Paper-based death record-keeping in Bangladeshi cemeteries: a qualitative exploration of practices and expectations.

Background: Countries like Bangladesh face significant challenges in effectively registering and tracking deaths within their civil registration systems, which are essential for public health. To improve data collection for public health policy, death record-keeping at burial sites should be enhanced, particularly in areas where burial certificates are issued. With this in mind, we examined the traditional paper-based practices for recording deaths, the perceived significance of these practices, and the associated challenges, expectations, and concerns related to death record-keeping in Bangladeshi cemeteries. Methods: In 2021, we conducted an exploratory qualitative study involving 25 in-depth interviews with individuals who had lost relatives during the COVID-19 pandemic and key informant interviews with service providers at cemeteries. We complemented these interviews with non-participant observations of burial registration practices in seven cemeteries across urban, peri-urban, and rural settings. We used thematic analysis to interpret the data. Results: Our findings reveal diverse death record-keeping practices influenced by sociocultural and administrative dynamics, emphasising the necessity of accurate documentation for securing legal rights and social benefits, such as inheritance and welfare. Notable tensions exist between bureaucratic demands and the emotional realities of grieving families, particularly in non-standardised cemeteries, where acquiring death certificates poses challenges. Stakeholders view the anticipated digitalisation of death record-keeping as a transformative opportunity to streamline processes and improve access to information. However, this transition also highlights existing generational and educational disparities in technological skills, alongside ethical concerns regarding data security and user confidentiality. Conclusions: Our findings showcase the complex interaction between cultural practices, bureaucratic frameworks, and emerging digital technologies in managing death records in Bangladesh. They also emphasise the challenges of modernising traditional documentation methods, as well as the importance of maintaining death records for enhancing civil registration and vital statistics, asserting property rights, and monitoring mortality. A digital system could provide innovative and reliable mortality surveillance from cemeteries.