A study of ill-defined causes of death in Bahrain: Determinants and health policy issues

Article · May 2010with78 Reads
Source: PubMed
Abstract
To find the actual cause of death in death certificates that had ill-defined causes in 2006, evaluate the correctness of the completion of those certificates, and recommend ways to decrease the proportion of ill-defined causes of death in Bahrain. This was a retrospective review of all death certificates that had ill-defined as a cause of death (International Classification of Diseases-10 codes R0-R99) from January through December 2006 in Bahrain. Of the decedents with ill-defined causes of death in 2006, 76.7% were Bahraini, 70.6% males, 37% older than 70 years, and 62.7% died in their homes. The underlying causes of death of 92% were recorded as brought dead and cardiopulmonary failure. Of those whose place of death was recorded as brought dead'', 86% had died in their homes. Sixty percent of the death certificates were signed by Salmaniya Medical Complex (SMC) physicians and the remaining by forensic doctors and over half by senior residents. Of the death certificates retrieved at SMC, 60% were corrected, 47.4% of which were certified by doctors from the accident and emergency department, 31.5% from medical, and 21.1% from surgical departments. Death certification in Bahrain should be reevaluated by all stakeholders to improve the quality of mortality data. The revised policy should stress upon increasing the awareness of the physicians on the implications of inaccurate death certification.
A study of ill-defined causes of death in Bahrain
Determinants and health policy issues
Najat M. Abulfatih, MD, MSc, Randah R. Hamadeh, MSc, DPhil (Oxon).
545
ABSTRACT

2006



   
  2006     R0-R99 
2006

76.7%2006
7037%70.6%
     62.7%    
92%

60%  86% 
   


)SMC(
60%
31.5%47.4% 
21.1%



Objectives: To find the actual cause of death in death
certificates that had “ill-defined” causes in 2006, evaluate
the correctness of the completion of those certificates,
and recommend ways to decrease the proportion of “ill-
defined” causes of death in Bahrain.
Methods: is was a retrospective review of all death
certificates that had “ill-defined” as a cause of death
)International Classification of Diseases-10 codes R0-
R99( from January through December 2006 in Bahrain.
Results: Of the decedents with “ill-defined causes” of
death in 2006, 76.7% were Bahraini, 70.6% males, 37%
older than 70 years, and 62.7% died in their homes.
e underlying causes of death of 92% were recorded as
“brought dead” and “cardiopulmonary failure.” Of those
whose place of death was recorded as “brought dead’’,
86% had died in their homes. Sixty percent of the death
certificates were signed by Salmaniya Medical Complex
)SMC( physicians and the remaining by forensic doctors
and over half by senior residents. Of the death certificates
retrieved at SMC, 60% were corrected, 47.4% of which
were certified by doctors from the accident and emergency
department, 31.5% from medical, and 21.1% from
surgical departments.
Conclusion: Death certification in Bahrain should be
reevaluated by all stakeholders to improve the quality
of mortality data. e revised policy should stress
upon increasing the awareness of the physicians on the
implications of inaccurate death certification.
Saudi Med J 2010; Vol. 31 (5): 545-549
From the Ministry of Health (Abulfatih) and Department of Family and
Community Medicine (Hamadeh), College of Medicine and Medical
Sciences, Arabian Gulf University, Manama, Bahrain.
Received 20th January 2010. Accepted 29th March 2010.
Address correspondence and reprint request to: Prof. Randah R. Hamadeh,
Department of Family and Community Medicine, College of Medicine
and Medical Sciences, Arabian Gulf University, PO Box 22979, Manama,
Kingdom of Bahrain. Tel. +973 (1) 7239433. Fax. +973 (1) 7230730.
