Only 11.4 per cent of deaths in Kerala medically certified in 2023

KOLLAM: How many know that a Medical Certificate of Cause of Death (MCCD) is legally required when a person dies under the care of a doctor, whether in a government hospital, private hospital, or at home? Despite Keralas reputation as a public health model, the state shows a serious gap in the medical certification of deaths. Only 11.4% of the deaths registered in the state in 2023 were medically certified, according to the latest MCCD report of the department of economics and statistics. Out of 30.4 lakh deaths registered, just 34,705 had a doctors certificate recording the cause of death. That despite MCCD being mandatory under the Registration of Births and Deaths Act when a doctor attended the patient during the last illness. The report points to limited implementation, with the MCCD scheme functioning only in five urban local bodies Thiruvananthapuram, Kollam, Kochi, Kozhikode and Alappuzha covering just 150 hospitals across both public and private sectors. Among the medically certified deaths, circulatory diseases such as heart attacks and strokes account for 26.4%. Diabetes-related deaths have doubled over the past decade, rising from 10% in 2014 to 19% in 2023. However, the report notes that these figures likely represent only a small portion of Keralas actual disease burden. The report also says that when preparing MCCD, doctors must note the underlying cause the root disease or condition that initiated the chain of events leading to death along with the immediate cause of death. Accurate documentation helps the government understand mortality trends and plan health interventions, particularly in managing chronic illnesses such as diabetes and cardiovascular diseases. A senior health department official tells TNIE that many government hospitals are not consistently following MCCD norms. Most hospitals skip issuing MCCD The cause of death is always a sensitive issue. Hospitals often record only the final event, like heart attack or multi-organ failure, without noting the underlying condition. Most hospitals skip issuing MCCD, and the details remain only in the patients case summary. Relatives are also not aware of the requirement, so they rarely demand it, the official said. Another official with the health department says families usually seek the certificate only when faced with insurance claims, pension benefits, inheritance procedures or legal disputes. Most families are not interested in MCCD unless they run into a legal or financial issue. When the cause of death is not certified, they may face delays or denial of benefits. Hospitals also avoid the process because the government is not pushing for it. A simple circular could make hospitals comply, he said.