The importance of statistics on cause of death is well recognized and this data is in demand by health planners, administrators and medical professional. The scheme on medical certification pf cause of death formulated by the office of the Registrar General, India is a big step forward towards establishment of a system in the country for data on cause of death. The scheme envisages the gradual introduction of medical certification of cause of death in a phased manner. Initially this is expected of doctors from medical and teaching hospitals and subsequently from doctors working at specialized hospitals district and sub divisional hospitals primary health centres and finally from private physicians. Thus there shall be enforcement of Registration of Births and Deaths Act 1969 in letter and spirit. The ambit of the act is to depend upon the involvement and cooperation of the physicians in preparing Medical Certificate of Cause of Death based on International Classification of Diseases (ICD) recommended by World Health Organization (WHO).
Mortality statistics forms an integral part of the vital statistics system. It is one of the basic components of population growth. The cause specific mortality rates are key indicators of the health trends in population and are provided on scientific basis by the system of Medical Certification of Death.
They help in assessing the effectiveness of public health programs and provide a feedback for future policy and implementation.
The enactment of Registration of Births and Deaths Act 1969 came into force from April 01, 1970 and at present it has been enforced in all the states / Union Territories. As per the act, every death must be registered with the sub registrar/ registrar of the concerned jurisdiction. It is the mandatory duty of every doctor to notify all deaths that he/ she attended.
“Legal and protective uses: For settlement of inheritance claims, claiming family allowance and other social security benefits etc.”
“Administrative uses: As indicators of the existence of infection and epidemic diseases and the need for immediate control measures. For public safety, accident prevention and eradication programs. In clearing of documents such as disease case registers, social security files, tax registers etc.”
“Statistical uses: In planning and evaluation of development plans. Useful in public health and medical research such as, in the study of mortality and the trends in mortality by age, sex and cause. The registration records thus are primarily useful for their value as legal documents and secondarily as source of vital statistics.”
The death events are recorded at the place of occurrence, in the office of the registrar of births and deaths for that area. When ever an event takes place, the informant specified for such an event has to declare the fact of the event along with certain particulars in the live birth report (Form 2) Still Birth Report (Form 3) or Death Report (Form 4) along with Form 8 / 8 A Medical Certificate of cause of Death for hospital inpatients (Form 8) and for non institutional deaths (Form 8 A) to the registrar of local area.
Every registrar maintains a register which consist of three parts such as I / II / III for registration of live births / still births/ deaths respectively. The certificate of death (Form 10) can be obtained from the registrar. It gives all facts of death such as date of death, place of death etc. but no disclosure is made regarding cause of death. It is certified by sub registrar or any officer specified under rules.
It is common (though wrong) practice to refer to form 8 / 8A (Medical Certificate of cause of death) issued by doctors as Death Certificate As per the act the term Certificate of Death or death Certificate refer to Form 10 issued by Office of Registrar and not by Doctor.
Doctor issues Medical Certificate of Death and the Registrar issues Death Certificate / Certificate of Death.
Form of Medical Certificate of Cause of Death (Form 8 / 8 A)
The format of the certificate proper (medical part) conforms to the standard prescribed by the WHO and has the following features.