E-mail: randah@agu.edu.bh
546
Ill-defined causes of death in Bahrain ... Abulfatih & Hamadeh
Saudi Med J 2010; Vol. 31 )5( www.smj.org.sa
Mortality statistics are one of the most important
health indicators for countries and the most
widely used data by health policy makers. ey are
valuable to policy makers in the development of public
health programs, allocation of health care resources,
and identification of priority areas for future research.
e accuracy of the mortality statistics depends on the
completeness and correctness of the death certificate;
mostly the underlying cause of death. Recent studies
have reported many inaccuracies in death certificates
worldwide, and their reliability has come under
increasing criticism in medical journals and among
health officials.1 Editorials have drawn attention to
the lack of information on causes of death in many
developing countries and the urgent need for the World
Health Organization )WHO( and other international
health agencies to take a lead in readdressing this
situation.2 In 2003, the WHO Director General stated
that strengthening of the vital statistics registration
system is one of his priorities.3 Despite many efforts
to increase the quality of vital statistics including the
development of the International Classification of
Diseases )ICD(, death registration remains inadequate in
several countries.1 Factors contributing to its deficiency
include incomplete coverage, late registration, missing
data, and errors in the reporting or classification of the
underlying cause of death.3 Although, autopsy findings
are believed to increase the reliability of mortality data,
they are not routinely performed by all countries.4
When comparing the rank of “ill-defined” causes of
death in Bahrain with that of the world, it is between
the developed and the less developed regions. ey
usually rank as the second cause of death after diseases
of the circulatory system; however, the latest available
data from the Ministry of Health )MOH(,5 Bahrain
has shown that they occupied the first rank. In 2006,
there were 2,317 deaths reported by the Public Health
Directorate )PHD(, 39.1% of which were among the
elderly )≥70 years(. Of these, cardiovascular diseases
)CVD( constituted the highest single cause of mortality
with a cause specific death rate )CSDR( of 60.5 per
100,000 and a proportional mortality rate )PMR( of
19.4%. “Ill-defined” causes of death were the second
cause of death with a CSDR of 59.4 per 100,000
and a PMR of 19%.5 Health services in Bahrain are
provided by governmental and private hospitals, health
centers, and clinics. e main governmental hospital
in the country is Salmaniya Medical Complex )SMC(
where most of the hospitalized deaths occur.5 Death
registration in Bahrain started in June 1970 following
an Amiri decree,6 and is administered by the Birth and
Death Registration Office )BDRO(. A standard Death
Certificate Notification Form is used in accordance with
the United Nations and WHO recommendations,7
and is coded using ICD-10. When death occurs in
health institutions, the physician must certify it and
record the cause on the certificate; forensic doctors
certify other deaths. Following certification, the death
certificates are forwarded to the BDRO for coding and
later to the Health Information Directorate )HID(,
MOH. Although Bahrain is known to have good health
indicators compared to other countries, the WHO’s
recent assessment of the global status of the causes of
death data rated the quality of mortality data in Bahrain
low as a quarter of deaths were assigned to “ill-defined”
causes despite the high rates of completeness )100%(
and coverage )90%(.1 Few studies have investigated the
possible causes of the low quality of mortality data in
Bahrain. Hamza et al8 reported that there was a lack of
concordance between the documented cause of death
and the underlying disease in the death certificates
that were reviewed at SMC. ey attributed the major
reason for this discordance to the fact that there is a
general tendency among doctors to assign death to
“cardiac failure”. Moreover, Mahroos9 concluded
that the national mortality statistics in Bahrain may
overestimate the frequency of coronary heart disease
)CHD( and emphasized the importance of taking
measures to improve precision in certification. is
problem has been exacerbated by the fact that autopsies
are not generally practiced in the country unless there
is suspicion of crime. e increase in “ill-defined”
causes of death (Figure 1) has always been a problem
in Bahrain,5,10 which significantly affects the quality of
vital statistics and can misguide the policy makers when
prioritizing health problems. us, it is very important
to understand the factors behind this chronic problem
to improve the quality of death certificates and mortality
statistics in the country. e objectives of this study were
to find the actual cause of death in death certificates that
had “ill-defined” causes in 2006, evaluate the correctness
of the completion of those certificates, and recommend
Figure 1 - Percentages of deaths with ill-defined causes in Bahrain from
1982-2007.
