Frequency, Plausibility and Internal Consistency of International Classification of Diseases (ICD) Coding Related to Cystic Echinococcosis Within the Jordanian Ministry of Health Database: A Quality-Assurance Study

Background/Objectives: Cystic echinococcosis (CE) remains endemic in many regions worldwide, including Jordan. It is one of the three zoonotic infections caused by the tapeworm of the genus Echinococcus. The epidemiology of CE in Jordan remains poorly defined, with systematic national investigations being absent for the past three decades. International Classification of Diseases (ICD) is a universal coding system for disease archiving within healthcare facilities. This coding system is utilized by the Hakeem program, a health informatics system that includes all Ministry of Health (MOH) hospitals and medical centers in Jordan. In this study, we assessed the frequency, plausibility, internal consistency, and administrative limitations of CE-related ICD codes within the MOH database, which have never been tested, and determined the validity of using the administrative data for epidemiological studies of CE in the future. Methods: A retrospective database study was conducted, using 12 echinococcosis-related ICD codes for electronic health record review. Data were retrieved from the Hakeem program. Unique patient entries recorded between 2010 and 2024 were extracted, and descriptive analytical methods were applied. Results: Over a 15-year period, 45,702 echinococcosis-related entries were reported across 178 healthcare facilities, with Amman accounting for the majority (59.1%) of reported entries. Entry numbers rose in the first 10 years (2010–2019) before a measurable decline and fluctuations in the following 5 years (2020–2024). Entries spanned all age groups, with middle-aged adults being the most frequently reported age group (42.45%). Females accounted for 74.4% of entries, reflecting a marked female predominance among coded entries. The most commonly reported ICD code was B67.8 (unspecified echinococcosis of the liver, 64.22%), followed by B67.5 (Echinococcus multilocularis infection of the liver, 33.57%). Confirmatory diagnostic data could not be extracted from the coding system. As a result, clinical validation could not be performed. Conclusions: The high frequency of echinococcosis-related entries suggests artificial inflation of CE-related codes, along with other data anomalies, reflecting internal inconsistencies and epidemiological implausibility of the administrative data within the Hakeem program. MOH should implement a dual, system-user-level plan to improve CE-related coding in the future.