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Magaço A, Maixenchs M, Macete Y, Escritório N, Mucor R, Calia A, Sitoe A, Xirinda E, Vitorino P, Garel M, Breiman RF, Amouzou A, Bassat Q, Mandomando I, Blevins J, Munguambe K. Experiences of parents and caretakers going through the consent process to perform minimally invasive tissue sampling (MITS) on their deceased children in Quelimane, Mozambique: A qualitative study. PLoS One 2023; 18:e0286785. [PMID: 37294780 PMCID: PMC10256146 DOI: 10.1371/journal.pone.0286785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/23/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND In Mozambique, the Countrywide Mortality Surveillance for Action (COMSA) Program implemented a child mortality surveillance to strengthen vital events registration (pregnancies, births, and deaths) and investigate causes of death using verbal autopsies. In Quelimane district, in addition to the abovementioned cause of death determination approaches, minimally invasive tissue sampling (MITS) was performed on deceased children <5years of age. This study focused on understanding deceased children parents' and caretakers' experiences of the consent process to perform MITS in order to contribute to the improvement of approaches to cause of death investigation and inform efforts to maximize acceptability of mortality surveillance activities. METHODS A qualitative study was conducted in six urban and semi-urban communities in Quelimane district. A total of 40 semi-structured interviews with family members of deceased children and 50 non-participant observations of the consent process were conducted to explore their experience with informed consent request to perform MITS on their child. Data analysis of the interviews and observations was thematic, being initially deductive (predetermined codes) followed by the generation of new codes according to the data (inductive).The Consolidated criteria for reporting qualitative research (COREQ) guidelines for reporting qualitative studies were performed. FINDINGS Although most participants consented to the performance of MITS on their deceased child, some stated they had not fully understood the MITS procedure despite the informed consent process due to unclear information and their state of mind after their loss. Consenting to MITS and doing so with family members disagreeing were also identified as stress-enhancing factors. Participants also described dissatisfaction of family members, resulting from the condition of the body delivered after tissue collection. In addition, the waiting time to receive the body and resulting delays for the funeral were considered additional factors that may increase stress and compromise the acceptability of MITS. CONCLUSION Family experiences were influenced by operational and logistical issues linked to the procedure itself and by it being in tension with social and cultural issues, which caused stress and discontentment on parents and caretakers of deceased children. The main factors that contributed to the experience of going through the MITS process were the state of mind after the death, complex decision making processes within the family, washing of the body for purification after MITS and seepage, and limited understanding of consent for MITS. When requesting consent for MITS, emphasis should be placed on transmitting clear and understandable information about MITS procedures to participants.
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Affiliation(s)
- Amilcar Magaço
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Maria Maixenchs
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Yury Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Nelson Escritório
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Raquel Mucor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - António Calia
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - António Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Elisio Xirinda
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Mischka Garel
- Emory Global Health Institute, Atlanta, GA, United States of America
| | - Robert F. Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Agbessi Amouzou
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique
| | - John Blevins
- Emory Global Health Institute, Atlanta, GA, United States of America
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
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Suwalowska H. The invisible body work of 'last responders' - ethical and social issues faced by the pathologists in the Global South. Glob Public Health 2022; 17:4183-4194. [PMID: 35587285 PMCID: PMC9901416 DOI: 10.1080/17441692.2022.2076896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This paper utilises empirical data to explore the value of 'body work' performed by last responders charged with the duty of dead body management, with a focus on the Global South. While frontline staff work to save lives, little is known about the experiences and roles of those who care for the dead in global health in times of crises and even during normal times. This paper discusses ethical and socio-cultural challenges pathologists face in 'working on the bodies of others' while conducting any form of post-mortem procedures - necessary for ascertaining and recording the causes of death. Identifying and reporting the cause of death have significant public health benefits and provide closure for bereaved families. Despite the foregoing, the pathology field does not attract funding from governments or donors, and it is overlooked compared to other disciplines. Autopsy procedure bears social stigma - as it is associated with body mutilation and therefore disrespecting the dead; certain cultural beliefs or taboos about impurity and death persist, further raising some social and ethical tensions. As a result, the dearth of autopsy procedures contributes to the cause of death uncertainty in global health.
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Affiliation(s)
- Halina Suwalowska
- Nuffield Department of Population Health, Ethox Centre, Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK, Halina Suwalowska Old Road Campus, Oxford OX3 7LF, UK
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Lawrence S, Namusanya D, Mohamed SB, Hamuza A, Huwa C, Chasweka D, Kelley M, Molyneux S, Voskuijl W, Denno D, Desmond N. Primary motivations for and experiences with paediatric minimally invasive tissue sampling (MITS) participation in Malawi: a qualitative study. BMJ Open 2022; 12:e060061. [PMID: 35676022 PMCID: PMC9185590 DOI: 10.1136/bmjopen-2021-060061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To understand family member consent decision-making influences and experiences in Malawi in order to inform future minimally invasive tissue sampling (MITS) studies. DESIGN Qualitative study. SETTING Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, which serves as the central referral hospital for southern Malawi and where MITS participants were recruited from. PARTICIPANTS Families of paediatric MITS participants. METHODS We conducted in-depth interviews with 16 families 6 weeks after the death of paediatric MITS participants. Data were analysed using a combination of thematic content and theoretical framework approaches to explain the findings. RESULTS Improved cause of death (CoD) ascertainment was the principal motivator for participation to protect remaining or future children. Community burial norms, religious doctrine and relationships with healthcare workers (HCWs) were not reported influencers among family members who consented to the procedure. Primary consenters varied, with single mothers more likely to consent independently or with only female family members present. Clear understanding of MITS procedures appeared limited 6 weeks postprocedure, but research was described as voluntary and preconsent information satisfactory for decision-making. Most families intended to share about MITS only with those involved in the consent process, for fear of rumours or judgement by extended family members and the wider community. CONCLUSION Among those who consented to MITS, decision-making was informed by individual and household experiences and beliefs, but not by religious affiliation or experiences with HCWs. While understanding of the MITS procedure was limited at the time of interview, families found informed consent information sufficient for decision-making. Future MITS studies should continue to explore information presentation best practices to facilitate informed consent during the immediate grieving period.