547
www.smj.org.sa Saudi Med J 2010; Vol. 31 )5(
Ill-defined causes of death in Bahrain ... Abulfatih & Hamadeh
ways to decrease the proportion of “ill-defined” causes
of death in Bahrain.
Methods. Although this study involved evaluating
the correctness of completing death certificates that had
“symptoms, signs, and abnormal clinical and laboratory
findings not elsewhere classified” )ICD-10 codes R0-
R99( as a cause of death in Bahrain during 2006, the term
“ill-defined” was used throughout this paper to present
this category. e Annual Health Reports of the MOH5
were reviewed for the period from 1982 to 2007 and
the percent of “ill-defined” causes of death for each year
were abstracted. A retrospective review of all 2006 death
certificates that had “ill-defined” as a cause of death in
Bahrain was carried out in 2007. A list of all names and
identity card numbers of decedents with “ill-defined
causes of death was obtained from the HID. Decedent’s
death certificates were retrieved from the BDRO files,
and copies of their death certificate forms were made.
Relevant data were abstracted on a designed form11
to evaluate the completeness of the death certificate.
It included demographic characteristics of decedents,
medical data, and administrative details. Furthermore,
the list of names and identity card numbers of the
decedents with “ill-defined” causes of death was given
to the Medical Records Department, SMC to retrieve
their files. e retrieved files were reviewed by one of
the researchers to identify the actual cause of death.
Data were analyzed using the Statistical Package for
Social Sciences )SPSS Inc, Chicago, IL, USA( program
version 14. We use descriptive statistics to describe our
data.
Results. e 2006 Annual Health Report indicated
that there were 441 deaths with “ill-defined” causes,
however, only 354 )75%( death certificates were
retrieved from the BDRO of which, 32 had their medical
records at SMC. Table 1 presents the age, gender, and
nationality of decedents whose death certificates were
retrieved at the BDRO. Most of the underlying causes of
death in the death certificates were recorded as “brought
dead” and “cardiopulmonary failure” (Table 2). Of
those whom had “brought dead” written as the place of
death, 86% had died at their homes. Table 3 shows the
physicians who certified the death certificates with “ill-
defined” causes of death by department, position, and
qualification. Sixty percent of the death certificates were
signed by SMC doctors and the remaining by forensic
doctors. Fifty-five percent of the death certificates were
certified by senior residents, and those with only MBBS
as a qualification. Of the death certificates retrieved at
SMC, 60% were corrected based on the details included
in the medical files. Of those, 47.4% were certified by
doctors from the accident and emergency department
)A&E(, 31.5% from medical, and 21.1% from surgical
Table 1 - Age, gender, nationality, and place of death of decedents with
“ill-defined” causes of death.
Variables n (%)
Age (years)
<10 years
10-30 years
31-50 years
51-70 years
71-90 years
>90 years
Total
19
27
89
88
112
19
354
)5.4(
)7.6(
)25.1(
)24.9(
)31.6(
)5.4(
(100.0)
Gender
Male
Female
Total
250
104
354
)70.6(
)29.4(
(100.0)
Nationality
Bahraini
Non-Bahraini
Total*
263
80
343
)76.7(
)23.3(
(100.0)
Place of death
Home
Hospital
Abroad
Total
222
115
17
354
)62.7(
)32.5(
)4.8(
(100.0)
*ere are missing data due to incomplete information
Table 2 - e recorded underlying causes of death on the death
certificates.
Causes of death n (%)
Brought dead
Cardio pulmonary failure
Old age
Normal death
Defined causes of death*
Unknown
Total
172
156
1
1
17
7
354
)48.6(
)44.0(
)0.3(
)0.3(
)4.8(
)2.0(
(100.0)
*Other than R0-R99
Table 3 - Doctors who certified death certificates with “ill-defined”
causes of death by department, position, and qualification
)N=354(.
