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Cause of Death
Uganda
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Uganda
Cause of Death
Medical Certification
Medical Certification
Compulsory Certification
Does the law require a cause of death (CoD) to register a death?
Yes medical certificate of cause of death required
Recommended Practice based on International Guidelines
Ideally, every death will have a cause of death (COD) medically certified by a trained physician. However, in circumstances where a medically certified cause of death (MCCD) is not available, the death should be registered without COD information. Cause of death should never be determined by a non-medical professional.
In some countries, an MCCD is a precondition for registering a death. In countries where there are not sufficient health professionals adequately trained in completing a MCCD, and in countries where many deaths occur at home, this can lead to low death registration rates. Policymakers should carefully consider whether an MCCD or COD is required to register a death, or if evidence of the fact of death alone may be submitted to the registrar.
A person notifying a death is required to give the prescribed particulars of the death to the best of the person’s knowledge. Form 12 is the form provided in the Registration of Persons (Births and Deaths) Regulations for notifying a death, and it includes cause of death as one of the required particulars. However, the form provided on the website of the National Identification and Registration Authority - which is probably the one used in practice - does not ask the informant to give information on the cause of death.
A Medical Certificate of the Cause of Death completed by a medical professional is provided directly to the registration officer by the medical professional.
The Death Registration Handbook published by the National Identification and Registration Authority in 2022 indicates that a Death Notification Record from a health facility or a local administrative authority should be submitted along with the form provided by the persons notifying the death (Form 12), and states that a Medical Certificate of Cause of Death must be provided before this Death Notification Record can be issued.
Form 12, the form provided in the Registration of Persons (Births and Deaths) Regulations for notifying a death, asks the informant (who is not a medical professional) to state the cause of death, but the form provided on the website of the National Identification and Registration Authority - which is probably the one used in practice - does not ask the informant to give information on the cause of death.
A Medical Certificate of the Cause of Death completed by a medical professional is provided directly to the registration officer by the medical professional.
Does the law clearly state who is responsible for medically certifying cause of death, for natural deaths occurring in a health facility?
Yes. Medical officer who attended the deceased during last illness.
Recommended Practice based on International Guidelines
The law should state what person is responsible for certifying cause of death. The certifier may vary, based on the circumstances of the death. For natural deaths that occur in health facilities, the head of the health facility should be required by law to ensure a death is medically certified. Ideally, the certifier of the cause of death should be the physician or surgeon who attended the decedent during their terminal illness, although in countries that lack a sufficient number of medical doctors to staff health facilities, a nurse or other health professional may be trained to certify cause of death.
In terms of section 46 of the Registration of Persons Act, in any situation where the deceased was attended during his or her last illness by a medical officer (regardless of the place of death), the medical officer is required to sign a certificate stating the cause of death to the best of the medical officer’s knowledge, and to forward this certificate forthwith to the relevant registration officer for entry into the register.
According to regulation 21(2) of the Registration of Persons (Births and Deaths) Regulations, where the death occurred in a medical facility, the administrator of the facility must forward the Medical Certificate of the Cause of Death to the relevant registration officer within seven days of the death.
Does the law designate a certifier of cause of death, for natural deaths occurring under medical supervision but outside a health facility?
Unclear
Recommended Practice based on International Guidelines
For a home-based death due to natural causes, a certifier may include a doctor, nurse, or other trained health professional who attended the deceased during that person’s illness.
There are conflicting provisions. In terms of section 46 of the Registration of Persons Act, whenever a deceased was attended during his or her last illness by a medical officer, the medical officer is required to sign a certificate stating the cause of death to the best of the medical officer’s knowledge, and to forward this certificate forthwith to the relevant registration officer for entry into the register. Failure to fulfill these duties without reasonable cause is a criminal offence.
According to regulation 21(3) of the Registration of Persons (Births and Deaths) Regulations, whenever a person dies outside of a medical facility, the certificate of cause of death must be forwarded to the relevant registration officer by the person who carries out the post-mortem examination.
Thus, it is unclear whether the duty lies with the medical officer who attended the deceased during last illness or the post-mortem examiner.
Does the law clearly state who is responsible for medically certifying cause of death when deaths are unnatural or suspicious, or otherwise referred to the MLDI authority?
