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Completeness and Quality of Khartoum Mortuary Data

Authors: Kavi Bhalla, Jerry P Abraham and Safa Abdalla

Date: July 6, 2010

 

Objective: To do a crude test of the completeness and quality of the Khartoum Mortuary Data

Method: The number of deaths in the mortuary records was compared with an estimate of the number of deaths expected in Khartoum state

Findings:

-          The mortuary dataset is not representative of all-cause deaths (80% of deaths are injury related)

-          The mortuary dataset captures a substantial fraction of injury deaths in Khartoum (84% by this calculation).

 

 

Background

-          Data Source Analyzed: Khartoum Teaching Hospital 2008 records

o   There are two mortuaries in the Khartoum Metropolitan Area located at the Khartoum Teaching Hospital and the Omdurman Teaching Hospital. The Omdurman mortuary was established in 2009. Thus, until 2008, the Khartoum Teaching Hospital Mortuary was the only mortuary in the region. Thus, we test the completeness and quality of this dataset.

-          Analysis in this report should be repeated with Census 2008 data:

o   The analysis in this report uses crude estimates of population and mortality in Khartoum. Typically these have been extrapolated from estimates available for the country in international databases. Accurate data for population and mortality in Khartoum will be available from the 2008 Census. This analysis should be updated then.

 

 

TABLE 1: Distribution of causes in the 2008 Khartoum Mortuary Dataset

INJURY DEATHS (CHAP 19,20)

DEATHS

% OF INJURY

ROAD INJURY

879

36%

DROWNING

115

5%

FIRE

99

4%

POISONING

17

1%

ANIMAL CONTACT

0

0%

FORCES OF NATURE

0

0%

ASSAULT

358

15%

UNSPECIFIEDS - FRACTURE

975

40%

TOTAL INJURY

2443

100%

OUTSIDE INJURY CHAPTER

629

 

TOTAL ALL-CAUSE

3072

 

-          Injury cases comprise 80% of the all-cause deaths in the mortuary dataset. The mortuary dataset is severely biased towards injury cases. The mortuary dataset is unlikely to be representative of all-cause mortality in Khartoum.

 


 

Assessment of Quality of Injury Coding

-          Outside the injury chapters:

o   The use of partially specified cause categories is relatively rare. Cause categories with more than 2% of mortuary cases are as follows:

§  Intra-cerebral hemorrhage: 6%

§  Other Diseases of the Respiratory System: 5%

o   The Intra-cerebral hemorrhage deaths may include injuries.

-          Within the injury chapter:

o   Key external causes that are not included:

§  Falls

§  Suicide

§  Sub-categories of road injuries, homicides, etc.

o   Dump codes: The only dump code used is “Fracture” – with 40% of the injury cases.

§  Falls are likely classified here

§  It is unclear if road injuries get classified here

-          It should be noted that prospective data gathering is ongoing at the recently established Omdurman mortuary. We expect that data from that mortuary will be available to us soon. The quality of cause-of-death attribution of that database is expected to be very high.

Assessment of Completeness

Coverage: It is assumed that the Mortuary receives cases only from Khartoum State.

Age aggregation:

-          The assessment focuses on deaths among young adults aged between 15-44 years in Khartoum. This was done to reduce uncertainty in this analysis. (Injuries occur primarily among young adults and the high mortality among children and older adults can add substantial uncertainty to analysis)

-          The cut-offs chosen were dictated by the age aggregation in the Khartoum Mortuary dataset. (Deaths among 45+ years are in one category)


 

TABLE 2: Assessment of completeness of the Khartoum Mortuary dataset

POPULATION CALCULATION

Population of Khartoum

 2,278,942

Male

Khartoum State urban population during 2008

 1,993,786

Female

 

 

Source: 2008 Population Census (Khartoum urban state)

 

Note: Khartoum State also has a rural population of ~ 1 million

% population between 15-44 years

47.64%

Male

% OF URBAN MALES THAT ARE 15-44 YEARS IN SUDAN (YEAR 2005)

47.62%

Female

% OF URBAN FEMALES THAT ARE 15-44 YEARS IN SUDAN

 

Source: UNPD World Population Prospects 2008 (all urban population)

Population of Khartoum State between 15-44 years

1,085,604

Male

 

 949,498

Female

 

 

Calculated from above

DEATHS CALCULATION

Death rate for 15-44 years in Khartoum

0.00538

Male

(per person)

0.00442

Female

 

 

Source: Estimated from UNPD all-cause deaths and UNPD population for year 2000

 

Note: Death rates in Khartoum are likely lower than national

Estimated all-cause deaths among 15-44 years in Khartoum

5840

Male

 

4201

Female

 

 

Source:  Death rate applied to Khartoum Population

Fraction of all-cause deaths due to injuries among 15-44 years

25.2%

Male

 

5.5%

Female

 

 

Source: GBD-2004, Africa region

Estimates of injury deaths among 15-44 years in Khartoum

 1,472

Male

 

 231

Female

 

 

Calculated from above

COMPLETENESS TEST

Injury deaths in the mortuary 2008 dataset between ages 15-44 years

1222

Male

 

208

Female

 

 

Source: Khartoum Teaching Hospital Mortuary

Completeness of injury deaths between ages 15-44 years

83%

Male

fraction of estimated injury deaths that were seen at the mortuary

90%

Female

 

84%

Total

 

 

Calculated from above

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