Deaths caused by HIV disease under-reported in South Africa

Abstract

Modelling of trends in age-specific death rates in South Africa suggests that deaths attributable to HIV are often misclassified on death notification forms. We compared the underlying cause of death from death notification forms with that based on scrutiny of medical records for 683 deaths in Cape Town. Of 129 deaths caused by HIV according to medical records, only 35 (27.1%) were ascribed to HIV on the death notification form using strict coding and 83 (64.3%) using interpretive coding.

Exposing misclassified HIV/AIDS deaths in South Africa

“…In addition, the developing country standard proved similar to the global standard for most Many of the source causes identified and the age and sex patterns noted for the corrected data are in line with previous findings. Tuberculosis and other respiratory infections, intestinal infectious diseases, parasitic diseases, meningitis, other infectious conditions, digestive disorders and ill-defined ailments were found to be common sources of misclassifications in an audit, 7 and Groenwald et al additionally identified nutritional deficiencies and non-communicable respiratory diseases as misclassification sources when they examined mortality rates between 1996 and 2001. 12 Nephritis, cancer and cardiovascular disease were also identified by these studies as potential misclassification sources 7,12 but were not found to be source causes in this analysis, perhaps because they contributed relatively little.…”

“…The use of codes for ill-defined conditions as underlying causes in death certificates often reflects local patterns of medical training 16 and, as mentioned earlier, coding quality is poor in South African death registration data. [7][8][9][10]12 The rise of co-infection with tuberculosis and HIV and the high rates of transmission of tuberculosis seen in mining communities have affected tuberculosis epidemiology in South Africa and may have altered the relative age pattern of deaths from tuberculosis. 1,[34][35][36] In addition, smooth relative death rates require large data sets.…”

“…Death certificate audits have revealed errors in as many as 45% of all records, a situation that hampers cause of death analysis. [7][8][9][10] Moreover, misclassification of HIV/AIDS deaths occurs for reasons beyond these general quality issues. According to the guidelines given in the International Classification of Diseases and Related Health Problems, tenth revision (ICD-10), HIV/ AIDS is the underlying cause of death when an HIV-positive individual dies from a co-morbid condition resulting from the HIV infection (codes B20-B24).…”

Correcting and estimating HIV mortality in Thailand based on 2005 verbal autopsy data focusing on demographic factors, 1996-2009

“…Underreporting of HIV deaths is common in developing countries, and has been documented in Botswana [1], Brazil [2,3], South Africa [4,5], and Thailand [6][7][8], due to under-registered deaths and misclassification of cause of death. These problems severely limit the value of routine mortality data for public utility and affect resource allocations by policymakers.…”

South Africa’s vital statistics are currently not suitable for monitoring progress towards injury and violence Sustainable Development Goals

“…[6] However, there are still concerns about the quality of data relating to the cause of death, i.e. underreporting of HIV/AIDS deaths owing to misclassification to other causes, [7][8][9][10] a large proportion of deaths with ill-defined causes, [11] and the validity of single-cause data. [12] The misclassification of injury deaths is another major limitation.…”