Drug-related Death low Registration in Iran: A Mixed Method Approach for Causes, Recommendations to Solve This Problem and Geographical Evaluation of an Intervention

Document Type : Original Article

Authors

1 1.Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran 2. Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran

2 Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran

3 Technical and Vocational Training, Mazandaran, Sari, Iran

4 Department of Social Medicine, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran

5 Vice Chancellery for Health, Iranian Ministry of Health and Medical Education, Tehran, Iran

6 Legal Medicine Research Center, Legal Medicine Organization, Tehran Iran

10.22122/ahj.2022.91975

Abstract

Background: The death registration is conducted by different systems in Iran. The drug-related death 
registration is exclusively conducted by Ministry of Health and Medical Education (MOHME) and Legal 
Medicine Organization (LMO). This study investigates the causes of undercounting drug-related deaths 
(DRDs) in Iran, provides recommendations for addressing this issue, and provides a geographical evaluation 
of the integrity and quality of drug-related mortality registration (2014–2017).

Methods: This is a mix-method study. In part1, individual targeted interviews were conducted with 12 
experts in death registration in MOHME and LMO to collect data on the causes of low registration in Iran 
and provide recommendations for resolving the issue. Part2 of the study involved an intervention in the 
form of a memorandum of understanding on reduction of low-registrations. This memorandum was signed 
to transfer information about the corpses between the MOHME and LMO. First, the number of DRDs (2014-
2017) was examined using capture-recapture method and, then, we calculated and compared the rate of preintervention (2014-2016) and post-intervention (2017) under-registration to assess whether this 
memorandum of understanding had been effective in reduction of under-registrations.

Findings: In part1, according to the participants, the causes of undercounting DRDs in LMO and MOHME 
were arranged and categorized into 4 categories: weak administration system, physician and personnel 
training problems, system constraints, and client-related problems. Also, some suggestions were presented 
to help resolving the problem of undercounting; these suggestions concern the administrative system, 
technology, and educational domains. In part 2, about half of the provinces in Iran had a positive 
performance in reducing the undercount.

Conclusion: At the macro level, the memorandum of understanding between the two organizations 
responsible for registering deaths was effective. However, increasing the quality of data registrations 
requires monitoring at the micro and organizational levels to lead to a positive performance in reducing 
death under-registration in all provinces.

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