Death by definition

MONITORING the number of deaths and their causes can help identify the next pandemic or health crisis, according to the United Nations Economic and Social Commission for Asia and the Pacific (Unescap).

Unescap said this is one of the key messages of the latest report on the region’s progress in achieving universal civil registration and vital statistics (CRVS) systems by 2024. The Regional Action Framework contains 15 targets.

The report noted that the timely mortality statistics disaggregated by causes of death are needed to develop and monitor public health policies and detect emerging health crises such as the Covid-19 pandemic.

“The recent surge in Covid-19 in our region once again highlights the urgent need for universal civil registration of births, deaths and causes of death,” Armida Salsiah Alisjahbana, United Nations Under-Secretary-General and Executive Secretary of Unescap, said. “These developments emphasize the importance of our work to improve CRVS systems in the region.”

Needed: Accurate doc’s certification

Unescap stressed that there is a need to further train doctors and increase their awareness of the importance of accurate death certification. These, the UN agency said, are some of the actions that countries can take to help combat this trend.

“While many countries have reported great success in reducing the number of children born without a birth certificate, far too few deaths in the region are registered with a medically certified cause of death,” Unescap said.

Based on the report, the Philippines is stagnating in meeting the targets on reducing ill-defined cause of death code and in the use of verbal autopsy.

The report stated that 22 countries did not have regular training provided on cause of death coding. The report added that nine of these countries did not have ad hoc training either.

Unescap said verbal autopsy involves interviewing persons familiar with the deceased to determine the likely cause of death. This is currently used by 13 countries, and more are planning to do so by the end of the decade.

Meanwhile, the Philippines was also stagnating in achieving higher birth registration of children under five and the population whose birth has been registered.

Unescap noted that birth registration is crucial in creating a legal identity and “permanent” record of a child’s existence.

This is also part of the targets set under the Sustainable Development Goals (SDGs) which need to be met by 2030.

“Even for countries with high birth registration completeness, it is not clear if they have truly achieved universal registration, and even one unregistered birth is one too many,” Unescap said.

The Unescap said since 2012, the number of unregistered children under five across Asia and the Pacific has been reduced by half, resulting in greater access to health, education and financial services.

However, death registration is lagging behind with only a third of all deaths in the region receiving a death certificate and medically certified cause of death. A key reason for this is a lack of training for doctors and coroners.

Causes of death

MOST of the 10 leading causes of death have already exceeded their averages in the last five years, according to the Philippine Statistics Authority (PSA).

Based on PSA data, ischemic heart diseases have killed 105,114 Filipinos in 2020. This is 22,567 more than the total average of 82,547 Filipinos who died of the disease between 2015 and 2019.

However, a total of 34,251 Filipinos died of pneumonia in 2020. This is 22,579 less than the 56,830 Filipinos who died of the disease between 2015 and 2019.

“The top three causes of death in 2020 retained their respective ranks in terms of their averages in the last five years,” the PSA added.

Filipinos who died of ischemic heart diseases in 2020 posted the highest increase compared to their five-year average, while pneumonia posted the largest reduction compared to the 2015 to 2019 period.

The top three causes of death in 2020 were ischemic heart diseases, neoplasms, and cerebrovascular diseases. A total of 66,179 Filipinos died of neoplasms and 64,104 passed away due to cerebrovascular diseases.

Deaths caused by Covid-19 last year accounted for a total of 30.14 deaths or 4.9 percent of the total registered deaths in 2020.

By classification, Covid-19 with virus not identified was the seventh leading cause of death in the country with 20,840 cases or 3.4 percent of the total deaths in 2020.

Meanwhile, registered deaths due to Covid-19 with virus identified accounted for 9,300 or 1.5 percent of the total deaths in 2020, making it the top 14 cause of death during the year.

By regions

Among the 17 regions, the National Capital Region (NCR) registered the highest number of deaths due to Covid-19 with 13,004 or 43.1 percent of the total Covid-19 deaths.

In NCR, Quezon City reported the highest number of deaths due to Covid-19, with 2,637 deaths or 20.3 percent of the total Covid-19 deaths in the region.

This was followed by the City of Manila and City of Pasig with 1,961 or 15.1 percent and 1,465 or 11.3 percent Covid-19 deaths, respectively.

The data also showed that Covid-19 deaths in Calabarzon ranked second with 7,001 deaths or 23.2 percent of total deaths in the country last year.

This was followed by Central Luzon, which came in third with 2,692 deaths, or a share of 8.9 percent of total Covid-19 deaths.

Other regions that registered over a thousand Covid-19 deaths were Central Visayas and Western Visayas, with 2,362 or a 7.8-percent share; and 1,138 or 3.8-percent share of deaths, respectively.

Meanwhile, the Autonomous Region in Muslim Mindanao (ARMM) reported the least number of registered Covid-19 deaths with only 52 or 0.2 percent of the total.

The PSA noted that the data on causes of death presented in this press release were obtained from the timely and late registered deaths at the Office of the City/Municipal Registrars throughout the country and submitted to the Office of the Civil Registrar General through the PSA Provincial Statistical Offices for encoding.

Information presented includes deaths that occurred from January 2020 until December 2020 (cut-off date is as of 17 June 2021 on the processed death certificates).

The data is considered preliminary and may differ in the final counts. Deaths of Filipinos abroad were also not yet included—only those who died in the country but whose usual residence is abroad.

Images courtesy of Bernard Testa, AP/Aaron Favila and unescao.org

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