Making COD statistics useful for public health at local level in the city of Cape Town: utilidad para la salud pública a nivel local en Ciudad del Cabo.
OBJECTIVE
To review the quality of the coding of the cause of death (COD) statistics and assess the mortality information needs of the City of Cape Town.


METHODS
Using an action research approach, a study was set up to investigate the quality of COD information, the accuracy of COD coding and consistency of coding practices in the larger health subdistricts. Mortality information needs and the best way of presenting the statistics to assist health managers were explored.


RESULTS
Useful information was contained in 75% of death certificates, but nearly 60% had only a single cause certified; 55% of forms were coded accurately. Disagreement was mainly because routine coders coded the immediate instead of the underlying COD. An abridged classification of COD, based on causes of public health importance, prevalent causes and selected combinations of diseases was implemented with training on underlying cause. Analysis of the 2001 data identified the leading causes of death and premature mortality and illustrated striking differences in the disease burden and profile between health subdistricts.


CONCLUSIONS
Action research is particularly useful for improving information systems and revealed the need to standardize the coding practice to identify underlying cause. The specificity of the full ICD classification is beyond the level of detail on the death certificates currently available. An abridged classification for coding provides a practical tool appropriate for local level public health surveillance. Attention to the presentation of COD statistics is important to enable the data to inform decision-makers.
Burden of Disease Research Unit, Medical Research Council, South Africa. debbie.bradshaw@mrc.ac.za
Debbie
D
Bradshaw
Pamela
P
Groenewald
David E
DE
Bourne
Hassan
H
Mahomed
Beatrice
B
Nojilana
Johan
J
Daniels
Jo
J
Nixon
D002423:Cause of Death / Q000639:trends*; D004282:Documentation / Q000592:standards*; D006801:Humans; D011635:Public Health Administration; D011786:Quality Control; D013019:South Africa / Q000453:epidemiology