The Covid-19 pandemic has shed new light on the number of deaths that are typically recorded in South Africa, with some questioning the manner in which these are recorded.
How does the process work? And what happens when a cause of death is unclear? We answer these and other questions in this factsheet.
Who must be notified when a person dies?
According to the the department of home affairs a death can be reported to:
An officer at the department
A member of the South African Police Service (SAPS), particularly in areas without a home affairs office
A South African embassy or consulate if the death happened outside the country
A legally recognised funeral undertaker
“Deaths must be reported within 72 hours,” Mosidi Nhlapo, director of births and deaths statistics at Statistics South Africa, the country’s national statistical agency, told Africa Check.
“In 2017, 78,5% of deaths were registered within this stipulated period, and almost 100% were registered by the end of the year.”
How are deaths recorded?
The DHA-1663 is also a source of statistical information on mortality and cause of death. It can be used to evaluate the health of the population, inform decisions on health policy and compare health across regions of the country.
How is the form completed?
According to the department of home affairs, a medical practitioner first confirms that the person is dead and verifies their identity. The doctor then completes four sections on the form, including the particulars of the deceased, their own details and the cause of death.
“The Births and Deaths Registration Act also authorises traditional leaders to complete a death notification form when a death occurs in remote rural areas where there is no access to health facilities,” Nhlapo said. Traditional leaders may then also describe the circumstances that led to the death.
The form is then given to the “informant”, usually a relative of the deceased, who provides their details on the form. The funeral undertaker completes the last section and submits the form to the department of home affairs.
If all is in order, the department will issue a death certificate and burial order. The department will also update the national population register to reflect the death.
Statistics South Africa collects the DHA-1663 forms from the department of home affairs for processing. The agency analyses the data and produces reports on mortality and causes of deaths, which are made available to the public.
How is the cause of death determined?
The guidelines are used to “maintain international comparability”, Nhlapo told Africa Check.
According to the ICD10, there are three types of cause of death:
The immediate cause is the final disease that directly caused the death.
The underlying cause is the disease that started the sequence of events leading to the death.
Contributing causes contribute to the death but are not part of the direct causal sequence.
When completing the DHA-1663, the medical practitioner must decide what initiated the sequence of events that led to the death – the underlying cause. This usually determines whether the death was due to natural or unnatural causes.
“The death certificate issued by the department of home affairs does not specify the cause of death, only whether it was natural or unnatural,” Debbie Bradshaw, chief specialist scientist at the South African Medical Research Council, told Africa Check.
How are deaths due to Covid-19 certified?
Certifiers should try to include as much detail on the causal sequence of events, the WHO says. For example, the international health organisation’s guidelines state that in cases where Covid-19 caused pneumonia and fatal respiratory distress, both pneumonia and fatal respiratory distress should be listed along with Covid-19.
It’s possible for a person with Covid-19 to die of other causes, such as trauma from a motor vehicle accident. Such deaths are not due to Covid-19, and should not be certified as such, the WHO says.
What happens if the cause of death is not clear?
When a previously healthy person dies unexpectedly, the certifying doctor has to refer the case for a post-mortem investigation, Bradshaw said.
Post-mortem examinations or autopsies are performed by forensic pathologists, usually in a hospital mortuary or special examination room similar to an operating theatre. The internal organs are removed from the body and examined.
The certifying doctor is expected to exercise clinical judgement and can report the cause of death even if they are not 100% sure what the disease was.
“This is provided nothing untoward occurred, such as an injury, a reaction to medication or an act of medical negligence,” Bradshaw said.
What happens when a South African dies outside of the country?
According to the department of home affairs, the death of a South African outside of the country must be reported to the nearest South African embassy or consulate. The country in which the death occurred will issue a death certificate, a copy of which must be submitted to the relevant embassy.
If the deceased is to be buried in South Africa, the embassy will assist with paperwork and arrangements to transport the body to South Africa.
Erroneously and fraudulently registered deaths
It is possible for deaths to be erroneously or fraudulently registered but measures have been put in place to prevent this.
For example, funeral undertakers need to be registered with the department of home affairs and have to provide their registration number and fingerprints on the DHA-1663 form, Nhlapo said.
The form also provides space for the fingerprints of the deceased. “This was done to reduce instances of fraudulent deaths,” Nhlapo said.
If a person is still alive but has been recorded as dead, it must be reported to the nearest department of home affairs office for investigation.