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Affiliation(s)
- Sarah Lawrence
- Pediatrics, University of Washington, Seattle, Washington, USA
| | - Dave Namusanya
- Behaviour and Health Research Group, Abertay University, Dundee, UK
- Behavior and Health Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Sumaya B Mohamed
- Global Health, University of Washington, Seattle, Washington, USA
| | - Andrew Hamuza
- Behaviour and Health Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Cornelius Huwa
- Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi
| | - Dennis Chasweka
- Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi
- KEMRI Wellcome Trust Research Programme, The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
| | - Maureen Kelley
- KEMRI Wellcome Trust Research Programme, The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sassy Molyneux
- KEMRI Wellcome Trust Research Programme, The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Wieger Voskuijl
- KEMRI Wellcome Trust Research Programme, The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- Pediatrics, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Donna Denno
- KEMRI Wellcome Trust Research Programme, The Childhood Acute Illness & Nutrition Network, Nairobi, Kenya
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Nicola Desmond
- Behaviour and Health Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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4
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Bassat Q, Varo R, Hurtado JC, Marimon L, Ferrando M, Ismail MR, Carrilho C, Fernandes F, Castro P, Maixenchs M, Rodrigo-Calvo MT, Guerrero J, Martínez A, Lacerda MVG, Mandomando I, Menéndez C, Martinez MJ, Ordi J, Rakislova N. Minimally Invasive Tissue Sampling as an Alternative to Complete Diagnostic Autopsies in the Context of Epidemic Outbreaks and Pandemics: The Example of Coronavirus Disease 2019 (COVID-19). Clin Infect Dis 2021; 73:S472-S479. [PMID: 34910176 PMCID: PMC8672745 DOI: 10.1093/cid/ciab760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Infectious diseases’ outbreak investigation requires, by definition, conducting a thorough epidemiological assessment while simultaneously obtaining biological samples for an adequate screening of potential responsible pathogens. Complete autopsies remain the gold-standard approach for cause-of-death evaluation and characterization of emerging diseases. However, for highly transmissible infections with a significant associated lethality, such as COVID-19, complete autopsies are seldom performed due to biosafety challenges, especially in low-resource settings. Minimally invasive tissue sampling (MITS) is a validated new approach based on obtaining postmortem samples from key organs and body fluids, a procedure that does not require advanced biosafety measures or a special autopsy room. Methods We aimed to review the use of MITS or similar procedures for outbreak investigation up to 27 March 2021 and their performance for evaluating COVID-19 deaths. Results After a literature review, we analyzed in detail the results of 20 studies conducted at international sites, whereby 216 COVID-19–related deaths were investigated. MITS provided a general and more granular understanding of the pathophysiological changes secondary to the infection and high-quality samples where the extent and degree of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related damage could be evaluated. Conclusions MITS is a useful addition in the investigation and surveillance of infections occurring in outbreaks or epidemics. Its less invasive nature makes the tool more acceptable and feasible and reduces the risk of procedure-associated contagion, using basic biosafety measures. Standardized approaches protocolizing which samples should be collected—and under which exact biosafety measures—are necessary to facilitate and expand its use globally.
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Affiliation(s)
- Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Melania Ferrando
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Mamudo R Ismail
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic, Institut D'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - José Guerrero
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Antonio Martínez
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.,Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane-ILMD, Manaus, Brazil
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Miguel J Martinez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
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5
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Rakislova N, Rodrigo-Calvo MT, Marimon L, Ribera-Cortada I, Ismail MR, Carrilho C, Fernandes F, Ferrando M, Sanfeliu E, Castillo P, Guerrero J, Ramírez-Ruz J, Saez de Gordoa K, López Del Campo R, Bishop R, Ortiz E, Muñoz-Beatove A, Vila J, Hurtado JC, Navarro M, Maixenchs M, Delgado V, Aldecoa I, Martinez-Pozo A, Castro P, Menéndez C, Bassat Q, Martinez MJ, Ordi J. Minimally Invasive Tissue Sampling Findings in 12 Patients With Coronavirus Disease 2019. Clin Infect Dis 2021; 73:S454-S464. [PMID: 34910166 PMCID: PMC8672758 DOI: 10.1093/cid/ciab812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Minimally invasive tissue sampling (MITS), a postmortem procedure that uses core needle biopsy samples and does not require opening the body, may be a valid alternative to complete autopsy (CA) in highly infectious diseases such as coronavirus disease-19 (COVID-19). This study aimed to (1) compare the performance of MITS and CA in a series of COVID-19 deaths and (2) evaluate the safety of the procedure. METHODS From October 2020 to February 2021, MITS was conducted in 12 adults who tested positive before death for COVID-19, in a standard, well-ventilated autopsy room, where personnel used reinforced personal protective equipment. In 9 cases, a CA was performed after MITS. A thorough histological evaluation was conducted, and the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated by real-time reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry. RESULTS The diagnoses provided by MITS and CA matched almost perfectly. In 9 patients, COVID-19 was in the chain of events leading to death, being responsible for diffuse alveolar damage and mononuclear T-cell inflammatory response in the lungs. No specific COVID-19 features were identified. Three deaths were not related to COVID-19. All personnel involved in MITS repeatedly tested negative for COVID-19. SARS-CoV-2 was identified by RT-PCR and immunohistochemistry in the MITS samples, particularly in the lungs. CONCLUSIONS MITS is useful for evaluating COVID-19-related deaths in settings where a CA is not feasible. The results of this simplified and safer technique are comparable to those of CA.
