The term “case register” (or disease register) is used for databases that have a clearly identified denominator population. Thus it can be used for epidemiological research and needs assessment, as well as to improve clinical care, and service quality. In the Dictionary of Epidemiology, Last had provided the following definition [5]:
· Register: In epidemiology the term register is applied to the file of data concerning all cases of a particular disease or other health-relevant condition in a defined population such that the cases can be related to a population base.
· Registration: the term implies something more than notification for the purpose of immediate action or to permit the counting of cases. A register requires that a permanent record be established, including the identifying data. Statistical tabulations may be prepared on frequency and associated factors. In addition, the persons listed on a register may be subjects of special studies.
Four characteristics that distinguished disease registers from other collections of clinical data are as follows (Institute of Health Sciences, UK): · Registers are based on people not events
· People registered have a feature in common
· Information held about these people is updated in a defined and systematic manner
· The register is based on a geographically defined population.
The International Epidemiological Association further distinguished three types of “register”: · Local hospital registers: serve one hospital and are files of all patients seen at that hospital with a particular disease
· Central registers: are as above, but include data from selected groups of contributing hospitals.
· Population-based registers: attempt to collect detailed information on all cases of a disease in a population of known size and composition. Effort is expanded to identify all cases whether treated in hospital or not.
It has been shown that a central register like NSRM can approximate a population-based register when all centres managing the condition in a defined area are contributing data and when the condition is universally managed in hospitals.
This is because the legal framework in Malaysia had provided for deaths by suicide, accident, disaster or ailment without recorded medical history to be considered as “sudden death” – which needs to be investigated and later required to be heard in an inquest by a magistrate’s court to establish whether there is any foul play. The post-mortem examination by a certified medical officer is one of the steps in these investigations, which means that the deceased shall be brought to the hospital. The Joint Technical Committee had had discussions with the Royal Malaysia Police regarding this matter, and the latter had given their assurance that this process had been already observed. The challenge now is to ensure the standard operating procedures for management of dead bodies by the respective hospitals is efficient enough to identify and capture cases of suicide. Another challenge is creating a reliable system for death certification for people staying in remote areas of the country.
