BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

CMapter1 .. ... XI!. Chages. ia Aignments daes of Death 329
underlying or an associated cause on final
assignment.
Agreement was greater for the postneonatal
deaths and those at 1-4 years of age
(59.2 and 58.1, respectively) than for neonatal
deaths (41.2 per cent). This was to
be expected, since infectious diseases and
external causes occurring after the neonatal
period are more readily recognized
and diagnosed than certain of the perinatal
causes. The problems encountered in classifying
the perinatal causes are discussed
later in this chapter.
The agreement of assignments, by age
group, is shown in Figure 164. The first
bar in each group is the critical one, measuring
the amount of agreement that the final
assignment of underlying cause on the basis
of all available information would have
with the underlying cause derived from the
death ce:tificate after coding in accordance
with international rules. The percentages
for neonatal deaths (41.2) and those in the
other two age groups combined (58.8) in-
FiG. 164. Agreement of Underlying Causes Based
on Death Certificates with the Final Assignments
in Children Under 5 Years, by Age Group, in 14
Projects Combined.
60
50
,0
Zunderlying
U. 30
0 U
UNDR 5YEARS NEONATAL POSTNEONATAL .4 YEARS
AGREEMENTWIT,,
UNDOEIYING CM ASSOCIATED E NO AGREEMENT
CAUSE
CAUSE
0
dicate that statistics on underlying causes
of death are not satisfactory enough at the
present time to give a true and realistic
picture of causes as the basis for health
planning. Actually, these data from death
certificates are probably superior to those
for a country as a whole, as tile quality of
such information in rural areas is even
poorer. For sound he"lth planning, it is
essential to improve the quality of medical
certification as well as the completeness of
registration, or else to obtain data for planning
from other sources, such as through
sampling surveys or through specific research
programs.
In the individual projects (Table 195 and
Figure 165) the general agreement of underlying
cause on death certificate with that
on final assignment for all the deaths under
5 years of age varied from 46.3 per cent
in Chaco Province to 64.3 per cent in Sherbrooke.
In eight projects 50.2 per cent or
more of the underlying causes were in general
agreement and in the remaining six
projects less than half.
In only eight projects was there as much
as 40 per cent agreement for deaths in the
neonatal period, while in the postneonatal
and 1-4 year age group six projects had at
least 60 per cent agreement (California,
Sherbrooke, Bolivia, Chile, Kingston-St.
Andrew, and Cali).
These percentages indicate lack of understanding
of the value of correctly stating
cause on the death certificate.
The agreement of underlying cause on the
certificate with associated cause assigned
in the Investigation indicated that many
times one of the consequences (such as
lneumonia) was given on the certificate
instead of the underlying cause. Hospitals
should set up clinical-pathological conferences
and institute procedures for providing
the certifying physicians with all available