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Strengthening local-level cause of death surveillance: a case study of Western Cape Province, South Africa
Meeting Abstracts
Strengthening local-level cause of death surveillance: a case study of Western Cape Province, South Africa Pam Groenewald, Tracey Naledi, Johann Daniels, Lesley Shand, Ian Neethling, Marcel Berteler, Manshil Misra, Charlene Jacobs, Vonita Thompson, William Msemburi, Richard Matzopoulos, Debbie Bradshaw
Abstract Published Online June 17, 2013 Medical Research Council of South Africa, Burden of Disease Research Unit, Cape Town, Western Cape, South Africa (P Groenewald MBChB, I Neethling MSc, W Msemburi MPhil, R Matzopoulos PhD, D Bradshaw DPhil); Department of Health, Provincial Government of the Western Cape, Cape Town, South Africa (T Naledi MBChB, L Shand BSc, M Misra MBChB, C Jacobs MPH, V Thompson BPharm); and Cape Metropole Health Information Group, City of Cape Town, South Africa (J Daniels Dip Acc, M Berteler BEng) Correspondence to: Debbie Bradshaw, Burden of Disease Research Unit, South African Medical Research Council, Francie van Zyl Drive, Cape Town, Western Cape 7505, South Africa [email protected]
Background The Western Cape Province has a local-level mortality surveillance system that has been upgraded to do automated cause of death coding using IRIS software, in concordance with the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes. This paper reviews the achievements in providing district-level and subdistrict-level mortality data, and describes the lessons learnt and the challenges for sustaining such a system. Methods Cause of death coding was upgraded from a shortlist to full ICD-10 coding for natural causes of death in a customised data capture system. We manually coded injury deaths information obtained from mortuaries. We continuously reviewed the development of the project to identify the progress, challenges, and lessons learnt. Findings A total of 33 564 deaths from natural causes were coded for 2009, with 9·4% (95% CI 9·1–9·7) due to illdefined causes. We estimated that completeness was 83·7% (95% CI 76·9–90·4) and provided mortality profiles for all health districts for the first time, highlighting district variations in age-standardised mortality rates, although HIV and tuberculosis were the leading causes of premature mortality across all districts. We learned of the necessity of training data capturers in medical terminology and doctors in death certification, as well as building quality assurance measures into the system. Local cause of death coding enables quality issues to be identified and addressed directly at source. IRIS makes it possible to standardise coding across districts for routine cases. Dissemination of local mortality information creates a demand for updated results, which are sometimes difficult to meet. Challenges include securing the appropriate resource allocation, integrating into a fragmented health system, and ensuring co-operation between government departments. Utilisation of information technology opportunities (eg, electronic registration of death) remains a challenge. Interpretation IRIS-automated coding software has made it possible to provide routine ICD-10 cause of death coding at local level in South Africa, providing opportunities for improving the quality and use of mortality data at both local and national levels. Funding South African Medical Research Council, Provincial Government of Western Cape. Contributors PG and DB were responsible for the conceptualisation, overall project management, data quality, data analysis, and reporting. TN was involved in the conceptualisation of the project. WM was responsible for data analysis. IN was responsible for data checking and cleaning. MB and JD developed the web-based data capture system and integrated IRIS software into the system. VT and RM set up the injury cause of death data collection system. MM assisted with preparation of cause-of-death data for automated coding in IRIS. LS and CJ were responsible for data collection. Conflicts of interest We declare that we have no conflicts of interest.
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Strengthening local-level cause of death surveillance: a case study of Western Cape Province, South Africa Pam Groenewald, Tracey Naledi, Johann Daniels, Lesley Shand, Ian Neethling, Marcel Berteler, Manshil Misra, Charlene Jacobs, Vonita Thompson, William Msemburi, Richard Matzopoulos, Debbie Bradshaw
Abstract Published Online June 17, 2013 Medical Research Council of South Africa, Burden of Disease Research Unit, Cape Town, Western Cape, South Africa (P Groenewald MBChB, I Neethling MSc, W Msemburi MPhil, R Matzopoulos PhD, D Bradshaw DPhil); Department of Health, Provincial Government of the Western Cape, Cape Town, South Africa (T Naledi MBChB, L Shand BSc, M Misra MBChB, C Jacobs MPH, V Thompson BPharm); and Cape Metropole Health Information Group, City of Cape Town, South Africa (J Daniels Dip Acc, M Berteler BEng) Correspondence to: Debbie Bradshaw, Burden of Disease Research Unit, South African Medical Research Council, Francie van Zyl Drive, Cape Town, Western Cape 7505, South Africa [email protected]
Background The Western Cape Province has a local-level mortality surveillance system that has been upgraded to do automated cause of death coding using IRIS software, in concordance with the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes. This paper reviews the achievements in providing district-level and subdistrict-level mortality data, and describes the lessons learnt and the challenges for sustaining such a system. Methods Cause of death coding was upgraded from a shortlist to full ICD-10 coding for natural causes of death in a customised data capture system. We manually coded injury deaths information obtained from mortuaries. We continuously reviewed the development of the project to identify the progress, challenges, and lessons learnt. Findings A total of 33 564 deaths from natural causes were coded for 2009, with 9·4% (95% CI 9·1–9·7) due to illdefined causes. We estimated that completeness was 83·7% (95% CI 76·9–90·4) and provided mortality profiles for all health districts for the first time, highlighting district variations in age-standardised mortality rates, although HIV and tuberculosis were the leading causes of premature mortality across all districts. We learned of the necessity of training data capturers in medical terminology and doctors in death certification, as well as building quality assurance measures into the system. Local cause of death coding enables quality issues to be identified and addressed directly at source. IRIS makes it possible to standardise coding across districts for routine cases. Dissemination of local mortality information creates a demand for updated results, which are sometimes difficult to meet. Challenges include securing the appropriate resource allocation, integrating into a fragmented health system, and ensuring co-operation between government departments. Utilisation of information technology opportunities (eg, electronic registration of death) remains a challenge. Interpretation IRIS-automated coding software has made it possible to provide routine ICD-10 cause of death coding at local level in South Africa, providing opportunities for improving the quality and use of mortality data at both local and national levels. Funding South African Medical Research Council, Provincial Government of Western Cape. Contributors PG and DB were responsible for the conceptualisation, overall project management, data quality, data analysis, and reporting. TN was involved in the conceptualisation of the project. WM was responsible for data analysis. IN was responsible for data checking and cleaning. MB and JD developed the web-based data capture system and integrated IRIS software into the system. VT and RM set up the injury cause of death data collection system. MM assisted with preparation of cause-of-death data for automated coding in IRIS. LS and CJ were responsible for data collection. Conflicts of interest We declare that we have no conflicts of interest.
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