Variables n (%)
SMC Department
Medical
Accident and Emergency
Surgical
Pediatrics
Ear, Nose, and roat
Family Physician Residency Program
Forensic
Total*
85
59
42
3
1
6
131
327
)26.0(
)18.0(
)13.0(
)0.9(
)0.3(
)1.8(
)40.0(
(100.0)
Position
Junior Resident
Senior Resident
Chief Resident
Total*
139
179
10
328
)42.4(
)54.6(
)3.0(
(100.0)
Qualification
MBBS
MBBS + other
Total*
173
144
317
)54.6(
)45.4(
(100.0)
SMC - Salmaniya Medical Complex, MBBS - Bachelor of Medicine,
Bachelor of Surgery, or in Latin Medicinae Baccalaureus, Baccalaureus
Chirurgiae. *ere are missing data due to incomplete information
548
Ill-defined causes of death in Bahrain ... Abulfatih & Hamadeh
Saudi Med J 2010; Vol. 31 )5( www.smj.org.sa
departments. Of those certified by SMC doctors, the
medical department doctors signed 43.4% of them
occupying the first rank.
Discussion. Of the retrieved death certificates,
95.2% had ICD-10 codes from R0 - R99 and 4.8%
were wrongly coded as “ill-defined.” If this percentage
were redistributed to other causes of death, it could
have lead to a smaller number of “ill-defined” causes
and would have increased the number of other causes of
death, which was underestimated.
In this study, around one third of the deceased with
“ill-defined causes” were over 70 years, which compares
to those reported by other international studies that
attributed this high percentage to the effect of age.12 It
was also similar to the proportion of all deaths )39.1%(
in that age group in Bahrain during 2006. As for gender,
there was a lower percentage of females )29.4%( with
ill-defined causes of deaths than that among all deaths
)40.5%( in the country during that year.5 Moreover,
the selection of a single underlying cause of death is
frequently problematic in the deceased elderly, who
often had several chronic diseases that concurrently led
to their death.1,13,14
e underlying cause of death that was recorded
in all the retrieved death certificates mostly included
“brought dead” and “cardiopulmonary failure.”
e high percentage of the former as an underlying
cause of death could be due to the lack of guidelines
and procedures followed by the A&E doctors on the
importance of investigating and certifying decedents
who are brought dead to the hospital and that the term
“brought dead” is not a cause of death, but the state in
which the decedent arrived to the hospital. Similarly, the
high percentage of death certificates with the latter as
the cause of death may be largely due to the physicians’
ignorance that “cardiopulmonary failure” is an “ill-
defined” cause and that they have to assign the actual
underlying cause instead. Hamza et al8 raised concerns
regarding this issue more than a decade ago, and
reported discordance between the underlying causes of
death and those reported in the SMC medical records.
ey attributed it to the fact that there was a general
tendency among doctors to assign “cardiac failure” as a
cause of death. Moreover, the overestimation of CVD
in death certificates in Bahrain has been reported.9
Furthermore, many physicians identify cardiovascular
events such as cardiac arrest as the primary cause of death
without realizing that a cardiovascular event is the final
pathway in death due to any cause.15 e Framingham
Heart Study suggested that CVD causes of death were
overestimated by at least 24% on death certificates.16
Although the governmental policy in Bahrain implies
that forensic doctors should certify deaths occurring
outside the premises of health institutes; the policy is
partially implemented. Moreover, investigations for the
underlying cause of death are not carried out except if
officially requested or upon suspicion of a crime. us,
forensic doctors would label other deaths that had
occurred outside health institutions as “cardiopulmonary
failure. is routine of writing “cardiopulmonary
failure” as the cause of death may be one of the factors
that increased the number of “ill-defined” causes of
death. e percentage )62.7%( of deaths of those that
occurred at home among the “ill-defined” was 3 times
higher than that of the total deaths )20.7%( in 2006.5
is implies that the major problem in mortality data in
Bahrain rises from those who die at home. Forty percent
of these death certificates were certified by forensic
doctors while the rest by non-forensic doctors. is
discrepancy between deaths that occurred at home with
those signed by forensic doctors could have resulted
from the absence of a system or a known procedure to
advise the relatives where to go when death occurs at
home.
