Challenges facing physicians in death certification of under-five mortality in Egypt

Area of Science:

• Public Health
• Pediatrics
• Medical Informatics

Background:

• Improving death certification for Under 5 Mortality (U5M) is vital for child health.
• Accurate U5M statistics are essential for effective public health interventions.
• Physician challenges in death certification impact data reliability.

Purpose of the Study:

• To understand the U5M death registration process.
• To identify challenges faced by physicians in accurate death certification.
• To address deficiencies in U5M data collection and reporting.

Main Methods:

• Qualitative descriptive study using 10 Focus Group Discussions (FGDs) with physicians.
• Inclusion of physicians from primary health care, health offices, and hospitals in Cairo, Giza, and Assiut.
• Field visits for observation of death registration procedures and review of forms and electronic systems, followed by inductive thematic analysis.

Main Results:

• Identified deficiencies in the registration and coding of causes of death (COD).
• Physicians exhibited negative attitudes, knowledge gaps, and difficulties in reporting the chain of events leading to death.
• Diagnostic limitations, fear of legal accountability, and issues with junior physician assignments and ICD-10 codes were significant challenges.

Conclusions:

• Enhancing the accuracy of Death Notification Forms (DNFs) in hospitals is critical for reliable U5M statistics.
• Prioritizing practical training for physicians on ICD-10 classification and COD reporting is essential.
• Implementing an audit system and updating electronic data entry software will significantly improve the certification process.