Completeness of death registration in Ghana: an evaluation of multiple data sources and methods
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Supporting information
Published version
Author(s)
Agyei-Asabere, Charles
Bawah, Ayaga Agula
Frempong-Ainguah, Faustina
Baumgartner, Jill
Agyei-Mensah, Samuel
Type
Journal Article
Abstract
Introduction
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.
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.
Findings
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.
Conclusions
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.
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.
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.
Findings
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.
Conclusions
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.
Date Issued
2026-07-23
Date Acceptance
2026-07-08
Citation
PLoS ONE, 2026, 21 (7)
ISSN
1932-6203
Publisher
Public Library of Science (PLoS)
Journal / Book Title
PLoS ONE
Volume
21
Issue
7
Copyright Statement
© 2026 Agyei-Asabere et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
License URL
Identifier
10.1371/journal.pone.0354361
Publication Status
Published
Article Number
e0354361