ASSESSING CHRONIC KIDNEY DISEASE AS A CAUSE OF DEATH ON MEDICAL CERTIFICATION RECORDS AT A TERTIARY HOSPITAL IN ZIMBABWE

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Abstract Title *

ASSESSING CHRONIC KIDNEY DISEASE AS A CAUSE OF DEATH ON MEDICAL CERTIFICATION RECORDS AT A TERTIARY HOSPITAL IN ZIMBABWE

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Co-author 1

Rumbidzai Dahwa rfdahwa@gmail.com University of Zimbabwe Faculty of Medicine and Health sciences Harare Zimbabwe * University of New South Wales Faculty of Medicine and Health Sydney Australia The George Institute for Global Health University of New South Wales Sydney Australia

Co-author 2

Rohina Joshi rohina.joshi@unsw.edu.au University of New South Wales Faculty of Medicine and Health Sydney Australia - The George Institute for Global Health University of New South Wales Sydney Australia

Co-author 3

Martin Gallagher martin.gallagher@unsw.edu.au University of New South Wales Faculty of Medicine and Health Sydney Australia - The George Institute for Global Health University of New South Wales Sydney Australia Liverpool Hospital Department of Renal Medicine Sydney Australia

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Introduction

Reliable data on causes of death is essential for health policy, planning, and evaluation. Chronic kidney disease (CKD) affects an estimated 10% of the global population and approximately 13.9% in Sub-Saharan Africa, yet it does not feature among the top ten causes of death in Zimbabwe according to the 2019 WHO report. This discrepancy suggests underreporting of CKD and other chronic diseases. This study aimed to (a) assess the quality of medical certification of cause of death (MCCD) at a tertiary care hospital in Zimbabwe and (b) explore the extent of underreporting of CKD as a cause of inpatient death.

Methods

A retrospective review was conducted of all adult inpatient deaths at Sally Mugabe Central Hospital, Harare, between January 1 and December 31, 2022. Deaths with CKD, kidney injury, or nephrotic syndrome listed as a cause of death were identified from the hospital health information system. Corresponding medical records were reviewed to verify the recorded causes of death through clinical history, laboratory, and radiological findings. Every tenth record among deaths without kidney disease mentioned was systematically sampled to assess for undocumented CKD. The quality of MCCDs was evaluated using a modified University of Melbourne Rapid Assessment Tool.

Results

Of 1,316 deaths, 56 (4.3%) listed kidney disease as a cause of death; 44 records were retrievable for analysis. The mean age was 59.8 years; 55% were female; HIV status was unknown in 55% and positive in 32%, with 30% of HIV-positive patients on Tenofovir. In 48% of cases listing kidney disease as a cause of death, the diagnosis was not supported by laboratory or radiological evidence. Among 126 systematically sampled records from non-kidney deaths, 35 (28%) showed clinical evidence of CKD not recorded on the MCCD. In 63% of these, CKD had been investigated but not diagnosed by the treating team.

Conclusion

CKD appears to be underreported as a cause of death in this tertiary hospital setting, and documentation quality on MCCDs is suboptimal. These findings highlight the need for structured training on accurate death certification to improve the quality of mortality data and strengthen health policy planning.

Kewords