Twenty-six percent of the death certificates were
from the medical department, similar to other reports.17
Over half of the death certificates were signed by doctors
with only a MBBS qualification. is is not surprising
as 42.4% of the death certificates were certified by
junior residents. ese findings are in line with previous
studies that reported that death certification is usually
assigned to the junior residents of the medical team.18,19
However, it has been suggested that the process of death
certification should be assigned to a senior member of
the medical team.19
e low percentage of retrieved medical records
could be partially due to the adoption of a policy by the
SMC administration to demolish files of patients not
attending the hospital for 7 years or over. However, the
fact that some of the deceased had never attended SMC
cannot be dismissed. e fact that 60% of the retrieved
medical records could be corrected, emphasizes the
importance of retrieving medical records in decreasing
the proportion of “ill-defined.” Moreover, the high
percentage of recording “ill-defined” causes of death
by the A&E doctors may be due to the nature of
the department and the unavoidable hastiness in
procedures.20
e fact that the medical files of the deceased with
“ill-defined” causes from other hospitals were not
retrieved, might have possibly lead to a lower correction
rate for the causes of death. ere was a discrepancy
between the numbers of deaths with “ill-defined” causes
reported by the HID and those found in the BDRO, and
this could have possibly inflated the reported percent of
“ill-defined” causes in Bahrain.
In conclusion, the process of death certification in
Bahrain should be re-evaluated with all the stakeholders
549
www.smj.org.sa Saudi Med J 2010; Vol. 31 )5(
Ill-defined causes of death in Bahrain ... Abulfatih & Hamadeh
enforcing the role of each in improving the quality
of mortality data and decreasing the category of “ill-
defined” causes of death. e revised death certification
procedures should highlight the importance of
continuous training of all doctors on death certificate
completion in medical school and during their practice.
e revised policy should also stress upon increasing the
awareness of physicians on the implications of incorrect
death certification on the quality of mortality data and
health indicators of the country. Specifically, forensic
doctors should realize that “cardiopulmonary failure,”
and A&E doctors that “brought dead,” are not causes
of death.
References
1. Mathers CD, Fat DM, Inoue M, Rao C, Lopez AD. Counting
the dead and what they died from: an assessment of the global
status of cause of death data. Bull World Health Organ 2005;
83: 171-177.
2. Sibai AM. Mortality certification and cause-of-death reporting
in developing countries. Bull World Health Organ 2004; 82:
83.
3. Jong-wook L. Global health improvement and WHO: shaping
the future. Lancet 2003; 362: 2083-2088.
4. Smith Sehdev AE, Hutchins GM. Problems with proper
completion and accuracy of the cause-of-death statement. Arch
Intern Med 2001; 161: 277-284.
5. Ministry of Health. Annual health reports )2000-2007(.
Ministry of Health, Bahrain. [Updated 2009 December 2;
Accessed date 2008 January 20]. Available from: http://www.
moh.gov.bh/EN/Publications/Statistics.aspx
6. United Nations Workshop on Improving Statistics on Fertility
and Mortality in ESCWA Region Cairo, Egypt, 3-6 December
2007. [Update date 2009 December 24; Accessed date 2008
February 12]. Available from: http://unstats.un.org/unsd/
demographic/meetings/wshops/Civil_Registration_Dec07_
Cairo/docs/Bahrain_Report.pdf
7. Division of Vital Statistics, National Center for Health
Statistics. Report of the panel to evaluate the U.S. standard
certificates. Available from: [Accessed date 2006 February 12;
updated date 2009 December 14].http://www.cdc.gov/nchs/
data/dvs/panelreport_acc.pdf
8. Hamza A, Fateha B, Nath B. Analysis of causes of death at
Salmaniya Medical Complex, Bahrain. Journal of the Bahrain
Medical Society 1995; 11: 39-44.
9. al-Mahroos R. Validity of death certificates for coding coronary
heart disease as the cause of death in Bahrain. East Mediterr
Health J 2000; 6: 661-669.