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Affiliation(s)
- Natalia Rakislova
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | | | - Lorena Marimon
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain
| | | | - Mamudo R Ismail
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Melania Ferrando
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain
| | - Esther Sanfeliu
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Paola Castillo
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - José Guerrero
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - José Ramírez-Ruz
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | | | | | - Rosanna Bishop
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Estrella Ortiz
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Abel Muñoz-Beatove
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Jordi Vila
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Mireia Navarro
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Maria Maixenchs
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain
| | - Vima Delgado
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain
| | - Iban Aldecoa
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain.,Neurological Tissue Bank of the Biobank, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain
| | | | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic, Institut D'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Quique Bassat
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Catalan Institution for Research and Advanced Studies, Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Miguel J Martinez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Spain.,Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
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Tikmani SS, Saleem S, Moore JL, Reza S, Gowder G, Dhaded S, Yogesh Kumar S, Goudar SS, Kulkarni V, Kumar S, Acetuino A, Parlberg L, McClure EM, Goldenberg RL. Factors Associated With Parental Acceptance of Minimally Invasive Tissue Sampling to Identify the Causes of Stillbirth and Neonatal Death. Clin Infect Dis 2021; 73:S422-S429. [PMID: 34910175 PMCID: PMC8963158 DOI: 10.1093/cid/ciab829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Minimally invasive tissue sampling (MITS) is a noninvasive technique used to determine the cause of deaths. Very little is known about the factors that affect MITS acceptance or refusal. We present findings from a prospective study conducted in Southeast Asia on the reasons for accepting or refusing MITS. Methods This substudy was conducted in India and Pakistan to determine the acceptability of MITS in women who had a stillbirth or preterm live birth who later died. A formal questionnaire was used to gather observations during the consent for MITS, such as reasons for acceptance or refusal of MITS, as well as which family members were involved in the decision process. Results In Pakistan, the MITS acceptability forms were completed for 470 of 477 women (98.5%) with an eligible stillbirth for this substudy, and 334 of 337 (99.1%) with an eligible preterm neonatal death. In India, MITS acceptability forms were completed in 219 of 305 women (71.8%) with an eligible stillbirth and 260 of 264 (98.4%) with an eligible preterm neonatal death. In India, the most common reasons for MITS refusal for both stillbirths and preterm neonatal deaths were cultural concerns, while in Pakistan, the most common reason for MITS refusal was a potential delay in the funeral. The primary reason for accepting MITS was that the parents wanted to understand the cause of death. At both sites, fathers, mothers, and relatives, often in consultation, choose whether or not to accept MITS to determine the cause of death in stillbirths and preterm neonatal deaths. Conclusions MITS was more commonly accepted in India than in Pakistan. Cultural concerns in India and funeral delays in Pakistan were common reasons for refusal. Parents from both sites were curious to know the cause of stillbirths and preterm neonatal deaths. The father, mother, and relatives were key decision makers for consenting to or declining MITS.
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Affiliation(s)
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Sayyeda Reza
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Sangappa Dhaded
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, India
| | - S Yogesh Kumar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, India
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's Jawaharlal Nehru Medical College, Belagavi, India
| | | | | | | | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York, USA
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7
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Munguambe K, Maixenchs M, Anselmo R, Blevins J, Ordi J, Mandomando I, Breiman RF, Bassat Q, Menéndez C. Consent to minimally invasive tissue sampling procedures in children in Mozambique: A mixed-methods study. PLoS One 2021; 16:e0259621. [PMID: 34748582 PMCID: PMC8575303 DOI: 10.1371/journal.pone.0259621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Minimally invasive tissue sampling (MITS), also named minimally invasive autopsy is a post-mortem method shown to be an acceptable proxy of the complete diagnostic autopsy. MITS improves the knowledge of causes of death (CoD) in resource-limited settings. Its implementation requires understanding the components of acceptability, including facilitators and barriers in real-case scenarios. METHODS We undertook a mixed-methods analysis comparing anticipated (hypothetical scenario) and experienced (real-case scenario) acceptability of MITS among relatives of deceased children in Mozambique. Anticipated acceptability information was obtained from 15 interviews with relatives of deceased children. The interview focus was on whether and why they would allow the procedure on their dead child in a hypothetical scenario. Experienced acceptability data were obtained from outcomes of consent requested to relatives of 114 deceased children during MITS implementation, recorded through observations, clinical records abstraction and follow-up informal conversations with health care professionals and semi-structured interviews with relatives. RESULTS Ninety-three percent of relatives indicated that they would hypothetically accept MITS on their deceased child. A key reason was knowing the CoD to take preventive actions; whereas the need to conform with the norm of immediate child burial, the secrecy of perinatal deaths, the decision-making complexity, the misalignment between MITS' purpose and traditional values, lack of a credible reason to investigate CoD, and the impotency to resuscitate the deceased were identified as potential points of hesitancy for acceptance. The only refusing respondent linked MITS to a perception that sharing results would constitute a breach of confidentiality and the lack of value attached to CoD determination. Experienced acceptability revealed four different components: actual acceptance, health professionals' hesitancy, relatives' hesitancy and actual refusal, which resulted in 82% of approached relatives to agree with MITS and 79% of cases to undergo MITS. Barriers to acceptability included, among others, health professionals' and facilities' unpreparedness to perform MITS, the threat of not burying the child immediately, financial burden of delays, decision-making complexities and misalignment of MITS' objectives with family values. CONCLUSIONS MITS showed high anticipated and experienced acceptability driven by the opportunity to prevent further deaths. Anticipated acceptability identified secrecy, confidentiality and complex decision-making processes as barriers, while experienced acceptability revealed family- and health facility-level logistics and practical aspects as barriers. Health-system and logistical impediments must also be considered before MITS implementation. Additionally, the multiple components of acceptability must be taken into account to make it more consistent and transferrable.
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Affiliation(s)
- Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Maria Maixenchs
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Rui Anselmo
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
| | - John Blevins
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Jaume Ordi
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic- Universitat de Barcelona, Barcelona, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique
| | - Robert F. Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Institución Catalana de Investigación y Estudios Avanzados (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Clara Menéndez
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Suwalowska H, Amara F, Roberts N, Kingori P. Ethical and sociocultural challenges in managing dead bodies during epidemics and natural disasters. BMJ Glob Health 2021; 6:bmjgh-2021-006345. [PMID: 34740913 PMCID: PMC8573672 DOI: 10.1136/bmjgh-2021-006345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background Catastrophic natural disasters and epidemics claim thousands of lives and have severe and lasting consequences, accompanied by human suffering. The Ebola epidemic of 2014–2016 and the current COVID-19 pandemic have revealed some of the practical and ethical complexities relating to the management of dead bodies. While frontline staff are tasked with saving lives, managing the bodies of those who die remains an under-resourced and overlooked issue, with numerous ethical and practical problems globally. Methods This scoping review of literature examines the management of dead bodies during epidemics and natural disasters. 82 articles were reviewed, of which only a small number were empirical studies focusing on ethical or sociocultural issues that emerge in the management of dead bodies. Results We have identified a wide range of ethical and sociocultural challenges, such as ensuring dignity for the deceased while protecting the living, honouring the cultural and religious rituals surrounding death, alleviating the suffering that accompanies grieving for the survivors and mitigating inequalities of resource allocation. It was revealed that several ethical and sociocultural issues arise at all stages of body management: notification, retrieving, identification, storage and burial of dead bodies. Conclusion While practical issues with managing dead bodies have been discussed in the global health literature and the ethical and sociocultural facets of handling the dead have been recognised, they are nonetheless not given adequate attention. Further research is needed to ensure care for the dead in epidemics and that natural disasters are informed by ethical best practice.
