Introduction Despite the importance of mortality data, official reporting systems rarely capture every death. Completeness of death reporting and the subsequent effect on mortality estimates was examined in Bohol province in the Philippines using a system review and capture-recapture analysis.
Methods Records of deaths were collected from local civil registration offices, health centres and hospitals, and parish churches, and reconciled using a specific set of matching criteria. Two and three source capture-recapture analysis was conducted. For the two-source analysis civil registry and health data were combined due to dependence between these sources, and analysed against church data.
Results Significant dependence between civil registration and health reporting systems was identified. There were 8075 unique deaths recorded in the study area between 2002 and 2007. Government records capture only 77% of deaths, while 5%–10% of deaths were not reported to any source. Average life expectancy (2002–2007) was estimated at 65.7 years and 73.0 years for males and females respectively, 4–5 years lower than estimated from civil registration data alone. Reporting patterns varied by age and municipality with childhood deaths more under-reported than adult deaths. Infant mortality was under-reported in civil registration data by 62%.
Conclusion Deaths are under-reported in Bohol and uncorrected mortality measures would subsequently be misleading if used for health planning and evaluation purposes. These findings highlight the importance of ensuring official mortality estimates from the Philippines are derived from data that has been assessed for under-reporting and corrected as necessary.