10. Bahrain Health Information Center, Ministry of Health. Health
Statistical Abstracts )1982 - 1999(. Bahrain: Ministry of Health;
2000.
11. Abulafatih NM. A study of ill-defined causes of death in Bahrain:
Determinants and Health Policy Issues. [MSc Dissertation].
Manama [Bahrain]: Arabian Gulf University; 2008.
12. Lu TH, Shau WY, Shih TP, Lee MC, Chou MC, Lin CK.
Factors associated with errors in death certificate completion.
A national study in Taiwan. J Clin Epidemiol 2001; 54: 232-
238.
13. Wall MM, Huang J, Oswald J, McCullen D. Factors associated
with reporting multiple causes of death. BMC Med Res Methodol
2005; 5: 4.
14. Betz ME, Kelly SP, Fisher J. Death certificate inaccuracy and
underreporting of injury in elderly people. J Am Geriatr Soc
2008; 56: 2267-2272.
15. Brindle P, Emberson J, Lampe F, Walker M, Whincup P,
Fahey T. Predictive accuracy of the Framingham coronary risk
score in British men: prospective cohort study. BMJ 2003; 327:
1267.
16. Fox CS, Evans JC, Larson MG, Lloyd-Jones DM, O’Donnell
CJ, Sorlie PD, et al. A comparison of death certificate out-of-
hospital coronary heart disease death with physician-adjudicated
sudden cardiac death. Am J Cardiol 2005; 95: 856-859.
17. Pritt BS, Hardin NJ, Richmond JA, Shapiro SL. Death
certification errors at an academic institution. Arch Pathol Lab
Med 2005; 129: 1476-1479.
18. Lakkireddy DR, Basarakodu KR, Vacek JL, Kondur AK,
Ramachandruni SK, Esterbrooks DJ, et al. Improving death
certificate completion: a trial of two training interventions. J
Gen Intern Med 2007; 22: 544-548.
19. Villar J, Pérez-Méndez L. Evaluating an educational intervention
to improve the accuracy of death certification among trainees
from various specialties. BMC Health Serv Res 2007; 7: 183.
20. Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac
death in the United States, 1989 to 1998. Circulation 2001;
104: 2158-2163.
Copyright
Whenever a manuscript contains material (tables, figures, etc.) which is
protected by copyright (previously published), it is the obligation of the
author to obtain written permission from the holder of the copyright (usually
the publisher) to reproduce the material in Saudi Medical Journal. is also
applies if the material is the authors own work. Please submit copies of the
material from the source in which it was first published.
  • [Show abstract] [Hide abstract] ABSTRACT: Cross-sectional and descriptive study, with quantitative approach, was also performed, whose data were collected from the Mortality Information System. From 2003 to 2008 a significant reduction in undefined causes in death certificates was found. In 2007 and 2008, most deaths from undefined causes were processed in the Death Verification Service; concentrated in the age group over 50 years of age and occurring at home. It was concluded that the most accurate information of the cause of death stated in death certificates, permits a reflection and planning of the practice of nurses and other professionals, managers and social control, because it permits the design of epidemiological indicators of health status, crucial subsidy in decision process and in the performance of public health policies.
    Article · Jan 2012
  • [Show abstract] [Hide abstract] ABSTRACT: Saudi Arabia has no precise data on causes of death. We sought to ascertain the commonest causes of death as stated in death certificates of adults and evaluate the completeness of death certificates at a teaching hospital in Riyadh. A cross-sectional study carried out at King Khalid University Hospital in Riyadh, Saudi Arabia, during the year 2008. All death certificates that were issued in 2008 were reviewed and data were checked by two reviewers. Causes of death were coded according to specially-designed codes. The mean (SD) age of death was 63.9 (20.7) years. More than 80% arrived alive at the hospital. Among the 410 certificates, 62.2% had the first reported cause of death being classified as "inappropriate" and this tended to be slightly, but significantly more frequent among women. The first most common appropriately reported cause of death was malignancy of any type (7.3%) followed by ischemic heart diseases (4.9%). Accidents and fractures were more common in the younger age groups and among men. This is the first study that documents the possible gaps among healthcare professionals in Saudi Arabia in their understanding of death and its certification based on the clinical assessment of the deceased. The findings needs to be validated by similar studies from other health care sectors. It is clear, however, that proven educational, system-related and legal interventions to improve the accuracy of death certification are strongly needed if the health care priorities are to be properly identified.