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Affiliation(s)
- Halina Suwalowska
- Nuffield Department of Population Health, Wellcome Centre for Ethics and Humanities, Ethox Centre, University of Oxford, Oxford, Oxfordshire, UK
| | - Fatu Amara
- Department of Chemistry, City University of New York, New York, New York, USA
| | - Nia Roberts
- Population Health and Primary Care Bodleian Health Care Libraries, University of Oxford, Oxford, Oxfordshire, UK
| | - Patricia Kingori
- Nuffield Department of Population Health, Wellcome Centre for Ethics and Humanities, Ethox Centre, University of Oxford, Oxford, Oxfordshire, UK
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9
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Das MK, Arora NK, Kaur G, Malik P, Kumari M, Joshi S, Rasaily R, Chellani H, Gaikwad H, Debata P, Meena KR. Perceptions of family, community and religious leaders and acceptability for minimal invasive tissue sampling to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study. Reprod Health 2021; 18:168. [PMID: 34348749 PMCID: PMC8336381 DOI: 10.1186/s12978-021-01218-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
Background Minimal invasive tissue sampling (MITS) has emerged as a suitable alternative to complete diagnostic autopsy (CDA) for determination of the cause of death (CoD), due to feasibility and acceptability issues. A formative research was conducted to document the perceptions of parents, community and religious leaders on acceptability of MITS. Methods This qualitative study was conducted at and around the Safdarjung Hospital, Delhi, India. Participants for in-depth interview included the parents who had either child or neonatal death or stillbirth and the key community and religious representatives. The focus group discussions (FGDs) involved community members. Process of obtaining consent for MITS was observed. Data were analyzed inductively manually for emerging themes and codes. Results A total of 104 interviews (parents of deceased children, neonates or stillbirths, n = 93; community members, n = 8 and religious leaders, n = 7), 8 FGDs (n = 72) were conducted and process of obtaining consent for MITS (n = 27) was observed. The participants were positive and expressed willingness to accept MITS. The key determinants for acceptance of MITS were: (1) understanding and willingness to know the cause of death or stillbirth, (2) experience of the healthcare received and trust, (3) the religious and sociocultural norms. Parents and community favored for MITS over CDA when needed, especially where in cases with past stillbirths and child deaths. The experience of treatment, attitude and communication from healthcare providers emerged as important for consent. The decision making process was collective involving the elders and family. No religious leader was against the procedure, as both, the respect for the deceased and need for medical care were satisfied. Conclusions Largely, MITS appeared to be acceptable for identifying the causes of child deaths and stillbirths, if the parents and family are counseled appropriately considering the sociocultural and religious aspects. They perceived the quality of care, attitude and communication by the healthcare providers as critical factors for acceptance of MITS. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01218-4. India tops the chart of childhood deaths and stillbirths globally. The causes of many childhood deaths and stillbirths remain unknown or ill-defined in India. For planning the health policies, program and clinical practices, the cause of death (CoD) and stillbirth are primarily determined by verbal autopsy (VA) method, which has several inherent limitations. The acceptance and implementation of complete diagnostic autopsy (CDA) or full autopsy for CoD determination is limited. Minimally invasive tissue sampling (MITS) is a suitable alternative to full autopsy for CoD determination. MITS has been found to be acceptable and being implemented in some low and middle income countries. Considering the multi-religion and sociocultural contexts of India, an understanding about the perceptions, practices, acceptance and barriers among the parents, community members and religious leaders regarding MITS was necessary for designing appropriate communication strategies and materials for consent. A qualitative study was undertaken in New Delhi, India using in-depth interviews with the parents of deceased children and stillbirths, community leaders, community health workers and religious leaders and focus group discussions with the community members and observation of obtaining consent for MITS. The parents and community members were positive about MITS and expressed willingness to accept it over full autopsy to know the CoD and stillbirths. The factors like past stillbirths and child deaths, experience of the healthcare received and trust, the religious and sociocultural norms emerged as important determinants for acceptance of MITS. The religious leaders were also positive about MITS if needed for treatment and benefit of the family.
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Affiliation(s)
| | | | - Gurkirat Kaur
- The INCLEN Trust International, New Delhi, 110020, India
| | | | - Mahisha Kumari
- The INCLEN Trust International, New Delhi, 110020, India
| | - Shipra Joshi
- The INCLEN Trust International, New Delhi, 110020, India
| | - Reeta Rasaily
- Division of Reproductive Biology Maternal and Child Health, Indian Council of Medical Research, New Delhi, 110029, India
| | - Harish Chellani
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Harsha Gaikwad
- Department of Obstetrics and Gynaecology, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Pradeep Debata
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - K R Meena
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
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10
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Rakislova N, Marimon L, Ismail MR, Carrilho C, Fernandes F, Ferrando M, Castillo P, Rodrigo-Calvo MT, Guerrero J, Ortiz E, Muñoz-Beatove A, Martinez MJ, Hurtado JC, Navarro M, Bassat Q, Maixenchs M, Delgado V, Wallong E, Aceituno A, Kim J, Paganelli C, Goco NJ, Aldecoa I, Martinez-Pozo A, Martinez D, Ramírez-Ruz J, Cathomas G, Haab M, Menéndez C, Ordi J. Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings. Pathogens 2021; 10:pathogens10040412. [PMID: 33915771 PMCID: PMC8065952 DOI: 10.3390/pathogens10040412] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/21/2021] [Accepted: 03/27/2021] [Indexed: 12/11/2022] Open
Abstract
Postmortem studies are crucial for providing insight into emergent diseases. However, a complete autopsy is frequently not feasible in highly transmissible diseases due to biohazard challenges. Minimally invasive autopsy (MIA) is a needle-based approach aimed at collecting samples of key organs without opening the body, which may be a valid alternative in these cases. We aimed to: (a) provide biosafety guidelines for conducting MIAs in COVID-19 cases, (b) compare the performance of MIA versus complete autopsy, and (c) evaluate the safety of the procedure. Between October and December 2020, MIAs were conducted in six deceased patients with PCR-confirmed COVID-19, in a basic autopsy room, with reinforced personal protective equipment. Samples from the lungs and key organs were successfully obtained in all cases. A complete autopsy was performed on the same body immediately after the MIA. The diagnoses of the MIA matched those of the complete autopsy. In four patients, COVID-19 was the main cause of death, being responsible for the different stages of diffuse alveolar damage. No COVID-19 infection was detected in the personnel performing the MIAs or complete autopsies. In conclusion, MIA might be a feasible, adequate and safe alternative for cause of death investigation in COVID-19 cases.
