Abstract
BACKGROUND: Improving death certification of Under 5 Mortality (U5M) is an important pre-requisite for improving child health. This study aimed to obtain a clear and comprehensive understanding of the process of death registration of U5M and address the challenges of accurate certification faced by physicians at hospitals and health offices. METHODS: A qualitative descriptive study was performed by conducting 10 Focus Group Discussions (FGDs) with physicians who are actively involved in the certification of U5M. Physicians were invited to participate from primary health care units, health offices, district and general hospitals in Cairo, Giza and Assiut Governorates. Field visits of health offices were performed to observe the procedure of death registration, visualize a sample of the hospitals' Death Notification Forms (DNFs) and death certificates of U5M, and explore the used electronic system of death registration. Data analysis was performed using inductive thematic analysis. RESULTS: The study clarified the procedure of death certification of U5M, starting from hospitals and ending at health offices. It was evident that there is a considerable deficiency in the system of registration and coding causes of death. Physicians of hospitals had a negative attitude regarding death registration. They were found to have deficient knowledge about standards of death certification. They had difficulty defining and reporting the chain of events leading to death. Poor diagnostic facilities hindered physicians from accurately reporting COD. Fear of legal accountability was a cause of avoiding detailed COD. For physicians in the health offices, other challenges were mentioned such as assigning junior physicians to manage the task of writing DNFs, poor quality of hospital reports and the unrealistic ICD-10 codes. CONCLUSION: Improving the accuracy of writing DNFs in hospitals is essential for providing reliable U5M statistics. Practical training of physicians, especially the junior ones, on ICD-10 classification and on identification and writing direct and indirect COD in the allocated lines in the death certificates is a priority. Establishing an audit system to assess the quality of the process of certification and updating the software of the electronic system for data entry would have a great impact.