The Evaluation of the Death Registration Coverage in the Civil Registration Organization of Iran (Case Study of Yazd Province, 2016)

Death-related indicators are the basis for determining the health status of a community and performing health planning. Death occurs over time, so the best way to collect data about it is the registration system. However, there are inaccurate results from the death registration system in most developing countries, and there is no confidence in their death registration coverage. Incomplete death registration coverage means that not all deaths are recorded and therefore underestimated mortality rates calculated for the population. The purpose of this study was to determine the extent of death registration coverage in the civil registration system in the Islamic Republic of Iran.

The basic assumption in this study is that the information in the cemeteries is the most complete data regarding death, so the research method is based on comparing the statistics in the cemetery with those recorded in the registry system. The death registration cover for Yazd province is estimated to be similar to the national level in previous studies, so it has been used in this study as a baseline study. In the initial evaluation of death data, three counties were selected from the province: Mehriz, Ashkzar, and Yazd. All cemeteries in towns and villages in the selected cities were visited and information was collected from the graves of the dead, including the name, surname and father's name. This information was then tracked in the registry system and their death registration status was checked. The study was conducted on deaths occurring in 2016 (1395 AH).

Keeping track of death data in the registry system indicates that most of them (over than 95%) have been registered. But there is a more important issue and it is the accuracy of the registered data. Death registration for adults is mainly affected by displacement error of residence and place of death, and child death registration, in addition to displacement error, is affected by error in recording postnatal death including abortion. The deaths of each county were calculated based on the total number of deaths recorded at the county location and most of the dead were buried in the central cemetery of the province and then transferred to their place of residence, but their registration was carried out at the cemetery site and was therefore calculated as the death of the central county of the province. A clear example of this is that, 80% of the dead women in the city of Ashkzar were not registered at their place of residence and were counted as the deaths of Yazd.Regarding mortality index, it is necessary to compare the number of deaths to the exposed population and thereby to calculate the mortality rate as an indicator of health status. Population information was collected by the statistics center and was precisely based on the location of the individuals.Therefore, death data must also be precise by location to estimate the rate index correctly. The issue was more complicated with children, deaths recorded for children were far below expectations. On the one hand, for many of the children in the cemetery, no information was found in the registration system and in fact no birth registration has been made for them. On the other hand, abortion and stillbirth cases were very high. From these cases, it can be concluded that many postnatal deaths were considered as stillbirths. In addition, there was also displacement error of residence and place of death in the case of child death. Many of infant deaths occurred in central city hospitals were transferred to central cemetery and counted as central county deaths. Infant mortality rates were one of the main determinants of community health status and accuracy of these indicators was very important. So, there are two basic suggestions derived from the results of this study, 1) registering the deaths by place of residence rather than the place of death or the place of burial, and 2) accurate recording of birth and death information for postnatal death.