Strengthening Mortality Statistics for Health Programs in Malaysia: Lessons from the Field

Malaysia is one of a few Asian countries with a longstanding history of vital registration systems. Yet, issues with data quality have limited the utility of available vital statistics for public health policy, program evaluation, and research [1,2]. Although death registration is complete for states located on Peninsular Malaysia, the problem of marginal underreporting of deaths still persists in the eastern states of Sabah and Sarawak [3]. However, initiatives have been recently launched by the Malaysian National Registration Department [Jabatan Pendaftaran Negara (JPN)] to resolve issues with registration rules and infrastructure in these states. The more significant concern lies with the poor quality of registered causes of death. About 50% of all deaths in Malaysia occur in hospitals and are registered with medically certified causes, which are of good quality. However, the remaining deaths that occur at home are registered with causes reported by family members. For statistical purposes, these are termed as “nonmedically certified deaths.” Each year, only about a third of these deaths are reported to be from specific causes, and the remaining 65–70% of these deaths are registered annually with vague and ill-defined causes including “old age,” “heart failure,” and “sudden death” [3]. These limitations in vital registration data necessitated the use of generic model-based adjustments to fill these data gaps, while estimating national mortality and burden of disease estimation for the years 2000 and 2008 [4,5]. These persistently high proportions of illdefined causes can still be observed even for the most recent period from 2009 to 2017 (Figure 1).