Accuracy of Death Certification of Cause of Death in Home Deaths by Grama Niladhari in Selected Divisional Secretariat Areas of Sri Lanka

Introduction: Accurate and complete medical data on the cause of death are critically important for designing and evaluating health programs and policies. Mortality medical data on deaths that occur inside a healthcare facility are certified by medical officers and therefore they are considered to be reliable and accurate. However, approximately one-half of the 130,000 deaths which occur each year in Sri Lanka take place outside a healthcare facility. There are several death certification systems existing for getting a death registered after determining the cause of death and obtaining the death certificate in home deaths in Sri Lanka without the involvement of a medical officer. Those systems involve either Inquire into Sudden Death, Grama Niladhari, Police Officer, or Estate Superintendent as the individual responsible for stating the cause of death. Few studies have analysed the causes of death stated by the ISD however, there are no published studies that have analysed the cause of death stated by Grama Niladharies on home deaths in Sri Lanka.Methods: This retrospective cross-sectional descriptive study was carried out on home deaths that occurred between September 2021 and September 2022 in the Matale and Ukuwela divisional secretariat areas of Sri Lanka using secondary data collected from B 24 forms which were filled by Grama Niladhari of respective divisions.Results: The study included 230 home deaths. 72% of medical records were of poor quality to assign a cause of death. In all these death certificates, the cause of death was not stated according to the WHO format of the cause of death. Fifty-four percent used an ill-defined condition as the underlying cause of death. Cancer was the cause of death in 11% of adults and accounted for the highest number of cases.Conclusions: Grama Niladhari in Sri Lanka has difficulties in completing the cause of death accurately. They routinely made errors in death certification because of these inaccurate causes of death. This situation needs rectifiable measures as home death data is very vital for certain healthcare decisions.