    Article · Nov 2012
  • Full-text · Article · Jan 2013 · Sultan Qaboos University medical journal
  • [Show abstract] [Hide abstract] ABSTRACT: Background: The high percentage of ill-defined causes of death has always been a problem in Bahrain. This affects the quality of vital statistics and misguides policy makers when prioritizing heath problems and allocating resources in disease prevention and control. Objectives: The objectives of the study were to assess the knowledge and practices of physicians in the completion of death certificates at Salmaniya Medical Complex (SMC). Methods: The study group consisted of a cross-section of physicians at SMC. A simple random sample of 204 physicians was selected and a self-administered questionnaire, whose reliability was 0.7 based on Cronbach's Alpha, was distributed. Results: The majority (91.3%) had MBBS as a qualification and 62.9% graduated in the year 2000 or in subsequent years. Forty-eight percent of the physicians had experience of 5 years or less and 51.1% were internal medicine specialists. Seventy two percent of the respondents were unaware of the death certificate completion guidelines and 97.2% did not know the coding system used for the causes of death in Bahrain. Based on the criteria used for assessment of the respondents' performance levels in completing death certificates, it was observed that 83.1% achieved a suboptimal level. Moreover, 81% of the physicians had not received any formal training in this regard during their practice. Conclusion: Physicians in SMC lack adequate knowledge, training and experience in completing death certificates. The accuracy of death certificates in SMC would improve if the process of death certification were revised in light of these factors, and that physicians received appropriate training to complete death certificates.
    Article · Jan 2013 · Sultan Qaboos University medical journal
  • [Show abstract] [Hide abstract] ABSTRACT: Objective: To assess the impact of an educational intervention on the accuracy of death certification of secondary healthcare physicians in Bahrain. Setting: Secondary Health Care, Ministry of Health. Design: Interventional study. Method: Twenty-seven secondary healthcare physicians were invited to attend an interactive workshop about death certificate completion. They were asked to complete a death certificate based on a Case-scenario at the start and after the end of the workshop. The errors made by the physicians were compared before and after the intervention. Result: Five (18.5%) physicians had some type of training about death certificate completion and 3 (11.1%) were aware of the death certificate completion guidelines. A highly significant (p<0.001) reduction in errors prior to the intervention and after was revealed, 25 (92.6%) errors versus 11 (40.7%). The most frequent error was listing the mechanism but it markedly dropped to one-third following the workshop. Conclusion: The number of errors has declined after attending the workshop. Training physicians in death certificate completion would improve the accuracy of mortality statistics.
    Full-text · Article · Jun 2013
  • [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to describe the epidemiology of breast cancer among the Bahraini female population in the years 2000-2010 and examine its health policy implications. All breast cancer cases in the Bahrain Cancer Registry from 1(st) January 2000 to 31(st) December 2010 were included. There were 1,005 cases, 12.7% of which were detected by screening. The overall mean age at diagnosis was 50.9 years (95% confidence interval 50.1-51.6). The age-standardised incidence rate declined from 58.2 per 100,000 in 2000 to 44.4 per 100,000 in 2010. The majority of cases were infiltrating ductal carcinoma (76.9%). Of the registered cases, 44.1% and 48.1% had an unknown grade and stage, respectively. The five-year survival rate was 63 ± 2%. The low percentage of cases detected by screening merits further evaluation of Bahrain's screening programme. More effort should be made to reduce the proportion of unknown stage and grade breast cancers. Future research has to be directed towards understanding the reasons for Bahrain having the highest incidence rate of breast cancer in the Gulf Cooperation Council countries.
    Full-text · Article · May 2014
Show more