposively selected the Patna and Vaishali districts of Bihar for the survey. Thematic analysis was done to identify the pattern across the data using the Atlas-ti software.

Results

Most participants showed a good understanding of registration procedures and birth and death registration benefits. The perceived need for death registration is lower than birth registration. Birth registration was higher among female children than male children. We found that most participants did not report children or adult female death due to lack of financial or property-related benefits. Most participants faced challenges in reporting birth and death due to poor delivery of services at the registration centres, higher indirect opportunity cost, and demand of bribes by the CRS staff for providing certificates. We found a lack of adequate investment, shortage of dedicated staff, and limited computer and internet services at the registration centres.

Conclusions

Poor data on birth and death registration could lead decision-makers to target health services inappropriately. Strengthening health institutions’ linkage with the registration centres, mobile registration in far-flung areas and regular CRS staff training could increase death registration levels. An adequate awareness campaign on the benefits of birth and death registration is required to increase the reporting of vital events.

Prevalence and determinants of death registration and certification uptake in Uganda

Death registration in Uganda remains extremely low, yet mortality statistics are vital in health policy, planning, resource allocation and decision-making. According to NIRA, only 1% of deaths are registered annually, while Uganda Bureau of Statistics estimates death registration at 24% for the period 2011–2016. The wide variation between the administrative and survey statistics can be attributed to the restriction to only certified death registration by NIRA while survey statistics relate to all forms of death notification and registration at the different sub-national levels. Registration of deaths is of critical importance to individuals and a country’s government. Legally, it grants administrative rights in management of a deceased’s estate, and access to social (insurance and pension) benefits of a deceased person. It is also essential for official statistics and planning purposes. There is an urgent need for continuous and real-time collection of mortality data or statistics in Uganda. These statistics are of significance in public health for identifying the magnitude and distribution of major disease problems, and are essential for the design, implementation, monitoring, and assessment of health programmes and policies. Lack of such continuous and timely data has negative consequences for the achievement of both national and Sustainable Development Goals 3, 11, 16, and 17. This study assessed the determinants of death registration and certification, using a survey of 2018–2019 deaths in 2,100 households across four administrative regions of Uganda and Kampala district. Multivariate–binary logistic regression was used to model factors associated with the likelihood of a death being registered or certified. We find that around one-third of deaths were registered while death certificates were obtained for less than 5% of the total deaths. Death registration and certification varied notably within Uganda. Uptake of death registration and certification was associated with knowledge on death registration, region, access to mass media, age of the deceased, place of death, occupation of the deceased, relationship to household head and request for death certificate. There is need for decentralization of death registration services; massive sensitization of communities and creating demand for death registration.