Issue: December 2009
December 01, 2009
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Experts: Reporting on AIDS-related mortality in Botswana requires improvements

Issue: December 2009
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The vital registration system in Botswana may benefit from improvements in hospitals and government offices, according to results of a recent study.

Training physicians and coders in accurate reporting and recording of death statistics, implementing continuous quality assurance methods and working with government officials to underscore the importance of using mortality statistics in future evidence-based planning are strategies recommended by the researchers involved in the study for improving the registration system of the country.

The researchers conducted a retrospective study of a sample of deaths reported to a government vital registration database. Three physicians conducted independent reviews to determine the accuracy of the information in the medical records of the patients. The researchers used these reviews to examine sensitivity, specificity and other validity statistics.

More than 40% of the deaths in the country in 2005 occurred in the eight hospitals involved in the study.

Of 5,276 registered deaths, 29% (n=259) were related to HIV/AIDS. The independent physician consensus determined that 247 of those deaths were determined to be related to HIV/AIDS. This indicates that the positive predictive value of the vital registration system was 95.5%, according to the researchers.

There were 1,568 deaths not related to HIV/AIDS in the sample. Physician consensus determined that 1,083 of those deaths were not HIV/AIDS-related, resulting in a negative predictive value of 69.1% in the registration system.

The sensitivity of the registration system was 55.7%, and the specificity was 97.3%.

After corrections for misclassification had been made, HIV/AIDS may have accounted for 48.8% to 54.4% of the deaths, depending on the definition.

Taffa N et al. J Intl AIDS Soc. 2009;12:24.