Understanding barriers and facilitators towards death notification and reporting in island districts of Uganda

Abstract

Death registration is a fundamental component of civil registration and vital statistics (CRVS) systems, providing essential data for public health monitoring and planning. However, many deaths remain unregistered, in low-resource settings such as island communities. Understanding the barriers and facilitators of death registration is critical for developing interventions and policies to improve compliance and improve CRVS systems. This study employed an exploratory qualitative approach, utilizing 8 focus group discussions with community health workers and leaders, 20 in-depth interviews with community members and 20 key informant interviews with officers involved in the death registration process. The study was conducted from February-August 2024 in Kalangala and Buvuma Districts, Uganda. Data were analyzed thematically, identifying barriers and facilitators. Key barriers included poverty, lack of awareness of death reporting and notification and fear of victimization, unknown identity of the deceased and privacy concerns regarding paternity and marital status. Additionally, religious and cultural beliefs, lack of skilled personnel to register deaths, shortage of supplies like registration forms, and an expensive unsynchronized system with many unofficial costs also hindered the process. However, family support, support from local authorities, and proximity to registration offices facilitated the death notification and reporting process. Addressing barriers to death registration necessitates a multifaceted approach, which includes ongoing community sensitization to raise understanding about the importance and process of death reporting and notification, as well as to eliminate fear of victimization. Community and religious leaders should be engaged during the sensitization process. Furthermore, NIRA and district health teams should procure more supplies while simultaneously hiring additional employees to bridge the human resource gap.