Citizen Junction / जनता कक्ष

How India's COVID -19 Death Recording System Works

Jaya Kumari

There is much chaos in general public and concerns about the accuracy of COVID - 19 death figures being made available by Government. Crematoriums and Graveyards are being approached to have an insight on the facts and data. Is the Government of India trying to hide the death figures. Are the death figures in India under reported and unaccounted?Let's dive in a little deeper to understand how exactly the database of deaths from COVID -19 is being prepared.So how the death is recorded for and being published?Firstly, There are 2 forms -Form -4 - Given by Hospital where the death occurred stating the reason of death according to the particulars mentioned therein, and Form - 4A - Given by Medical Practitioner under whom the Demised person was being treated at his /her own residence. (Many a time this form is ignored)These are the only readily available data right now with government, which govt. is publishing on their health Bulletin and is being shown in Media.The Crematoriums figures: Extent of accuracyWhen the relatives visit Crematoriums to bid adieu to their loved ones, they are asked to fill out a register specifying the reason of death.Who are these people maintaining the register(Form -2)?These people are called " notifier" under Civil Registration System of Govt of India. Now, no ordinary person in India are qualified enough to mention the appropriate technical terms in Reason of Death category. Normally they just give the reason as - Covid death or any other reason in their own word on the basis of their own perception and frame of mind.This data is not Internationally accepted and is used only for issuance of death registration certificate. And even that doesn't contain the reason of death.Final Database : Total Deaths at all India Level How finally the absolute figure of total Deaths is calculated and presented by GOI? The final database of Medically certified death is prepared under Civil registration System using the forms - Form-4 and Form-4A. This data present approximately only 21% (as per the WHO statement on 2018 data) of the total deaths at all India level. Earlier there were only 39,936 MCCD units covering only Govt. hospitals but many private hospitals have been added from 2020 in this list of MCCD units. This will definitely increase the coverage of MCCD for 2020 and 2021. This is the final data that gets recorded and published in Public domain and Annual report of Medical Certification of Causes of Death (MCCD) and is being reported in media.Reason of Death : Not a layman's JobWhile processing the data available from the forms, each death is classified under the specified reason of Death (Coded as per the guidelines of ICD-10 ( International Classification of Diseases , framed by WHO and accepted globally).Where is the final data?Now , a lot of people will say - "but this is not at all the final data". Like this, many deaths will go unrecorded and unaccounted for.There is no such term as Absolute numbers when it comes to Data. There is one more database that is prepared separately from these MCCD data through what they call as "Verbal Autopsy". These are the detailed oral questions that are asked from the members of the deceased person's family in the SRS units. At present, SRS is operational in 8847 sample units (4,961 rural and 3,886 urban) covering about 8.1 million population, spread across all States and Union territories.Verbal Autopsy: Bridging the Gap"VA can fill a critical gap in measuring the mortality from COVID-19 and other reasons for deaths which occur outside of a healthcare setting. A set of questions to identify COVID-19 deaths has been included in version 1.5.3 of the electronic (ODK) 2016 WHO VA instrument"How it is done: Through Sample registration system."A brief technical note has been added to the WHO VA Standards Manual that offers guidance for the use of VA to identify COVID-19 deaths. Specific information on each of the new questions can be found in the updated sections of the question by question instructions (Appendices A-C) of the VA Field Interviewer Manual for the 2016 WHO VA Instrument."These Field Interviewer from office of Registrar General Of India fills the VA forms designed by WHO and accepted internationally. These Field interviewers visits SRS units periodically (6 monthly) to record Verbal Autopsy.Codification of these VA forms are done by the qualified doctors under the entire supervision of AIIMS under the guidelines of WHO , and are finally inflated using the statistical tools meticulously designed by experts. This entire exercise takes time and currently due to various technical reasons -Lockdown, COVID Protocols etc. this has been delayed further. The technicality involved in the whole process cannot be covered under the single article.Lastly, today, amidst the crisis the world and India is going through , the pandemic that we are facing, where we all have lost someone ,this become all the more important to have an informed opinion. The data of deaths could be and is under reported owing to the fact that this only represent the Medically Certified Deaths but no death in India is going unaccounted for.(Views expressed in Citizen Junction columns are that of the author and solely of the author. Jaano Junction only provides the platform to publish your thoughts, opinions and concerns.)

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