Yes.
Recommended Practice based on International Guidelines
Deaths due to unnatural causes (such as accident, self-harm or violence); man-made or natural disasters; suspicious causes, or where CoD cannot be determined by the attending physician should be referred to the Medicolegal Death Investigation (MLDI) authority for medical certification of cause of death. The certifier of cause of death should be the forensic physician working with the MLDI authority who conducted the post-mortem examination on the deceased.
Deaths are referred to the coroner for a possible inquest whenever there is reasonable cause to suspect that the death was violent or unnatural, or caused or accelerated by violence or wrongful conduct. Inquests are required in every case where a person died in custody or in a road accident, a workplace accident or a mine.
A coroner may require any government medical officer or any other medical practitioner to conduct a post-mortem examination, with a view to determining the cause of death, if the coroner considers it necessary for the purposes of investigation. In such instances, the person who carries out the post-mortem examination will complete a medical report stating the cause of death and provide this report to the coroner. The certificate of cause of death must be forwarded to the relevant registration officer by the person who carries out the post-mortem examination. If an inquest is held, it is the duty of the presiding Magistrate to forward a certified copy of the inquest finding to the registration officer for entry into the register.
In any case where a person dies outside of a medical facility, the certificate of cause of death is forwarded to the relevant registration officer by the person who carries out the postmortem examination. This rule would cover some suspicious deaths that are the subjects of inquests.
Does the law provide a form to certify cause of death? If yes, does the form accord with WHO Medical Certificate of Cause of Death Form?
Yes the law provides a form for certifying cause of death that does not accord with WHO Standard MCCD Form
Recommended Practice based on International Guidelines
The WHO international form of Medical Certificate of Cause of Death (WHO MCCD) is the recommended form for recording information regarding cause of death for certification of all deaths, including stillbirths and unnatural or suspicious deaths. There may be modifications to the form including addition of biographical information of the deceased in an administrative section. Countries may also modify the Manner of Death section in Frame B as appropriate for their context; however, the form should always include Frame B, including a manner of death section.
Two forms are provided for certification of cause of death, but neither is consistent with the WHO Medical Certificate of Cause of Death Form.
In terms of section 46 of the Registration of Persons Act and its accompanying regulations, a medical officer certifying a death uses Form 13 which is appended to the Registration of Persons (Birth and Death) Regulations. This Form records the following particulars: name of medical officer, name and address of hospital, name of deceased, the period that the medical officer has taken care of the deceased, the date of death and a certification of the cause of death to best of the medical officer’s knowledge and belief. It is to be modified as necessary in the case of deaths occurring outside a medical facility.
Where a Coroner orders a post-mortem examination, the medical report must be in Form D set out in Schedule 2 to the Inquests Act, which appears to be required in addition to Form 13. Form D records the following particulars: date and hour of receipt of corpse at mortuary, condition of corpse on arrival, mode in which packed, date and hour of holding examination, name of deceased (if known), the person who identified the body, approximate age, sex, height, hair color, eye color, peculiar clothing and any other marks or means of identity, and the probable date of death.
Form 13 is no longer used in practice despite remaining in the law; it has been replaced by Health Management Information System (HMIS) 100, which contains all of the fields contained on the WHO MCCD and facilitates reporting the immediate, antecedent and underlying causes of death, as well as manner of death. This form is used in all cases and submitted together with Form D in respect of deaths investigated by medicolegal authorities.
Is the same form used for all types of deaths, including natural deaths and deaths referred to MLDI?
Yes
Recommended Practice based on International Guidelines
It is recommended practice to use the same MCCD form which should be WHO MCCD compliant) for all types of deaths, including natural and unnatural deaths (and fetal deaths).
Although the law is not entirely clear on this point, it appears to require that Form 13 which is appended to the Registration of Persons (Birth and Death) Regulations is to be submitted in all cases of certification of cause of death, supplemented by Form D in Schedule 2 to the Inquests Act where a Coroner orders a post-mortem examination.
In practice, Form 13 has been replaced by Health Management Information System (HMIS) 100, which is used in all cases, and submitted together with Form D in respect of deaths investigated by medicolegal authorities.
