DOI: 10.11648/j.wjph.20261104.14 ISSN: 2637-6059

Availability and Utilization of Tools for the Medical Certification of Causes of Death in Public Health Facilities in Senegal in 2025

Tidiane Gadiaga, Adja Diane, Ibrahima Ndiaye, Ngone Seck, Ousmane Dia, Amina Abdoulaye, Benjamin Clapham, Mohamed Soumah, Ousmane Thiam, Babacar Gueye
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Reliable data on causes of death are essential to guide health policy, yet fewer than one in ten deaths is medically certified in many sub-Saharan African countries. Since 2021, Senegal has progressively deployed a harmonized set of WHO-aligned death management tools, including a medical certificate of cause of death (MCCD); an initial 2023 assessment had revealed partial tool availability, frequent completion errors, and insufficient trained staff. A second national cross-sectional assessment was conducted in 2025, combining a facility-level structural audit with a systematic review of MCCDs completed in 2024, using a standardized digitized tool to record tool availability, utilization, and training coverage, and to score certificate content and form (score out of 30 points: poor ≤10, medium 11-20, good 21-30); data were analyzed descriptively. Of 183 targeted facilities, 147 (80.3%) were supervised (27/39 public hospitals [EPS], 69.2%; 120/144 health centers [CS], 83.3%). MCCD availability exceeded 90% in most EPS clinical departments but fell to 50-60% in surgery and intensive care and was nil in mortuaries; in CS, clinical documents were available in 99% of cases, versus 69-70% for mortuary-related registers, and utilization was consistently lower than availability. Training coverage reached 72.8% of supervised EPS departments and 73% of supervised CS. Among 1,469 MCCDs examined, representing 25% of the 5,852 medically certified deaths recorded nationally in 2024, only 292 (19.9%) were of good quality, 596 (40.6%) of medium quality, and 581 (39.6%) of poor quality, with poor quality predominating throughout the year (35.0-48.9% by month). The interval between disease onset and death was most frequently left blank (77%), and the causal sequence showed the highest error rate (27%), most often recording a sign or mechanism of death instead of a diagnosis. Only 46% of certificates were written in capital letters, 79% were legible, 66% were free of abbreviations, and 77% were free of crossing-out. Training deficit was the most frequently reported obstacle (65.6% of facilities), followed by non-availability of tools (13.1%). After two years of implementing harmonized death management tools, this assessment shows improved tool availability in Senegal's public health facilities but reveals persistent gaps in effective utilization and, above all, in the technical quality of medical certification, which remains well below what is required for reliable mortality statistics. Sustained initial and continuing training, systematic supervision, and uniform tool availability, particularly in surgery, intensive care, and mortuary services, are needed to ensure reliable cause-of-death data for national health policy.

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