Published in PLOS One on 2026-07-23, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Charles Agyei-Asabere, Ayaga Agula Bawah, Faustina Frempong-Ainguah, Jill Baumgartner, Samuel Agyei-Mensah, Emmanuel Botchway, Victor Sowah Abordo, Majid Ezzati
Source: PLOS One • DOI 10.1371/journal.pone.0354361
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The lack of a robust and comprehensive civil registration system undermines efforts to develop policies that address emerging health issues in a population. While Ghana has made significant strides in birth registration, progress in death registration has lagged despite the system’s introduction in 1888. Death records are dispersed across institutions and hampered by weak coordination and inconsistent data sharing. The study aims to evaluate the completeness of death registration using both demographic and empirical methods.
We assessed the quality of mortality data using demographic methods and further applied Death Distribution Methods (DDM) as well as the Empirical Completeness Method (ECM) to evaluate the completeness of death registration from the 2022 mortality register and two rounds of population and housing censuses.
Age reporting ranged between fairly accurate and rough, with noticeable under-reporting of under-five deaths. Death registration completeness was estimated at 28.7 percent and 56 percent using the ECM and DDM, respectively. DDM results reveal that male completeness was highest (101%) in the Volta Region and lowest (42%) in the Western Region, while female completeness was highest in Upper East (89%) and lowest in Western (35%) regions. Sub-national variations in completeness were further highlighted by the ECM, with completeness ranging from nearly 70 percent in Greater Accra to barely 8 percent in the Oti Region.
The study revealed that completeness of death registration remains low and incomplete, with minimal improvement over the past two decades. The findings underscore the urgent need to adopt innovative, targeted and coordinated approaches to improve completeness, ensuring Ghana can meet international commitments such as SDG 17.19.2.
Introduction
Death registration plays a key role in the production of accurate, timely, and reliable information on mortality and its causes, which is essential for developing effective public health policies to address emerging health issues in any population [1–4]. This aligns with global (the 2030 Agenda for Sustainable Development), regional (Agenda 2063: The Africa We Want), and national (Agenda for Jobs II: Creating Prosperity and Equal Opportunity for All 2022–2025) development goals. As reducing under-five and maternal mortality, as well as mortality rates attributable to non-communicable diseases, has become a focus, it is essential that countries are able to measure completely and accurately all forms of death to help monitor these targets. Although most countries have a method of recording deaths, completeness varies, with highly developed countries often achieving near completeness of registration [5–7].
Despite adopting successful methods, many low and middle-income countries (LMIC), especially in sub-Saharan Africa (SSA), struggle to achieve adequate completeness of death registration [8]. While improvements in healthcare and education often correlate with better registration, examples from Mexico, Serbia, and Moldova show that national wealth alone does not ensure registration [7,9,10]. Individual factors such as age, sex, socioeconomic status, and the deceased’s place of residence [11,12], circumstances of death, and where the death occurred [13] may influence the chances of the event being registered. Beyond these, the Civil Registration System (CRS) serves as a systemic determinant of death registration completeness [14]. Implying, not every death has the same chance of being registered.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Charles Agyei-Asabere, Ayaga Agula Bawah, Faustina Frempong-Ainguah, Jill Baumgartner, Samuel Agyei-Mensah, Emmanuel Botchway, Victor Sowah Abordo, Majid Ezzati. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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