ABSTRACT
This study was undertaken to identify the underlying causes of death as recorded in the death certificates over a one year period [1995] at the Salmaniya Medical Complex [SMC], Bahrain. The 741 death certificates reviewed in this study represented 88% of 842 deaths occurred at SMC, and 41% of the total 1786 deaths in Bahrain, as reported in the National Health Data of the Ministry of Health. The underlying causes of death as recorded in the SMC and the National Data showed differences that were statistically significant [P<0.005]. Moreover, there was lack of concordance between the documented cause of death and the underlying disease in 26.9% of cases in the reviewed certificates. This discordance was specifically noticed in the case of deaths assigned to cardiovascular disease and septicemias, where more deaths were assigned to these two categories than was justified from the records. Furthermore, diseases like researchers were able to reinterpret the records and revise the recorded causes of death and the underlying diseases. It was also noticed that death could not be attributed to any specific cause in 3.1% of reviewed certificates. It is concluded that the death certificates should be recorded by experienced clinicians and should represent the correspondence between the actual cause of death and the underlying disease, thus maintaining the relationship between morbidity and mortality statistics