A district-level model review system to strengthen coverage and quality of Medical Certification of Cause of Death in India: Protocol for a population based feasibility and effectiveness study

Abstract Background: The current coverage of MCCD in India is only 22%. This is due to incomplete coverage of hospitals under MCCD and also lack of a system for non-institutional deaths in the country. The quality of MCCD in the country is also poor. One of the main reasons for this is the lack of review and feedback at the district level. This study would be the first of its kind study in the country to test the effectiveness and feasibility of involving the district level CRS/Health dept officials in review of MCCD Objectives: To assess the feasibility and effectiveness of a district level review system for MCCD in improving the coverage and quality of MCCD Methods: The study would be conducted in Chikkaballapura district for a period of 2 years. Local Registrars would do a first level of review of MCCD forms for completeness, use of abbreviations, legibility. They would also ensure that form 4/4A is written for all registered deaths in their area. A MCCD review committee would assess the quality of MCCD forms on a monthly basis and provide feedback to the certifying doctors. Comparison of the pre-test and post-test coverage and quality of MCCD will be done. Results: Constitution of the audit committee, training of local registrars, doctors and committee members and baseline assessment have been completed. Intervention has been started from Nov 2025. Expected Outcomes: Improved coverage and quality of MCCD and as a result cause of death data of the district