Death certification status in Eastern Mediterranean Region: A systematic review

Figures & data

Table 1. Quality assessment results using elements of Johnna Briggs Institute (JBI) critical appraisal checklist for studies.

Study: first author (year)	Sample frame appropriate to address the target population	Participants sampled in an appropriate way	Sample size adequate	Subjects and the setting described in detail	Data analysis of sufficient coverage	Valid methods for identifying the condition	Condition measured in a standard, reliable way for all participants	Appropriate statistical analysis?	Response rate adequate; if not, low response rate managed appropriately	Quality score
Abdulmalek (2013)	Y	Y	Y	Y	Y	U	Y	Y	N/A	8.8
Abulfatih (2010)	Y	Y	N	Y	Y	Y	Y	Y	N/A	8.8
Al-Kubaisi (2013)	Y	Y	Y	Y	U	Y	Y	Y	Y	8.9
Ali (2013)	N	Y	N	Y	N	Y	Y	Y	Y	6.7
Alipour (2020)	Y	Y	U	Y	Y	Y	Y	Y	N/A	8.8
Aljerian (2019)	N	Y	Y	N	Y	Y	Y	U	N/A	6.3
Ansary (2012)	N	Y	Y	N	N	Y	Y	Y	N/A	6.3
Arif (2014)	N	Y	U	Y	N	Y	Y	Y	N/A	6.3
Ben Khelil (2017)	N	Y	Y	Y	N	Y	Y	Y	N/A	7.5
BinSaeed (2008)	N	Y	N	Y	N	Y	Y	N	N/A	5
El-Nour (2007).	Y	Y	Y	Y	U	Y	Y	Y	N/A	8.8
Haghighi (2014)	N	Y	Y	Y	N	Y	Y	Y	N/A	7.5
Haque (2013)	Y	Y	U	Y	Y	Y	Y	Y	N/A	8.8
Kheir (2016)	N	Y	U	Y	N	Y	Y	Y	N/A	6.3
Mahdavi (2015)	Y	Y	N	Y	Y	Y	Y	Y	Y	8.9
Mousa (1990)	Y	Y	U	U	U	U	U	Y	N/A	3.8
Qaddumi (2017)	Y	Y	Y	Y	U	Y	Y	Y	N/A	8.8
Qaddumi (2018)	Y	U	Y	Y	Y	Y	Y	Y	Y	8.9
Sibai (2002)	Y	Y	Y	Y	Y	Y	Y	U	N/A	8.8

Y: yes; N: no; U: unclear; N/A: not applicable.

Figure 1. Flow chart showing screening of publications for inclusion in the systematic review using the PRISMA flow diagram.

TABLE 2. Common errors in death certificates.

	Errors in cause of death								Editing errors
	Incorrect or missing
Study	ICOD	ACOD	UCOD	Disagree with medical file	Sequence	Mechanism as cause	Competing causes of death	Translation	Use of abbreviations	Illegible handwriting	Missing information
Abdulmalek, 2013	✓		✓					✓			✓
Abulfatih, 2010						✓
Al-Kubaisi et al. 2013	✓		✓			✓			✓	✓
Aljerian, 2019	Reported errors in the cause of death, did not specify whether in UCOD, ICOD or ACOD					✓			✓ (zero reporting)	✓
Alipour, 2020			✓	✓	✓	✓	✓		✓	✓	✓
Ansary et al. 2012						✓
Arif et al. 2014	✓		✓		✓	✓					✓
Ben Khelil et al. 2017					✓	✓	✓		✓	✓	✓
Binsaeed et al. 2008	✓		✓	✓		✓		✓			✓
El-Nour et al. 2007	✓	✓	✓			✓	✓				✓
Haghighi et al. 2014					✓	✓	✓			✓
Haque et al., 2013	✓		✓		✓	✓
Kheir et al., 2016	✓	✓	✓				✓	✓			✓
Moussa et al., 1990			✓			✓
Qaddumi et al., 2017	✓		✓		✓	✓	✓		✓	✓	✓
Qaddumi et al., 2018	✓		✓		✓	✓	✓		✓	✓	✓
Sibai et al., 2002			✓								✓

DC: death certificate; ICOD: immediate cause of death; ACOD: antecedent cause of death; UCOD: underlying cause of death.

*17 of the 19 included studies are included in this table; the remaining two studies assessed only physicians’ knowledge in filling out DCs without referring to errors (Ali and Hamadeh 2013; Mahdavi et al. 2015).

*Abdulmalek, L. (2013). The accuracy of hospital death certificate in Benghazi, Libya. 2nd Libyan Scientific Conference of Medical Students and Young Doctors.

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*Al-Kubaisi, N. J., Said, H., & Horeesh, N. A. (2013). Death certification practice in Qatar. Public Health, 127(9), 854–859. https://doi.org/https://doi.org/10.1016/j.puhe.2012.12.016.

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*Alipour, J., Karimi, A., Hayavi Haghighi, M. H., Hosseini Teshnizi, S., & Mehdipour, Y. (2020). Death certificate errors in three teaching hospitals of Zahedan, southeast of Iran. Death Studies, 0(0), 1–9. https://doi.org/https://doi.org/10.1080/07481187.2020.1801893.

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*Aljerian, K. (2019). Death certificate errors in one Saudi Arabian hospital. Death Studies, 43(5), 311–315. https://doi.org/https://doi.org/10.1080/07481187.2018.1461712.

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*Ansary, L. A., Esmaeil, S. A., & Adi, Y. A. (2012). Causes of death certification of adults: An exploratory cross-sectional study at a university hospital in Riyadh, Saudi Arabia. Annals of Saudi Medicine, 32(6), 615–622. https://doi.org/https://doi.org/10.5144/0256-4947.2012.615.

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*Kheir, A., Abdelghani, A., Abdalrahman, I., & Dafaalla, M. (2016). Adequacy of death certification in a tertiary teaching hospital in Sudan. The Online Journal of Clinical Audits, 8(3).

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*Mahdavi, A., Sedghi, S., Sadoghi, F., & Fard Azar, F. E. b. (2015). Assessing the awareness of agents involved in issuance of death certificates about death registration rules in Iran. Global Journal of Health Science, 7(5), 371–379. https://doi.org/https://doi.org/10.5539/gjhs.v7n5p371

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*Sibai, A., Nuwayhid, I., Beydoun, M., & Chaaya, M. (2002). Inadequacies of death certification in Beirut: Who is responsible? Bulletin of the World Health Organization, 80(7), 555–561. https://doi.org/https://doi.org/10.1590/S0042-96862002000700007

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*Ali, N. M. A., & Hamadeh, R. R. (2013). Physicians’ knowledge and practices in death certificate completion in the Kingdom of Bahrain. Journal of the Bahrain Medical Society, 24(1), 17–23.

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