Death Certificate Download Tamilnadu

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Background: Registration of the fact of death is almost complete in the city of Chennai and not so in the rural Villupuram district in Tamilnadu, India. The cause of death is often inadequately recorded on the death certificate in developing countries like India. A special verbal autopsy (VA) study of 48,000 adult (aged >or= 25 yrs) deaths in the city of Chennai (urban) during 1995-97 and 32,000 in rural Villupuram during 1997-98 was conducted to arrive at the probable underlying cause of death to estimate cause specific mortality.

Methods: A ten day training on writing verbal autopsy (VA) report for adult deaths was given to non-medical graduates with at least 15 years of formal education. They interviewed surviving spouse/close associates of the deceased to write a verbal autopsy report in local language (Tamil) on the complaints, symptoms, signs, duration and treatment details of illness prior to death. Each report was reviewed centrally by two physicians independently. Random re-interviewing of 5% of the VA reports was done to check the reliability and reproducibility of the VA report. The validity of VA diagnosis was assessed only for cancer deaths.

Results: Verbal autopsy reduced the proportion of deaths attributed to unspecified and unknown causes from 54% to 23% (p < 0.0001) in urban and from 41% to 26% (p < 0.0001) in rural areas in Tamilnadu for adult deaths (>or= 25). The sensitivity of VA to identify cancer was 95% in the age group 25-69.

Conclusion: A ten day training programme to write verbal autopsy report with adequate feed back sessions and random sampling of 5% of the verbal autopsy reports for re-interview worked very well in Tamilnadu, to arrive at the probable underlying cause of death reliably for deaths in early adult life or middle age (25-69 years) and less reliably for older ages (70+). Thus VA is practicable for deaths in early adult life or middle age and is of more limited value in old age.

1. 21 Days to 30 Days Rs. 100/- 2. After 30 Days to 1 year Written permission of the Officer prescribed and on payment of late fee of Rs. 200/-. 3. After 1 year Any birth or death which has not been registered within one year of its occurrence shall be registered by an order of the Executive Magistrate not below the rank of a Revenue Divisional Officer and on payment of late fee of Rs. 500/-.

Corporation Sanitary Inspector Municipality, Township Sanitary Inspector Town Panchayats Executive Officer/ Sanitary Inspector Village Panchayats Village Administrative Officer Primary Health Centres Health Inspector Government Institutions located in Village Panchayats Multi Purpose Health Supervisor (Male) Cantonment Sanitary Inspector Estates / Plantations Manager How many copies of birth or death certificate can be obtained:

In developed countries, data on disease-specific mortality by age are readily available from national vital registration. In developing countries, where 80% of the world's deaths occur, estimation of cause of death is more difficult because the levels of coverage of vital registration and reliability of cause of death stated on the death certificate are generally low (especially in rural areas).

A reliable assessment of disease-specific mortality rates is not yet possible in many parts of India, either because the underlying cause of the terminal illness was never known or because the relevant information was not recorded. For legal purposes death records do usually subdivide the causes of death into medical and non-medical (external) causes. But once non-medical causes have been excluded, specification of the underlying cause of a death from disease may be inaccurate, misclassified or missing for about 50% of adult deaths. For example, in Chennai, Tamilnadu, (south India) about half of those who died at home soon after the diagnosis of cancer (and whose deaths were therefore, in almost all cases, likely to have been caused by their cancer) do not have cancer mentioned on their death certificate [1], and for other diseases the problems might well be even worse.

This consisted of a basic three day introduction to anatomy, collecting data on history of past illness (refer Appendix I in Additional file 1), using symptoms/signs checklist of various diseases (refer Appendix II in Additional file 1) and to interview the surviving spouse/close associates or relatives of the deceased, the other members of the community such as neighbours to get data on train of events or circumstances preceding the death. Reports are to include complaints, symptoms, signs, duration of illness and treatment details of the illness prior to death.

If the respondent is able to give the major symptoms and circumstances leading to death, then additional probing questions are asked about the associated symptoms using the symptoms/signs checklist (Appendix II(A & B) in Additional file 1) If the respondent is not able to give sufficient information on the symptoms of the illness prior to death or have difficulty in remembering any major symptom, then get necessary information to rule out non-medical causes of death. When the interviewer is sure that the death was not due to unnatural cause, the following procedure is used to collect necessary data on the symptom.

Thus, the methodology of collecting data in the open format using 'symptoms/signs checklist' is an interactive process, with the respondent taking the lead in providing the information, and the interviewer prompting where necessary for more details. The Field Interviewer gathers as much information as possible on the underlying cause of death from the respondent. It is imperative to get a logical and complete history of symptoms, signs, events, investigations and treatment, so that the medical reviewer gets sufficient information to assign a probable specific underlying cause of death.

In the following two days, mock interviews were organized to illustrate techniques of probing a respondent to get the required information on cause of death as well as how to write the verbal autopsy report in local language (Tamil) in Appendix I in Additional file 1 as stated by the respondent.

The third component of training included three days of hands on verbal autopsy training in the field. To limit distress over the terminal event, the field visit was carried out at least six months after death. Name of the deceased, father's name (if the deceased was a male) or spouse name (if the deceased was a female), age, gender, informant's name and address of the deceased at the time of death were given to field interviewers to locate the house of the deceased. The Field Interviewers carry Appendix I and II (symptoms/signs checklist) in Additional file 1 to the field. They were blind to the cause of death stated on the death certificate. The Field Interviewer located the house of the deceased based on the data given to him. He introduced himself to the respondent and began the interview. Each one completed twenty reports which were reviewed and feedback was provided two days after completion of field work to maximize quality of writing the verbal autopsy report.

The final component of training was feed back session for 2 days. This session involved teaching them how to include essential information in report writing. The feedback session mainly focused discussion on reports which did not have a specified underlying cause of death and reports with minimal information to arrive at the probable underlying cause of death; for example, a report may say that a person had a stroke ten days ago but did not specify the type of onset (sudden or gradual, whether the person was conscious or unconscious, had difficulty in speaking or not, which parts of the body may have been affected etc.) or a report may say that the deceased had fever for ten days and died. It did not give details about the fever and other associated symptoms if any.

Feed back sessions were organized regularly throughout the study period to improve the quality of the verbal autopsy reports and 5% of the field visit reports were validated by re-interview one week after completion of the main interview, and blind to its results. This re-interviewing was done by one or other of two special interviewers because knowledge that a resurvey might well take place would ensure reliably motivated fieldwork at the initial survey, and also to check whether there were any systematic defects in the technique of any of the field workers: none were found. The underlying cause of death arrived based on re-interview data was not substantially different from the one arrived based on main interview data.

All verbal autopsy reports were centrally reviewed by two physicians independently in order to arrive at "probable underlying cause of death". Each made a diagnosis based on signs, symptoms and sequence of events prior to death given in the verbal autopsy report, which were then coded according to the 9th International Classification of Diseases, Injuries and Causes of Death [8]. The same 2 physicians reviewed all the 80,000 verbal autopsy reports. The discrepancies in the underlying causes of death were noted in 5% of verbal autopsy reports. These were discussed and resolved. The disagreement between 2 physicians in arriving at underlying cause of death was noted before classifying causes of death into broad groups. For example, 'Pneumonia' and 'Lower respiratory infection' were grouped under 'Infection'. According to one physician the underlying cause of death was pneumonia and for another physician it was lower respiratory infection. ff782bc1db