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Affiliation(s)
- Natalia Rakislova
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Lorena Marimon
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
| | - Mamudo R. Ismail
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo 1653, Mozambique; (M.R.I.); (C.C.); (F.F.)
- Department of Pathology, Maputo Central Hospital, Maputo 1653, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo 1653, Mozambique; (M.R.I.); (C.C.); (F.F.)
- Department of Pathology, Maputo Central Hospital, Maputo 1653, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo 1653, Mozambique; (M.R.I.); (C.C.); (F.F.)
- Department of Pathology, Maputo Central Hospital, Maputo 1653, Mozambique
| | - Melania Ferrando
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
| | - Paola Castillo
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Maria Teresa Rodrigo-Calvo
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - José Guerrero
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Estrella Ortiz
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Abel Muñoz-Beatove
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Miguel J. Martinez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Juan Carlos Hurtado
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Mireia Navarro
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Quique Bassat
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
- ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Maria Maixenchs
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
| | - Vima Delgado
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
| | - Edwin Wallong
- Department of Pathology, Kenyatta National Hospital (KNH), Nairobi 20723-00202, Kenya;
| | - Anna Aceituno
- RTI International (Research Triangle Institute), Research Triangle Park, NC 12255, USA; (A.A.); (J.K.); (C.P.); (N.J.G.)
| | - Jean Kim
- RTI International (Research Triangle Institute), Research Triangle Park, NC 12255, USA; (A.A.); (J.K.); (C.P.); (N.J.G.)
| | - Christina Paganelli
- RTI International (Research Triangle Institute), Research Triangle Park, NC 12255, USA; (A.A.); (J.K.); (C.P.); (N.J.G.)
| | - Norman J. Goco
- RTI International (Research Triangle Institute), Research Triangle Park, NC 12255, USA; (A.A.); (J.K.); (C.P.); (N.J.G.)
| | - Iban Aldecoa
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
- Neurological Tissue Bank of the Biobank-IDIBAPS, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Antonio Martinez-Pozo
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Daniel Martinez
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - José Ramírez-Ruz
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Gieri Cathomas
- Institute of Pathology, Cantonal Hospital Baselland, 4410 Liestal, Switzerland;
| | - Myriam Haab
- Department of Pathology, Saarland University Medical Center, 66421 Homburg/Saar, Germany;
| | - Clara Menéndez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
- Correspondence:
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11
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Paganelli CR, Goco NJ, McClure EM, Banke KK, Blau DM, Breiman RF, Menéndez C, Rakislova N, Bassat Q. The evolution of minimally invasive tissue sampling in postmortem examination: a narrative review. Glob Health Action 2021; 13:1792682. [PMID: 32713325 PMCID: PMC7480574 DOI: 10.1080/16549716.2020.1792682] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Because of low acceptance rates and limited capacity, complete diagnostic autopsies (CDAs) are seldom conducted in low- and middle-income countries (LMICs). There have been growing investments in less-invasive postmortem examination methodologies, including needle-based autopsy, known as minimally invasive autopsy or minimally invasive tissue sampling (MITS). MITS has been shown to be a feasible and informative alternative to CDA for cause of death investigation and mortality surveillance purposes. OBJECTIVE The aim of this narrative review is to describe historical use and evolution of needle-based postmortem procedures as a tool to ascertain the cause of death, especially in LMICs. METHODS Key word searches were conducted in PubMed and EBSCO in 2018 and 2019. Abstracts were reviewed against inclusion and exclusion criteria. Full publications were reviewed for those abstracts meeting inclusion criteria and a start set was established. A snowball search methodology was used and references for all publications meeting inclusion criteria were manually reviewed until saturation was reached. RESULTS A total of 1,177 publications were initially screened. Following an iterative review of references, 79 publications were included in this review. Twenty-nine studies, published between 1955 and 2019, included MITS as part of postmortem examination. Of the publications included, 76% (60/79) have publication dates after 2010. More than 60% of all publications included addressed MITS in LMICs, and a total of nine publications compared MITS with CDA. CONCLUSIONS Although there is evidence of less-invasive postmortem sampling starting in the 1800s, more structured needle-based postmortem examination publications started to appear in the mid-twentieth century. Early studies were mostly conducted in high-income countries but starting in 2010 the number of publications began to increase, and a growing number of studies were conducted in LMICs. Initial studies in LMICs were disease-specific but since 2015 have evolved to include more expansive postmortem examination.
