Introduction Vital registration is an important element in health information systems which can inform policy and strengthen health systems. Mexico has a well-functioning vital registration system; however, there is still room for improvement, especially for deaths of children under 5. This study assesses the quality of the vital registration system in capturing deaths and evaluates the quality of cause of death certification in under-5 deaths in Yucatan, Mexico. Methods We collected information on under-5 deaths that occurred in 2015 and 2016 in Yucatan, Mexico. We calculated the Vital Statistics Performance Index (VSPI) to have a general assessment of the vital registration performance. We examined the agreement between vital registration records and medical records at the individual and population levels using the chance-corrected concordance (CCC) and cause-specific mortality fraction (CSMF) accuracy as quality metrics. Results We identified 966 records from the vital registry for all under-5 deaths, and 390 were linked to medical records of deaths occurring at public hospitals. The Yucatan vital registration system captured 94.8% of the expected under-5 deaths, with an overall VSPI score of 87.2%. Concordance between underlying cause of death listed in the vital registry and the cause determined by the medical record review varied substantially across causes, with a mean overall chance-corrected concordance across causes of 6.9% for neonates and 46.9% for children. Children had the highest concordance for digestive diseases, and neonates had the highest concordance for meningitis/sepsis. At the population level, the CSMF accuracy for identifying the underlying cause listed was 35.3% for neonates and 67.7% for children. Conclusions Although the vital registration system has overall good performance, there are still problems in information about causes of death for children under 5 that are related mostly to certification of the causes of death. The accuracy of information can vary substantially across age groups and causes, with causes reported for neonates being generally less reliable than those for older children. Results highlight the need to implement strategies to improve the certification of causes of death in this population.

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Background Reducing neonatal and child mortality is a top priority for global health agendas and relies in part on the degree to which the population can access quality health services in a timely manner. This study explores the delays faced during the search for care by caregivers of children under the age of 5 who died in the State of Yucatan, Mexico, during 2015–2016 using the three delays framework as a way to identify bottlenecks and areas susceptible to intervention to reduce these deaths.Methods Cross-sectional study of all children under 5 years of age who died in the State of Yucatan, Mexico, during 2015 – 2016. Information on delays was obtained through household interviews with the caregiver of the child.Results Among 298 cases of children who experienced a health problem and searched for care, 252 had complete information for the study. Over 61% of those children visited more than one facility to seek care and had long times to start seeking care. The beginning of the search for care process was shorter when mothers or caregivers sought care initially at a public facility, and when some symptoms like coughing, lethargy, or rash were detected in the child. The second delay, travel time to facilities, was longer in children enrolled in Seguro Popular as compared to children covered by other forms of social security. Finally, the third delay, waiting time to be seen in the facility, was more common in public facilities that are not hospitals, and more common among children who also experienced a long travel time.Conclusions The results suggest that health promotion actions to reduce the time to search for care when facing a health problem and providing resources to mothers and caregivers to access health services in a timely manner may reduce these delays. This information can help in the planning of health services and improve their impact on population health.