Sensitivity and Positive Predictive Value of Child Death Certificates in Iran: A Cross-Sectional Study

Accurate information on the causes of child mortality is required to achieve Millennium Development Goal 4 (MDG4). The causes of child mortality are used to assess the pattern of diseases and make health policies. The accuracy of these mortality statistics depends on the proper completion of death certificates.

The study aimed to measure the sensitivity and positive predictive value (PPV) of death certificates obtained from the hospital information system (HIS) in a children's specialized hospital in Iran.

This cross-sectional study assessed death certificates of 580 children of 1-59-month-old died in the hospital from 2011 to 2018. Pediatricians identified the minor and major errors and the underlying causes of death (COD). A misclassification matrix was used to measure agreement, sensitivity, and PPV using multiple causes obtained from death certificates and pediatrician reviews.

The HIS had a sensitivity of 43.27% and a PPV of 39.37%. The highest sensitivity was 73.33% for kidney diseases and urinary tract infections, and the lowest sensitivity was 18.18% for diarrhea and dehydration. The HIS had the highest PPV for accidents and injuries and the lowest PPV for diarrhea and dehydration (65.63% and 20.69%, respectively). The most identified underestimation and overestimation numbers were related to "respiratory disease and pneumonia" and "cardiac arrest", respectively.

A large proportion of CODs in death certificates were registered inaccurately. The mortality statistics should be used with caution for planning and policy-making.