A Study of Autopsy Procedures in Ghana: Implications for the Use of Autopsy Data in Epidemiological Analyses

The study of cause of death certification remains a largely neglected field in many developing countries; including Ghana. Yet; mortality information is crucial for establishing mortality patterns over time and for estimating mortality attributed to specific causes. In Ghana; in deaths occurring in homes and those occurring within 48 hours after admission into health facilities; autopsies remain the appropriate option for determining the cause of death. Although these organ-based autopsies may generate convincing results and are considered the `gold standard' tools for ascertainments of causes of death; procedural and practical constraints could limit the extent to which autopsy results can be accepted and/or trusted. The objective of our study was to identify and characterise the procedural and practical constraints as well as to assess their potential effects on autopsy outcomes in Ghana. We interviewed 10 Ghanaian pathologists and collected and evaluated procedural manuals and operational procedures for the conduct of autopsies. A characterisation of the operational constraints and the Delphi analysis of their potential influence on the quality of mortality data led to a quantification of the validity threats as moderate (average expert panel score = 1) in the generality of the autopsy operations in Ghana. On the basis of the impressions of the expert panel; it was concluded that mortality data generated from autopsies in urban settings in Ghana were of sufficiently high quality to guarantee valid use in health analysis

Review of the Structure and Function of Vital Registration System in Ghana: Towards Improvement in Mortality Data Quality for Health Policy Analysis

Vital registration systems (VRS) are important in the collection of routine data on indicators of development. These are particularly useful if they are properly built to address weaknesses in the system leading to poor data quality. For instance; routine data on health events (e.g. morbidity; mortality etc.) are crucial for rapid assessment of disease burden and mortality trends in the population. They are also useful in the identification of vulnerable groups in populations. Despite their usefulness; VRS in many developing countries including Ghana are poorly structured raising questions about the quality of the output data from these systems. The present study aimed at assessing and documenting the structure and function of the VRS in Ghana; as well as at identifying the structural features that potentially compromise the reliability and validity of the output data the system. To perform this study; collection and review of policy and legal documents establishing the VRS; documentation and evaluation of component structures of the system; assessment of procedural protocols guiding data collection processes and in-depth interviews with staff at the Ghana Births and Deaths Registry were performed. The assessment of the structure of the Ghana VRS; policy documents setting it up and the operational procedures reveals important lapses (e.g. presence of outmoded practices; imperfections in Births and Deaths Registry Act; 1965; Act 301 and imperfect system design) in the system that could compromise validity and reliability of the data generated from the registration in Ghana