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Affiliation(s)
| | | | | | - Kathryn K Banke
- Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Dianna M Blau
- Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, GA, USA
| | - Clara Menéndez
- ISGlobal Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal Department of Pathology Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| | - Quique Bassat
- ISGlobal Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
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Lawrence S, Namusanya D, Hamuza A, Huwa C, Chasweka D, Kelley M, Molyneux S, Voskuijl W, Denno DM, Desmond N. Hypothetical acceptability of hospital-based post-mortem pediatric minimally invasive tissue sampling in Malawi: The role of complex social relationships. PLoS One 2021; 16:e0246369. [PMID: 33539411 PMCID: PMC7861399 DOI: 10.1371/journal.pone.0246369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Child mortality rates remain unacceptably high in low-resource settings. Cause of death (CoD) is often unknown. Minimally invasive tissue sampling (MITS)-using biopsy needles to obtain post-mortem samples-for histopathological and microbiologic investigation is increasingly being promoted to improve child and adult CoD attribution. "MITS in Malawi" is a sub-study of the Childhood Acute Illness & Nutrition (CHAIN) Network, which aims to identify biological and socioeconomic mortality risk factors among young children hospitalized for acute illness or undernutrition. MITS in Malawi employs standard MITS and a novel post-mortem endoscopic intestinal sampling approach to better understand CoD among children with acute illness and/or malnutrition who die during hospitalization. AIM To understand factors that may impact MITS acceptability and inform introduction of the procedure to ascertain CoD among children with acute illness or malnutrition who die during hospitalization in Malawi. METHODS We conducted eight focus group discussions with key hospital staff and community members (religious leaders and parents of children under 5) to explore attitudes towards MITS and inform consent processes prior to commencing the MITS in Malawi study. We used thematic content analysis drawing on a conceptual framework developed from emergent themes and MITS acceptability literature. RESULTS Feelings of power over decision-making within the hospital and household, trust in health systems, and open and respectful health worker communication with parents were important dimensions of MITS acceptability. Other facilitating factors included the potential for MITS to add CoD information to aid sense-making of death and contribute to medical knowledge and new interventions. Potential barriers to acceptability included fears of organ and blood harvesting, disfigurement to the body, and disruption to transportation and burial plans. CONCLUSION Social relationships and power dynamics within healthcare systems and households are a critical component of MITS acceptability, especially given the sensitivity of death and autopsy.
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Affiliation(s)
- Sarah Lawrence
- Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
| | - Dave Namusanya
- Behaviour and Health Research Group, Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
| | - Andrew Hamuza
- Behaviour and Health Research Group, Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
| | - Cornelius Huwa
- Department of Paediatrics and Child Health, College of Medicine, Blantyre, Malawi
- The Childhood Acute Illness & Nutrition (CHAIN) Network, C/o KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Dennis Chasweka
- Department of Paediatrics and Child Health, College of Medicine, Blantyre, Malawi
- The Childhood Acute Illness & Nutrition (CHAIN) Network, C/o KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Maureen Kelley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, C/o KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Wellcome Centre for Ethics & Humanities and Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sassy Molyneux
- The Childhood Acute Illness & Nutrition (CHAIN) Network, C/o KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Wellcome Centre for Ethics & Humanities and Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Wieger Voskuijl
- Department of Paediatrics and Child Health, College of Medicine, Blantyre, Malawi
- The Childhood Acute Illness & Nutrition (CHAIN) Network, C/o KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Amsterdam Centre for Global Child Health, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Donna M. Denno
- Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
- The Childhood Acute Illness & Nutrition (CHAIN) Network, C/o KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Nicola Desmond
- Behaviour and Health Research Group, Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Islam MS, Al-Masud A, Maixenchs M, Cossa S, Guilaze R, Diarra K, Fofana I, Hussain F, Blevins J, Kone A, Arifeen SE, Mandomando I, Bassat Q, Sage EO, Gurley ES, Munguambe K. Rumor surveillance in support of minimally invasive tissue sampling for diagnosing the cause of child death in low-income countries: A qualitative study. PLoS One 2021; 16:e0244552. [PMID: 33507902 PMCID: PMC7842994 DOI: 10.1371/journal.pone.0244552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/13/2020] [Indexed: 11/25/2022] Open
Abstract
In low-and middle-income countries, determining the cause of death of any given individual is impaired by poor access to healthcare systems, resource-poor diagnostic facilities, and limited acceptance of complete diagnostic autopsies. Minimally invasive tissue sampling (MITS), an innovative post-mortem procedure based on obtaining tissue specimens using fine needle biopsies suitable for laboratory analysis, is an acceptable proxy of the complete diagnostic autopsy, and thus could reduce the uncertainty of cause of death. This study describes rumor surveillance activities developed and implemented in Bangladesh, Mali, and Mozambique to identify, track and understand rumors about the MITS procedure. Our surveillance activities included observations and interviews with stakeholders to understand how rumors are developed and spread and to anticipate rumors in the program areas. We also engaged young volunteers, local stakeholders, community leaders, and study staff to report rumors being spread in the community after MITS launch. Through community meetings, we also managed and responded to rumors. When a rumor was reported, the field team purposively conducted interviews and group discussions to track, verify and understand the rumor. From July 2016 through April 2018, the surveillance identified several rumors including suspicions of organs being harvested or transplanted; MITS having been performed on a living child, and concerns related to disrespecting the body and mistrust related to the study purpose. These rumors, concerns, and cues of mistrust were passed by word of mouth. We managed the rumors by modifying the consent protocol and giving additional information and support to the bereaved family and to the community members. Rumor surveillance was critical for anticipating and readily identifying rumors and managing them. Setting up rumor surveillance by engaging community residents, stakeholders, and volunteers could be an essential part of any public health program where there is a need to identify and react in real-time to public concern.
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Affiliation(s)
- Md Saiful Islam
- Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
- * E-mail:
| | - Abdullah Al-Masud
- Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Saquina Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Rui Guilaze
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Issa Fofana
- Center for Vaccine Development, Bamako, Mali
| | - Faruqe Hussain
- Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - John Blevins
- Emory Global Health Institute, Atlanta, GA, United States of America
| | - Ahoua Kone
- Emory Global Health Institute, Atlanta, GA, United States of America
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Emily S. Gurley
- Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane Universities, Maputo, Mozambique
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14
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Oruko K, Maixenchs M, Phillips-Howard P, Ondire M, Akelo C, Sanz A, Ordi J, Menéndez C, Bassat Q, Odhiambo FO, Munguambe K. Conceptual frameworks for understanding the acceptability and feasibility of the minimally invasive autopsy to determine cause of death: Findings from the CADMIA Study in western Kenya. PLoS One 2020; 15:e0242574. [PMID: 33315918 PMCID: PMC7735626 DOI: 10.1371/journal.pone.0242574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/04/2020] [Indexed: 11/17/2022] Open
Abstract
Establishing the cause of death (CoD) is critical to better understanding health and prioritizing health investments, however the use of full post-mortem examination is rare in most low and middle-income counties for multiple reasons. The use of minimally invasive autopsy (MIA) approaches, such as needle biopsies, presents an alternate means to assess CoD. In order to understand the feasibility and acceptability of MIA among communities in western Kenya, we conducted focus groups and in-depth interviews with next-of-kin of recently deceased persons, community leaders and health care workers in Siaya and Kisumu counties. Results suggest two conceptual framework can be drawn, one with facilitating factors for acceptance of MIA due to the ability to satisfy immediate needs related to interest in learning CoD or protecting social status and honoring the deceased), and one framework covering barriers to acceptance of MIA, for reasons relating to the failure to serve an existing need, and/or the exacerbation of an already difficult time.
