Factors influencing knowledge of doctors on medical certification of cause of death in Limpopo Province

The quality of mortality data in South Africa has been questioned because of the high percentage of deaths reported to be due to ill-defined causes. We sought to assess the level of knowledge of doctors on the International Classification of Diseases (ICD) rules for medical certification of cause of death and determine the factors influencing that knowledge. Methods A cross-sectional study was conducted across 12 hospitals in Limpopo Province among the five districts stratified by level of care. Doctors completed selfadministered questionnaire, which included the baseline characteristics and questions that tested their theoretical knowledge of the ICD rules of death certification. The outcome, an adequate level of knowledge was set at a score of ≥ 60%. A chi square test was used to determine the factors associated with the outcome. Ethical approval was obtained from Turfloop Research Ethics Committee, University of Limpopo. Results Of the 301 doctors who participated, 50.5% were female, 64% were junior doctors and 13% were specialists. Up to 49% of doctors worked in the two tertiary hospitals. Only 18% of the doctors have ever attended a Continuing Professional Development (CPD) on the topic. The mean overall score on knowledge of medical certification for all the doctors was 59.80% (±11.95) with 53% obtaining at least 60% on the questionnaire. Doctors lacked knowledge on identifying unnatural deaths and discerning the underlying cause of death. Factors associated with the adequate knowledge included years of clinical experience (p=0.01), previous training (p<0.001), awareness of guidelines (p=0.04), comfort level (p=0.01) and rank (p=0.02). Conclusion The study highlighted the need for training of all doctors in the province and identified the knowledge gaps. Interactive capacity-building workshops have been shown to improve knowledge of doctors on medical certification of cause of death in other studies. To improve the quality of mortality data in Limpopo Province