Improving the quality of cause of death data for public health policy: are all 'garbage' codes equally problematic?

All countries need accurate and timely mortality statistics to inform health and social policy debates and to monitor progress towards national and global health development goals. In many countries, however, civil registration and vital statistics (CRVS) systems are poorly developed. Consequently, the statistics they produce are not fit for purpose. In part, this arises because the physicians certifying cause of death (COD) have either not been adequately trained in how to complete a death certificate according to the current International Statistical Classification of Diseases – Version 10 (ICD-10) [1], or they fail to appreciate the public health importance of what is often perceived as a largely administrative task [2]. This can be reinforced by cultural attitudes and perceptions among hospital administrators, who are generally unaware of the critical contribution that accurate medical certification of CODs makes to generating essential public health intelligence that can be used for planning. Unsurprisingly, these system deficiencies usually result in a high proportion of CODs being assigned to ‘garbage’ codes [3]. These have little or no public health value because they are too vague, are an immediate or intermediate COD, or are impossible as an underlying cause of death (UCOD). For example, septicaemia is often chosen as the underlying or precipitating COD when it is, in fact, the immediate cause arising from a many possible UCODs including communicable or non-communicable diseases, or an injury [3]. Prevention strategies would differ markedly depending on the UCOD; hence the importance of correct certification. Garbage codes bias a country’s true pattern of mortality. Studies of the quality of mortality statistics carried out in Thailand [4], Sri Lanka [5], and Iran [6], for example, have repeatedly found that the population’s likely true mortality pattern was considerably different from the pattern reported by the CRVS system. These discrepancies have been largely attributed to physicians’ extensive use of garbage codes

Medicinal and ethnoveterinary remedies of hunters in Trinidad

BACKGROUND: Ethnomedicines are used by hunters for themselves and their hunting dogs in Trinidad. Plants are used for snakebites, scorpion stings, for injuries and mange of dogs and to facilitate hunting success. RESULTS: Plants used include Piper hispidum, Pithecelobium unguis-cati, Bauhinia excisa, Bauhinia cumanensis, Cecropia peltata, Aframomum melegueta, Aristolochia rugosa, Aristolochia trilobata, Jatropha curcas, Jatropha gossypifolia, Nicotiana tabacum, Vernonia scorpioides, Petiveria alliacea, Renealmia alpinia, Justicia secunda, Phyllanthus urinaria,Phyllanthus niruri,Momordica charantia, Xiphidium caeruleum, Ottonia ovata, Lepianthes peltata, Capsicum frutescens, Costus scaber, Dendropanax arboreus, Siparuma guianensis, Syngonium podophyllum, Monstera dubia, Solanum species, Eclipta prostrata, Spiranthes acaulis, Croton gossypifolius, Barleria lupulina, Cola nitida, Acrocomia ierensis (tentative ID). CONCLUSION: Plant use is based on odour, and plant morphological characteristics and is embedded in a complex cultural context based on indigenous Amerindian beliefs. It is suggested that the medicinal plants exerted a physiological action on the hunter or his dog. Some of the plants mentioned contain chemicals that may explain the ethnomedicinal and ethnoveterinary use. For instance some of the plants influence the immune system or are effective against internal and external parasites. Plant baths may contribute to the health and well being of the hunting dogs