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Affiliation(s)
- Kelvin Oruko
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.,Kenya Medical Training College, Nairobi, Kenya
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Maureen Ondire
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Clarah Akelo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Ariadna Sanz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Frank O Odhiambo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Khatia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
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15
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Blum LS, Karia FP, Msoka EF, Oshosen Mwanga M, Crump JA, Rubach MP. An In-Depth Examination of Reasons for Autopsy Acceptance and Refusal in Northern Tanzania. Am J Trop Med Hyg 2020; 103:1670-1680. [PMID: 32748779 DOI: 10.4269/ajtmh.20-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Uncertainty about the causes of death (COD) in low- and middle-income countries (LMICs) has been recognized as a constraint to global health and development. Although complete diagnostic autopsy (CDA) is the best way to assess COD, it is uncommon in LMICs because of low investment priority and assumptions about poor acceptability. Social science research was conducted from May 2016 through July 2017 to examine issues related to acceptability of CDAs in northern Tanzania where autopsy was being offered in two referral hospitals to assess COD associated with febrile illness. Initial formative research entailed 29 key informant interviews, seven observations of burial practices, and four group discussions. In-depth interviews were conducted with families of deceased, including nine families that accepted and 11 families that refused CDA. The formative research identified concepts related to death, understandings of CDA, and cultural practices and psychosocial considerations associated with death that informed the authorization process. Most families who accepted CDA cited the desire to get clarity regarding the COD as a primary reason for acceptance. An unexpected finding was that CDA is perceived as a means to determine witchcraft involvement, a common explanation for COD and a common reason for postmortem acceptance. Death resulting from chronic illness or conditions presumed to have a clinical diagnosis were reasons for CDA to be viewed as unnecessary. The timing, way families were approached, and content of information shared during authorization influenced acceptance and refusal of CDA. Findings show that CDAs can be acceptable in settings where traditional disease models prevail.
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Affiliation(s)
| | - Francis P Karia
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | | | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand.,Duke Global Health Institute, Duke University, Durham, North Carolina.,Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Matthew P Rubach
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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16
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Lewis C, Hutchinson JC, Riddington M, Hill M, Arthurs OJ, Fisher J, Wade A, Doré CJ, Chitty LS, Sebire NJ. Minimally invasive autopsy for fetuses and children based on a combination of post-mortem MRI and endoscopic examination: a feasibility study. Health Technol Assess 2020; 23:1-104. [PMID: 31461397 DOI: 10.3310/hta23460] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Less invasive perinatal and paediatric autopsy methods, such as imaging alongside targeted endoscopy and organ biopsy, may address declining consent rates for traditional autopsy, but their acceptability and accuracy are not known. OBJECTIVES The aims of this study were to provide empirical data on the acceptability and likely uptake for different types of autopsy among key stakeholders (study 1); and to analyse existing autopsy data sources to provide estimates of the potential efficacy of less invasive autopsy (LIA) and its projected utility in clinical practice (study 2). REVIEW METHODS Study 1: this was a mixed-methods study. Parents were involved in research design and interpretation of findings. Substudy 1: a cross-sectional survey of 859 parents who had experienced miscarriage, termination of pregnancy for fetal anomaly, stillbirth, infant or child death, and interviews with 20 responders. Substudy 2: interviews with 25 health professionals and four coroners. Substudy 3: interviews with 16 religious leaders and eight focus groups, with 76 members of the Muslim and Jewish community. Study 2: a retrospective analysis of national data in addition to detailed information from an existing in-house autopsy database of > 5000 clinical cases that had undergone standard autopsy to determine the proportion of cases by clinical indication group for which tissue sampling of specific internal organs significantly contributed to the diagnosis. RESULTS Substudy 1: 91% of participants indicated that they would consent to some form of LIA, 54% would consent to standard autopsy, 74% to minimally invasive autopsy (MIA) and 77% to non-invasive autopsy (NIA). Substudy 2: participants viewed LIA as a positive development, but had concerns around the limitations of the technology and de-skilling the workforce. Cost implications, skills and training requirements were identified as implementation challenges. Substudy 3: religious leaders agreed that NIA was religiously permissible, but MIA was considered less acceptable. Community members indicated that they might consent to NIA if the body could be returned for burial within 24 hours. Study 2: in 5-10% of cases of sudden unexplained death in childhood and sudden unexplained death in infants, the final cause of death is determined by routine histological sampling of macroscopically normal organs, predominantly the heart and lungs, and in this group routine histological sampling therefore remains an important aspect of investigation. In contrast, routine histological examination of macroscopically normal organs rarely (< 0.5%) provides the cause of death in fetal cases, making LIA and NIA approaches potentially highly applicable. LIMITATIONS A key limitation of the empirical research is that it is hypothetical. Further research is required to determine actual uptake. Furthermore, because of the retrospective nature of the autopsy data set, findings regarding the likely contribution of organ sampling to final diagnosis are based on extrapolation of findings from historical autopsies, and prospective data collection is required to validate the conclusions. CONCLUSIONS LIA is viable and acceptable (except for unexplained deaths), and likely to increase uptake. Further health economic, performance and implementation studies are required to determine the optimal service configuration required to offer this as routine clinical care. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - John C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
| | - Megan Riddington
- Department of Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Angie Wade
- Institute of Child Health; Population, Policy and Practice, University College London, London, UK
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Neil J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
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17
