Thailand's national death registration reform: verifying the causes of death between July 1997 and December 1999

A fundamental aspect of public health is the accuracy of death certification. Assessing the death registration system is a step toward improving the quality of death reporting. Thailand implemented a more rigorous and informative pilot death registration system in March 2001 in 18 provinces, followed by nationwide implementation in August 2003. Since Thailand is an industrializing nation, its experiences will be of interest to other developing nations planning similar reforms. The causes of all deaths in the 15 provincial pilot projects (of Thailand's 76 provinces) and a random sampling in Bangkok were investigated between July 1997 and December 1999. Health workers interviewed close relatives and three medical doctors reviewed hospital records to verify the causes of death. We were able to interview 78% of the relatives (i.e. 47,632 in number). Three-quarters (76%) of the deceased had sought prior medical care; 41% died in hospital and 54% at home. The overall agreement between the causes of death in our survey vs. that reported on the death certificate was 29%. The highest agreement was for: 'Ill-defined' causes (33%), 'Cancer and Tumors' (17%), 'External Causes' (16%), and 'Infectious Diseases' (10%). Considering the different patterns among age groups and sex, hypertension with stroke, cancer of the liver and bile duct, and HIV infection, were the highest ranking causes among females. Infectious diseases (especially HIV/AIDS), hypertension with stroke and accidents, were the leading causes of deaths among males. External causes were highest among children and young adults.