An evaluation of 1987 tuberculosis deaths in Singapore

Tuberculosis was responsible for 177 deaths in 1987. This study evaluated the accuracy of tuberculosis death certification by hospital doctors and general practitioners in 111 cases where hospital case-notes were available for verification. It revealed that only 49 cases (44%) died of active tuberculosis, 12 (11%) died of late effects of tuberculosis and 41 (37%) died of causes unrelated to tuberculosis. There was no evidence of tuberculosis in 9 cases. Only 39 cases (56%) of active tuberculosis certified by hospital doctors were correct compared to 10 (24%) certified by general practitioners. Hospital doctors certified 6 out of 9 deaths which had no evidence of tuberculosis. The actual tuberculosis mortality rate was estimated to be between 1.9 and 4.9 per 100,000 instead of the officially published 6.8 per 100,000 for 1987.