Prevalence and determinants of death registration and certification uptake in Uganda

Death registration in Uganda remains extremely low, yet mortality statistics are vital in health policy, planning, resource allocation and decision-making. According to NIRA, only 1% of deaths are registered annually, while Uganda Bureau of Statistics estimates death registration at 24% for the period 2011-2016. The wide variation between the administrative and survey statistics can be attributed to the restriction to only certified death registration by NIRA while survey statistics relate to all forms of death notification and registration at the different sub-national levels. Registration of deaths is of critical importance to individuals and a country's government. Legally, it grants administrative rights in management of a deceased's estate, and access to social (insurance and pension) benefits of a deceased person. It is also essential for official statistics and planning purposes. There is an urgent need for continuous and real-time collection of mortality data or statistics in Uganda. These statistics are of significance in public health for identifying the magnitude and distribution of major disease problems, and are essential for the design, implementation, monitoring, and assessment of health programmes and policies. Lack of such continuous and timely data has negative consequences for the achievement of both national and Sustainable Development Goals 3, 11, 16, and 17. This study assessed the determinants of death registration and certification, using a survey of 2018-2019 deaths in 2,100 households across four administrative regions of Uganda and Kampala district. Multivariate-binary logistic regression was used to model factors associated with the likelihood of a death being registered or certified. We find that around one-third of deaths were registered while death certificates were obtained for less than 5% of the total deaths. Death registration and certification varied notably within Uganda. Uptake of death registration and certification was associated with knowledge on death registration, region, access to mass media, age of the deceased, place of death, occupation of the deceased, relationship to household head and request for death certificate. There is need for decentralization of death registration services; massive sensitization of communities and creating demand for death registration.