Mortality statistics are widely used for medical research, monitoring of public health, evaluating health interventions, and planning and follow-up of health care.

Rules adopted by the World Health Assembly (WHA) regarding the selection of a single cause or condition, from death certificates, for the routine tabulation of mortality statistics are provided to standardize the production of mortality data.

WHO lists here ICD guidelines and tools for cause of death recording and reporting.

Implementation of the ICD for mortality further requires establishing an infrastructure for finding the dead person (civil registration), recording, reporting and storing information, information flows, quality assurance and feedback, and training for classification users working with the input or output of data.

It was agreed by the Sixth Decennial International Revision Conference 1948 (for ICD) that the cause of death for primary tabulation should be designated the underlying cause of death.

Effective public health interventions prevent harm or death by breaking the chain of events that lead to harm and death. WHO has defined the ‘underlying cause of death’ as follows:

the disease or injury which initiated the train of morbid events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury

- WHO definition of 'Underlying cause of death'

Reporting cause of death

Medical Certification - International form of medical certificate of cause of death

The principle of a cause of death and an underlying cause of death can be applied uniformly by using the medical certification form recommended by the World Health Assembly. It is the responsibility of the medical practitioner signing the death certificate to indicate which morbid conditions led directly to death and to state any antecedent conditions giving rise to the underlying cause of death.

Nationally, this “form of medical certificate of cause of death” is frequently incorporated into a form that includes other information required for administration purposes by national registration. It is sometimes referred to as 'medical certificate', 'cause of death certificate' or simply as 'death certificate'.

The current form was updated last in 2016, after more than 50 years. Changes are infrequent, because they require changes in national legislation and information systems.

International form of medical certificate of cause of death

The international mortality coding instructions presuppose that data have been collected with a death certificate conforming to the international form of Medical Certificate of Cause of Death as recommended by the WHO.

Go to form

ICD-11 reference guide

The Reference Guide contains information about design, context and use of ICD. For mortality, specific sections instruct about:
• Filling in the medical certificate of cause of death. It includes basic and advanced coding instructions for mortality.
• Coding the recorded information with ICD
• Selecting the underlying cause of death
• Standards and definitions for national and international reporting
The guidelines for mortality recording and coding applicable to ICD-10 can be found in Volume II of the 10th revision of the International statistical classification of diseases and related health problems.

ICD-11 reference guide

Cause of death flyer

A quick reference guide on how to fill in the medical certificate of cause of death. It includes a step by step approach and the frequently used ill-defined terms.

Cause of death flyer

WHO Recommendations for conducting an external inspection of a body and filling in the Medical Certificate of Cause of Death (MCCD)

Download

Download

Verbal Autopsy

Verbal autopsy has become an important source of information about causes of death in populations lacking medical certification. Verbal autopsy is an interview carried out with family members or caregivers of the deceased using a structured questionnaire to elicit signs and symptoms and other pertinent information that can later be used to assign a probable underlying cause of death.

WHO Verbal autopsy standards homepage

Mortality digital end to end solution

Forms, tools and training modules

electronic Medical Certificate of Cause of Death (eMCCD)

The medical certificate of cause of death is the basis for collecting information on causes of death electronically. The form is designed to collect all relevant aspects to assigning the cause of death.

In addition to the paper form template, the technical specifications for a digital form are made available.

The specifications serve to standardize input in line with the standard form and include a data dictionary for field names and content-encoding that allows processing the content with the API for coding and software for selecting the single underlying cause of death.

Digital tools for the cause of death selection

Coding software for mortality consists of programs that assist in coding, selecting the single underlying cause of death and assessing the quality of the coding or the quality of the data at the population level.

The WHO Digital Open Rule Integrated cause of death Selection DORIS tool assists in the selection of the underlying cause of death. It can be used online and offline.

The ICD mortality rules were converted into a digital format for processing by this software. WHO is aiming at convergence in the different efforts in programming such software.

Go to DORIS tool

Analysing Mortality and Causes of Death 3 (ANACoD-3)

This software performs a comprehensive and systematic analysis of mortality and cause-of-death data.

ANACoD3 analyzes sub-national level data to inform of potential health equity issues or outbreak patterns and to assess the plausibility of the results.

It also analyzes data over multiple time periods for trend analyses and allows for the analysis of cause-of-death data coded in ICD-10 as well as ICD-11.
It is available in multiple languages.

Go to ANACoD-3 tool

CoDEdit

Software that helps producers of cause-of-death statistics in strengthening their capacity to perform routine plausibility checks on their coding of data.

Allows for the analysis of cause-of-death data coded in ICD-10 as well as ICD-11.

Go to CoDEdit tool

Training module

Available modules

ICD-11 Training Package

This ICD-11 e-learning Tool is designed to build-up and enhance ICD-11 coding competency among the health coding workforce and other producers of ICD coded data.

This package has module on death certification.

Go to ICD-11 Training Package

WHO Interactive self-learning tool

The WHO electronic training tool is designed for self-learning and classroom use. The modular structure of this training permits user groups specific individualised tailoring of courses if desired. There are two mortality related modules of the training tool:
1- Certification self-learning module
2- Recommendations for conducting an external inspection of a body module and filling in the medical certificate of cause of death (upcoming).

Go to WHO Interactive self-learning tool

Forthcoming

WHO Academy ICD-11 coding and medical certification of cause of death courses

The Academy course for self-learning about ICD-11 addresses health coding workforce & Users of coded data, implementers and decision-makers. The courses are designed for digital learning and onsite learning. They will be available in UN languages, and can be used for learning individually or in a team. The design is modular, subdivided in fundamentals and in-depth learning. Accredited courses ensure quality with verifiable credentials The course will become available during 2022.