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Blevins J, O'Mara Sage E, Kone A, Maixenchs M, Raghunathan PL, Guilaze RA, Cossa S, Girma Z, Zegeye Y, Ackley C, Hussain F, Islam S, Myburgh N, Ngwenya N, Madhi SA, Otieno P, Ochola K, Munguambe K, Breiman RF. Using Participatory Workshops to Assess Alignment or Tension in the Community for Minimally Invasive Tissue Sampling Prior to Start of Child Mortality Surveillance: Lessons From 5 Sites Across the CHAMPS Network. Clin Infect Dis 2020; 69:S280-S290. [PMID: 31598665 PMCID: PMC6785692 DOI: 10.1093/cid/ciz563] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022] Open
Abstract
The Child Health and Mortality Prevention Surveillance (CHAMPS) program is a 7-country network (as of December 2018) established by the Bill & Melinda Gates Foundation to identify the causes of death in children in communities with high rates of under-5 mortality. The program carries out both mortality and pregnancy surveillance, and mortality surveillance employs minimally invasive tissue sampling (MITS) to gather small samples of body fluids and tissue from the bodies of children who have died. While this method will lead to greater knowledge of the specific causes of childhood mortality, the procedure is in tension with cultural and religious norms in many of the countries where CHAMPS works—Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. Participatory Inquiry Into Community Knowledge of Child Health and Mortality Prevention (PICK-CHAMP) is a community entry activity designed to introduce CHAMPS to communities and gather initial perspectives on alignments and tensions between CHAMPS activities and community perceptions and priorities. Participants’ responses revealed medium levels of overall alignment in all sites (with the exception of South Africa, where alignment was high) and medium levels of tension (with the exception of Ethiopia, where tension was high). Alignment was high and tension was low for pregnancy surveillance across all sites, whereas Ethiopia reflected low alignment and high tension for MITS. Participants across all sites indicated that support for MITS was possible only if the procedure did not interfere with burial practices and rituals.
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Affiliation(s)
- John Blevins
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Elizabeth O'Mara Sage
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ahoua Kone
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Maria Maixenchs
- ISGlobal, Hospital Clinic-Universitat de Barcelona, Spain.,Centro de Investigacao en Saude de Manhica (CISM), Maputo, Mozambique
| | - Pratima L Raghunathan
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rui A Guilaze
- Centro de Investigacao en Saude de Manhica (CISM), Maputo, Mozambique
| | - Saquina Cossa
- Centro de Investigacao en Saude de Manhica (CISM), Maputo, Mozambique
| | - Zerihun Girma
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yosef Zegeye
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Caroline Ackley
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Faruqe Hussain
- PEI, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Saiful Islam
- PEI, Infectious Disease Division, icddr,b, Dhaka, Bangladesh.,University of New South Wales, Syndey, Australia
| | - Nellie Myburgh
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences Johannesburg, South Africa
| | - Noni Ngwenya
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | | | | | - Khátia Munguambe
- Centro de Investigacao en Saude de Manhica (CISM), Maputo, Mozambique.,Community Health Department, Eduardo Mondlane University, Faculty of Medicine, Maputo, Mozambique
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
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Shelmerdine SC, Hutchinson JC, Ward L, Sekar T, Ashworth MT, Levine S, Sebire NJ, Arthurs OJ. Feasibility of INTACT (INcisionless TArgeted Core Tissue) biopsy procedure for perinatal autopsy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:667-675. [PMID: 31271478 PMCID: PMC7317589 DOI: 10.1002/uog.20387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine the feasibility and tissue yield of a perinatal incisionless ultrasound-guided biopsy procedure, the INcisionless Targeted Core Tissue (INTACT) technique, in the context of minimally invasive autopsy. METHODS Cases of perinatal death in which the parents consented for minimally invasive autopsy underwent postmortem magnetic resonance imaging and an INTACT biopsy procedure, defined as needle biopsy of organs via the umbilical cord, performed under ultrasound guidance. In each case, three cores of tissue were obtained from seven target organs (both lungs, both kidneys, heart, spleen and liver). Biopsy success was predefined as an adequate volume of the intended target organ for pathological analysis, as judged by a pathologist blinded to the case and biopsy procedure. RESULTS Thirty fetuses underwent organ sampling. Mean gestational age was 30 weeks (range, 18-40 weeks) and mean delivery-to-biopsy interval was 12 days (range, 6-22 days). The overall biopsy success rate was 153/201 (76.1%) samples, with the success rates in individual organs being highest for the heart and lungs (93% and 91%, respectively) and lowest for the spleen (11%). Excluding splenic samples, the biopsy success rate was 150/173 (86.7%). Histological abnormalities were found in 4/201 (2%) samples, all of which occurred in the lungs and kidneys of a fetus with pulmonary hypoplasia and multicystic kidney disease. CONCLUSIONS Incisionless ultrasound-guided organ biopsy using the INTACT procedure is feasible, with an overall biopsy success rate of over 75%. This novel technique offers the ideal combination of an imaging-led autopsy with organ sampling for parents who decline the conventional invasive approach. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S. C. Shelmerdine
- Department of Clinical RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
| | - J. C. Hutchinson
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - L. Ward
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - T. Sekar
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - M. T. Ashworth
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - S. Levine
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - N. J. Sebire
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - O. J. Arthurs
- Department of Clinical RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
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Factors Influencing Acceptance of Post-Mortem Examination of Children at a Tertiary Care Hospital in Nairobi, Kenya. Ann Glob Health 2019; 85. [PMID: 31276331 PMCID: PMC6634467 DOI: 10.5334/aogh.2504] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Clinical autopsies are not often part of routine care, despite their role in clarifying cause of death. In fact, autopsy rates across the world have declined and are especially low in sub-Saharan Africa. OBJECTIVES We set out to identify factors associated with acceptance of pediatric autopsies among parents of deceased children less than five years old, and examined local preferences for minimally invasive tissue sampling (MITS) procedures during post-mortem (PM) examinations. METHODS From December 2016 to September 2017, we contacted 113 parents/next of kin who had been previously approached to consent to a PM examination of their deceased child as part of a Kenyan study on cause of death. