Objectives. To investigate the quality of cause of deathcertification and assess the level of under-reporting of HIV/AIDS as a cause of death at an academic hospital.Design. Cross-sectional descriptive retrospective review ofdeath notification forms (DNFs) of deaths due to naturalcauses in an academic hospital in Cape Town during 2004.Errors in cause of death certification and ability to code causesof death according to the 10th revision of the InternationalStatistical Classification of Diseases and Related Health Problems(ICD-10) were assessed. The association between seriouserrors and age, gender, cause of death and hospital ward wasanalysed. A sample of DNFs (N=243) was assessed for level ofunder-reporting of HIV/AIDS.Results. A total of 983 death certificates were evaluated.Almost every DNF had a minor error; serious errors werefound in 32.2% (95% confidence interval (CI) 29.3 - 35.1%).Errors increased with patient age, and cause of death wasthe most important factor associated with serious errors.Compared with neoplasms, which had the lowest error rate,the odds ratios for errors in endocrine and metabolic diseasesand genito-urinary diseases were 17.2 (95% CI 8.7 - 34.0) and17.3 (95% CI 7.8 - 38.2), respectively. Based on the sub-sample,the minimum prevalence of HIV among the deceased patientswas 15.7% (95% CI 11.1 - 20.3%) and the under-reporting ofdeaths due to AIDS was 53.1% (95% CI 35.8 - 70.4%).Conclusion. Errors were sufficiently serious to affectidentification of underlying cause of death in almost a thirdof the DNFs, confirming the need to improve the quality ofmedical certification
