Assessment of the national and subnational completeness of death registration in Nepal

Abstract

Background Reliable and timely mortality data from a civil registration and vital statistics (CRVS) system are of crucial importance for generating evidence for policy and monitoring the progress towards national and global development goals. In Nepal, however, the death registration system is not used to produce mortality statistics, because it does not providing data on age at death and only reporting deaths by year of registration. This study assesses the completeness of death registration in Nepal – both the existing offline system and the newer online system – as well as the completeness of death reporting from a CRVS Survey, and assesses differences by year, sex, ecological belt, and province. Methods The empirical completeness method is used to estimate completeness at all ages from the offline (paper-based) registration system (2013-17), the online registration system (2017-19) and the CRVS Survey (2014-15). Results Completeness of the offline death registration system was 69% in 2017, not increasing since 2013 and being higher for males (73%) than females (65%). Completeness of online registration was only 32% in 2019, but almost double the 2017 figure. Completeness of death reporting in the CRVS Survey was 75% in 2015. The largest subnational differentials in completeness exist for the offline registration system, ranging from 90% in Gandaki to just 39% in Karnali. Conclusions Improvement in the utility of the Nepalese death registration system for mortality statistics is dependent on continued roll-out of the online death registration system (which reports age at death and deaths by year of occurrence) throughout the country, focusing on areas with low registration, building a strong coordination mechanism among CRVS stakeholders and implementing public awareness programs about death registration.

Death Registration coverage in India: Results from nationally representative survey

“…A sizeable sex difference in death registration could be attributed to a lower proportion of females employed in the formal sector; therefore, a lower incentive is associated with female death registration. 13,14 In addition, a global scenario showed that female has a longer life expectancy than male, and India is not an exception to this fact, which may mean that there is no one to register a wife’s death after the death of the husband in a single household. 15 A higher proportion of accidental deaths among males (which are usually the subject of a police investigation) may lead to higher odds of death registration among males.…”

Estimation of national and subnational all-cause mortality indicators in Nepal, 2017

“…A study conducted to assess the quality and completeness of death registration data found that the completeness of the paper-based death registration system (i.e. offline data) is 69% at the national level, being below 50% in recent years in Madhesh and Karnali [ 13 ]. The recently introduced online death registration system still only operates in a minority of districts throughout the country, and so has completeness of just 32% [ 13 ].…”

“…offline data) is 69% at the national level, being below 50% in recent years in Madhesh and Karnali [ 13 ]. The recently introduced online death registration system still only operates in a minority of districts throughout the country, and so has completeness of just 32% [ 13 ]. Further, a limitation of the offline registration data for the production of mortality indicators is that it does not provide aggregated data by age at death.…”

“…Further, a limitation of the offline registration data for the production of mortality indicators is that it does not provide aggregated data by age at death. Further detail of the Nepal CRVS system is provided elsewhere [ 13 ].…”

“…In the absence of reliable data sources, the primary estimates of mortality in Nepal are reliant on irregular data from Population Censuses (conducted every 10 years, most recently in 2011) and surveys such as the Demographic and Health Survey (DHS) and the CRVS Survey [ 14 – 16 ]. The most recent data of reported deaths at all ages from one of these sources is from the CRVS Survey 2015/16, which had an estimated completeness of 75% [ 13 ]. Official mortality estimates are made indirectly by the Central Bureau of Statistics (CBS), who estimate the level and patterns of child mortality, life expectancy at birth and maternal mortality ratio by applying demographic methods to different data sources, including the Population Census and DHS [ 17 , 18 ].…”