Staff shortage and the “casual approach” of physicians have crippled the state health intelligence department’s efficacy to pinpoint the leading cause of death in the city in the last two years. In 2011, officials were compiling data for the cause of deaths in 2005-06. This year, it has come to light that ischaemic heart disease was the leading cause of death in 2009-11.
Cause of death data are needed for shaping public health programmes and deciding priorities. They are vital to clinical and epidemiological research. To ensure physicians do not adopt a casual approach to determining the cause of death, the state health department has issued fresh circulars to 23 municipal corporations, 223 municipal councils, 7 cantonment boards and 345 rural hospitals to ensure a correct coding of medical certificate of cause of death (MCCD).
In the state, MCCD is available at all urban areas as well as rural hospitals and as per Rule 7 of the Maharashtra Registration of Births and Deaths Rules, 2000, it is obligatory to submit medical cause of death to local health officials. The prescribed form 4/4A has to be correctly filled by the physician and cause of death specified as per International Classification of Diseases (ICD-10). State health officials said each institution will have to submit the report on number and cause of deaths.
Barring Mumbai, which registered 100 per cent medically certified deaths, no district in the state has done so. In 2009, there were 6,33,206 registered deaths in Maharashtra of which 3,24,768 were deaths categorised in urban areas. The number of medically certified deaths were 2,12,335. In 2010, according to data from state health intelligence department, out of 6, 63 ,383 deaths in Maharashtra, only 2,13,826 were medically certified deaths. In 2011, the number of deaths registered were 6,24,791 out of which 2,15,619 were medically certified deaths. While Mumbai had 1,90,033 medically certified deaths, in Pune, out of 48,505 deaths in 2009 only 21,311 were medically certified ones. In 2010, out of 49,385 deaths, only 19431 were medically certified ones.
When contacted, Dr P S Pawar, Deputy Chief Registrar of Births and Deaths said that an average of 32-33 per cent deaths are medically certified out of the total registered deaths. While Mumbai has a unique system of coding deaths, places like Sangli, Thane, Wardha, Ahmednagar ensure that a minimum of 60 to 70 per cent deaths are medically certified of the total registered deaths.
Officials from the state health intelligence and vital statistics department admitted that there was a paucity of staff and data entry of the records could not be taken up immediately. “We have recruited staff on contract basis and analysed the causes of death from 2009-11. It is a similar trend where ischaemic heart disease and cardiac deaths top the list of causes of deaths and this is followed by infectious diseases,” said Pawar. He said that by March 2015, the data of causes of deaths from 2012 would be compiled.