Linking mortuary data improves vital statistics on cause of death of children under five years in the Western Cape Province of South Africa.
OBJECTIVE
Reducing child mortality requires good information on its causes. Whilst South African vital registration data have improved, the quality of cause-of-death data remains inadequate. To improve this, data from death certificates were linked with information from forensic mortuaries in Western Cape Province.


METHODS
A local mortality surveillance system was established in 2007 by the Western Cape Health Department to improve data quality. Cause-of-death data were captured from copies of death notification forms collected at Department of Home Affairs Offices. Using unique identifiers, additional forensic mortuary data were linked with mortality surveillance system records. Causes of death were coded to the ICD-10 classification. Causes of death in children under five were compared with those from vital registration data for 2011.


RESULTS
Cause-of-death data were markedly improved with additional data from forensic mortuaries. The proportion of ill-defined causes was halved (25-12%), and leading cause rankings changed. Lower respiratory tract infections moved above prematurity to rank first, accounting for 20.8% of deaths and peaking in infants aged 1-3 months. Only 11% of deaths from lower respiratory tract infections occurred in hospital, resulting in 86% being certified in forensic mortuaries. Road traffic deaths increased from 1.1-3.1% (27-75) and homicides from 3 to 28.


CONCLUSIONS
The quality and usefulness of cause-of-death information for children in the WC was enhanced by linking mortuary and vital registration data. Given the death profile, interventions are required to prevent and manage LRTI, diarrhoea and injuries and to reduce neonatal deaths.
Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
Pam
P
Groenewald
Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
Debbie
D
Bradshaw
Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
Ian
I
Neethling
Division of Forensic Medicine & Toxicology, University of Cape Town, Cape Town, South Africa.
Lorna J
LJ
Martin
Division of Forensic Medicine and Pathology, Stellenbosch University, Stellenbosch, South Africa.
Johan
J
Dempers
Health Impact Assessment, Western Cape Department of Health, Cape Town, South Africa.
Erna
E
Morden
Health Impact Assessment, Western Cape Department of Health, Cape Town, South Africa.
Nesbert
N
Zinyakatira
Health Impact Assessment, Western Cape Department of Health, Cape Town, South Africa.|School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
David
D
Coetzee
causas de muerte; causes de décès; causes of death; child mortality; data linking; forensic mortuary; infección del tracto respiratorio inferior; infections des voies respiratoires inférieures; liaison des données; lower respiratory tract infections; morgue judiciaire; morgues forenses; mortalidad infantil; mortalité infantile; registros vitales; vinculación de datos; vital registration; état civil