Introduction: Vital statistics is the core of a country's health information system as it provides estimates of the prevalence and distribution of mortality due to diseases and injuries guiding the health policies. Most developing countries face the challenges of data quality analysis of trends regarding the main causes of death since reliable data are restricted to either areas with a high socioeconomic level or metropolitan cities. Objectives: The objectives of this work were to; Identify the trend of ill-defined death rates in Egypt from 2000 to 2013 and to compare the trends of ill-defined causes of death in Egypt with that of selected countries of the EMR as well as to evaluate the impact of an intervention study on the accuracy of death certification in four health units of one district in Cairo, Egypt. Material and Methods: An ecological, exploratory study of multiple age groups and temporal series from 2000 to 2013, where it is possible to evaluate the temporal evolution of rates of ill-defined causes of death (CoD), through secondary data analysis, which included the total number of ill-defined CoD that were recorded as due to symptoms, signs, event of undetermined intent and ill-defined conditions, separated by sex and age groups. In parallel, a pilot intervention study to evaluate the impact of on job training on the accuracy of death certification in one district in Cairo, Egypt has been conducted. Results: A total of 3,385,965 ill-defined causes of death out of 6,478,279 deaths were identified between 2000 and 2013, mostly associated with coded symptoms and signs (chapter XVIII and event of undetermined intent) followed by heart failures 8.5-23% and 10-17% respectively. A reduction in the overall ill-defined causes of death from 0.41 before intervention to 0.22 after on job training which was conducted using lectures and discussion seminars.