Death certificates in the Middle East are often inaccurate, two new studies have found, which makes it difficult to determine which causes of death researchers and public-health specialists should focus their efforts on.
The first study, published in the Journal of Forensic and Legal Medicine, pooled the findings of five individual research papers, which had recorded or mentioned inaccuracies in death certificates throughout the region.
It’s difficult to even determine how inaccurate Middle Eastern death certificates are. Different Arab countries have different error rates, according the study authors, but there isn’t enough data to reliably assign a specific percentage to each country. They estimate that most countries in the Middle East have an error rate somewhere between 15 and 40 percent. Even the error rates at the lower end of that spectrum are significant enough to undermine the precision of scientific research that depends on death certificates.
“I’ve moved past the stage of panic and shock,” says Mohammed Madadin, an associate professor of forensic medicine at Imam Abdulrahman Bin Faisal University in Saudi Arabia and one of the study’s authors. “I’m now trying to gather more proof and information to describe the problem so we can begin to solve it.”
The most common errors that Madadin and his co-researchers observed in the certificates included the failure to detail the time interval between the onset of the cause of death and the death itself, the use of layman’s language instead of precise medical terms, the lack of a doctor’s signature, and even the failure to list the cause of death itself.
He is also suspicious of the recorded cause of death in many cases. For example, he says it’s very common to write “cardiac arrest” as the cause of death without any supporting evidence. Cardiac arrest means loss of blood flow because the heart has stopped beating, but that should be listed as a mechanism rather than a primary cause, he says.