Death Certificate in Bangladesh: A Guide to Writing According to ICD-10

Introduction

A death certificate is an official document that records a person’s death and its cause. The International Classification of Diseases, 10th Revision (ICD-10) provides a standardized method for documenting causes of death. Proper completion of a death certificate is essential for legal, medical, and statistical purposes. This guide will explain the key components, structure, and best practices for writing a death certificate according to ICD-10.

Importance of a Properly Completed Death Certificate

A well-documented death certificate serves multiple purposes:

• Legal Requirement: Acts as proof of death for inheritance, insurance, and legal matters.
• Public Health Monitoring: Helps in identifying disease trends and mortality rates.
• Medical Research: Contributes to epidemiological studies and healthcare planning.
• Family Records: Provides information for genealogical studies and personal records.

Structure of a Death Certificate

A standard death certificate includes three major sections:

1. Personal Information of the Deceased
2. Cause of Death Section
3. Certifier’s Information

1. Personal Information of the Deceased

This section records details such as:

• Full Name
• Date of Birth and Date of Death
• Sex
• Place of Death (Hospital, Home, or Other Location)
• Marital Status
• Occupation

Example:

Name: John Doe
Date of Birth: 15 March 1950
Date of Death: 20 June 2025
Sex: Male
Place of Death: General Hospital, Dhaka
Marital Status: Married
Occupation: Retired Teacher

2. Cause of Death Section

ICD-10 mandates a sequence-based format to record the cause of death. The sequence consists of:

• Immediate Cause (Line a): The final disease or condition leading to death.
• Intermediate Cause(s) (Line b & c): Conditions that led to the immediate cause.
• Underlying Cause (Last Line): The root condition that initiated the chain of events leading to death.
• Other Significant Conditions: Contributing conditions that played a role in death but were not the primary cause.

Example:

(a) Acute Respiratory Distress Syndrome (ARDS)  – Immediate Cause
(b) Pneumonia – Intermediate Cause
(c) Chronic Obstructive Pulmonary Disease (COPD) – Underlying Cause
Other significant conditions: Hypertension, Diabetes Mellitus

Example:

Here, hypertension led to coronary artery disease, which resulted in a heart attack.

Part 2: Contributing Conditions

Mention any other conditions that contributed to death but were not directly responsible.

Example: Diabetes Mellitus (E11.9)

This format ensures a logical progression from underlying to immediate cause, aligning with ICD-10 classification.

3. Certifier’s Information

This section contains details of the healthcare provider or certifier, including:

• Name of the certifier
• Qualification (e.g., MD, MBBS)
• Signature
• Date of Certification
• License Number (if applicable)
• Institution Name

Example:

Certifier Name: Dr. Sarah Ahmed
Qualification: MBBS, MD (Internal Medicine)
Signature: [Dr. Sarah Ahmed]
Date: 21 June 2025
License Number: 123456
Institution: General Hospital, Dhaka

Common Errors to Avoid

1. Using Mechanisms Instead of Causes: Avoid terms like “cardiac arrest” or “respiratory failure” unless specifying an underlying cause.
2. Illegible Handwriting: Always ensure clarity to prevent misinterpretation.
3. Incomplete Information: Every section must be thoroughly filled.
4. Incorrect Sequence of Causes: Ensure the correct progression from underlying to immediate cause.

Special Cases

1. Death Due to External Causes (Accidents, Homicide, Suicide)

For unnatural deaths, mention the exact cause and manner (e.g., motor vehicle accident, firearm injury).

Example:

(a) Traumatic Brain Injury – Immediate Cause
(b) Road Traffic Accident – Underlying Cause
Manner of Death: Accident

2. Maternal Death

If the deceased was pregnant or postpartum, specify complications related to pregnancy.

Example:

(a) Postpartum Hemorrhage – Immediate Cause
(b) Placental Abruption – Underlying Cause
Manner of Death: Natural (Pregnancy-Related)

3. Infectious Diseases (COVID-19, TB, HIV/AIDS)

For infectious diseases, clearly mention the pathogen if known.

Example:

(a) Acute Respiratory Distress Syndrome (ARDS)
(b) COVID-19 Pneumonia
(c) SARS-CoV-2 Infection
Other Conditions: Hypertension

Common Errors to Avoid

• Illegible Handwriting: Can cause misinterpretation and legal issues.
• Incomplete Information: Missing details can delay legal processes.
• Incorrect Cause of Death: Ensure alignment with ICD-10 coding.
• Vague Terms: Avoid terms like “old age” or “natural causes” without specifying medical conditions.

How to Improve Death Certification Practices in Bangladesh

• Training for Healthcare Professionals: Educate doctors on proper cause-of-death documentation.
• Mandatory Electronic Reporting: Implement digital death certification to reduce errors.
• Legal Reforms: Update laws to make death reporting more efficient and transparent

How to Overcome Documentation Challenges

• Use ICD-10 Guidelines: Refer to the WHO coding manual for accurate disease classification.
• Seek Clarification: Consult with colleagues or pathologists when uncertain.
• Use Electronic Death Certificates (EDCs): Digital systems reduce errors and improve legibility.

Frequently Asked Questions (FAQ) about Death Certificate

1. What is the ICD-10 Code for Death Certificates?

ICD-10 does not have a single code for death but classifies causes under categories like I46.9 (Cardiac Arrest, Unspecified) or J18.9 (Pneumonia, Unspecified).

2. Who Can Issue a Death Certificate?

A registered medical practitioner, coroner, or authorized health official can issue a death certificate.

3. Can Family Members Fill Out a Death Certificate?

No, only a licensed medical professional can certify the cause of death.

4. How to Handle an Unknown Cause of Death?

If the cause is unknown, mention “pending investigation” or “cause unknown” and update it once the autopsy report is available.

5. What Happens if a Death Certificate is Incorrect?

Corrections must be made by the certifying doctor and reissued through the legal process.

Conclusion about Death Certificate

Writing a death certificate according to ICD-10 requires precision, adherence to guidelines, and a clear cause-of-death sequence. Avoiding common errors and using standardized documentation improves medical records and public health data. By following these guidelines, healthcare professionals can ensure accuracy and reliability in death certification.

By understanding and applying ICD-10 principles correctly, medical professionals can contribute to better health statistics, policy-making, and patient record accuracy.

Bangladesh Birth & Death Registration Authority
https://bdris.gov.bd/

World Health Organization (WHO) – ICD-10 Guidelines
https://www.who.int/classifications/icd/en/