Differentials, barriers and enablers of death registration in Nepal: evidence from the Civil Registration and Vital Statistics (CRVS) survey

Death registration in Nepal is incomplete, which limits its utility as a routine source of mortality data to inform policy development. This study uses data from the Civil Registration and Vital Statistics (CRVS) Survey 2015/16 in Nepal conducted among households and CRVS service providers (local registrars) to assess the likelihood of death registration, using logistic regression with covariates of socio-economic, demographic and geographic characteristics. Respondents' main reasons for registration and non-registration of deaths and ways to improve the CRVS system are also analysed. Death registration (70%) was more likely where the decedent was male (77%) versus female (60%), older aged (45 years and above 70%) versus young aged (0-14 years 26%) or died of injuries (more than 70%) compared with maternal causes (12%), where the household head's education was higher and where the household haf more communication facilities. There were also large differences death registration by province and for certain ethnic groups. The main reasons for death registration were to transfer property entitlements, access social security or for other legal processes (a combined 85% of registered deaths). The major reason for non-registration of deaths according to most households (72%) and service providers (70%) was that it was not necessary. Both households and service providers stated that registration would be made more convenient by arranging mobile teams for registration, allowing registration at place of occurrence, and promoting online registration. The barriers and enablers identified in this study are valuable evidence to inform CRVS strengthening efforts in Nepal and other countries facing a similar challenge of incomplete death registration.