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Cause of Death
Zambia
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Zambia
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.
In cases where a registered medical practitioner attended a deceased during his or her last illness, unless there is reason to believe that the death did not result from natural causes, the medical practitioner is required to provide a certificate of the cause of death to any person with a duty to notify the death. This informant must deliver the certificate to the Registrar of the district where the death occurred within 48 hours of receiving it.
According to Rule 34(4) of the Births and Deaths Registration (General) Rules, a Registrar is not allowed to register a death without a medical certificate of cause of death or a coroner’s certificate provided at the conclusion of an inquest. However, the form for Notice of Death (Form XIII) appears to contemplate the alternatives of information from the police where a dead body has been found or a letter from a traditional leader regarding cause of death for home deaths.
In cases of medically attended deaths, the medical practitioner is required to provide a medical certificate of cause of death to the informant. This informant must deliver the certificate to the Registrar of the district where the death occurred within 48 hours of receiving it. Rule 34(4) of the Births and Deaths Registration (General) Rules, states that a Registrar is not allowed to register a death without a medical certificate of cause of death or a coroner’s certificate provided at the conclusion of an inquest.
However, in cases where death was not medically attended, it appears from the Notice of Death form (Form XIII) that the cause of death can be provided in a letter from a traditional leader. Form XIII also indicates that police must provide information about the cause of death where a body is discovered and brought in dead - but if the death is determined to have resulted from unnatural causes, the cause of death is determined in the coroner’s report. Under Section 14 of the Inquests Act, the coroner may direct that a post-mortem examination be carried out by a medical practitioner as part of the investigation into the circumstances of the death.
Does the law clearly state who is responsible for medically certifying cause of death, for natural deaths occurring in a health facility?
Yes
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 every case of a natural death where a registered medical practitioner attended the deceased during his or her last illness, Section 18(3) of the Births and Deaths Registration Act requires that medical practitioner to provide a certificate of the cause of death.
Does the law designate a certifier of cause of death, for natural deaths occurring under medical supervision but outside a health facility?
Yes
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.
In every case of a natural death where a registered medical practitioner attended the deceased during his or her last illness, regardless of whether the death occurred inside or outside a health facility, Section 18(3) of the Births and Deaths Registration Act requires that medical practitioner to provide a certificate of the cause of death.
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.
If an inquest takes place in terms of the Inquests Act, the cause of death will be determined in the course of the inquest. There is no explicit direction about transmission of inquest findings to the Registrar, but Rule 36 of the Births and Deaths Registration (General) Rules directs the Registrar to record the information from the coroner’s certificate in the register after an inquest.
The coroner has discretion to dispense with an inquest if it appears to the coroner that the death was due to natural causes, either on the basis of a post-mortem examination conducted by a medical practitioner or otherwise. It is not clear in the latter situation how the cause of death is determined and reported to the Registrar.
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 accords 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.
The medical certificate of cause of death for natural deaths is “Medical Form No. 14”, which is referenced but not prescribed by Rule 33 of the Births and Deaths Registration (General) Rules. The template for this form appears to emanate from the Ministry of Health; since it is not prescribed in law, it could change from time to time. The current version requests information on the immediate, antecedent and underlying cause of death, which is to be transferred to the Notice of Death (Form XIII) by the Registrar. An additional, more detailed cause of death form is prescribed for completion by a medical practitioner who attended the deceased during his or her last illness as a pre-condition for cremation [Form 2 in the Public Health (Crematoria and Cremation) Regulations].
Where a death is referred for a possible inquest, the inquests Act provides two forms that request information on the cause of death - one for the post-mortem examination conducted by a medical practitioner on the order of the coroner (Coroner's Form 3), and one to be completed by the coroner at the conclusion of the inquest (Coroner's Form 5). These forms both contain a "cause of death" data field but do not request immediate, antecedent, and underlying causes of death – making them inconsistent with the WHO MCCD. However, in practice, the coroner provides this information in the space at the end of the form.
Is the same form used for all types of deaths, including natural deaths and deaths referred to MLDI?
No
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).
The medical certificate of cause of death for natural deaths is “Medical Form No. 14”, which is referenced but not prescribed by Rule 33 of the Births and Deaths Registration (General) Rules. An additional, more detailed cause of death form is prescribed for completion by a medical practitioner who attended the deceased during his or her last illness as a pre-condition for cremation (Form 2 in the Public Health (Crematoria and Cremation) Regulations). Where a death is referred for a possible inquest, there are two forms that request information on the cause of death - one for the post-mortem examination conducted by a medical practitioner on the order of the coroner (Coroner's Form 3), and one to be completed by the coroner at the conclusion of the inquest (Coroner's Form 5).
