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Table 2 Quality assessment of medical certificates of cause of death pre- and post-training in the Philippines, Myanmar, and Sri Lanka (training of trainers strategy)

From: Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative

AssessmentPhilippinesMyanmarSri Lanka
MCCODs with errors (%)MCCODs with errors (%)MCCODs with errors (%)
Pre-training (N = 975)Post-training (N = 959)Percentage improvement*Pre-training (N = 595)Post-training (N = 600)Percentage improvement*Pre-training (N = 517)Post-training (N = 558)Percentage improvement*
Incorrectly completed certificates (at least one error)72.943.640.199.874.833.495.468.528.2
 Certificates with one error37.228.423.621.723.7−9.225.932.3−24.7
 Certificates with two or more errors35.715.357.
Certificates with at least one major error41.622.645.663.244.829.158.837.536.2
Certificates with minor errors only31.321.132.536.630.018.036.631.015.3
Certificates with major errors
 Multiples causes per line21.26.071.624.410.855.738.920.846.5
 Incorrect sequence of events leading to death27.112.454.27.95.826.537.117.054.1
 Illegible handwriting0.81.1− 
 Ill-defined condition entered as an underlying cause of death28.615.545.844.532.726.54.410.6140.9
 Additional information on external cause not available4.81.275.0
 Additional information on neoplasms not available2.31.917.01.40.378.54.30.595.0
Certificates with minor errors
 Presence of blank lines within the sequence of events0.20.350.02.12.7− 28.6
 Abbreviations used in certifying the death7.10.888.750.831.038.936.020.343.6
 Absence of disease time interval37.423.736.693.465.330.
 Additional errors on the certificate5.
  1. Total column percentages may total > 100% as a single MCCOD may contain more than one error
  2. No data available
  3. *Negative values indicate lower quality after training
  4. Category may contain minor errors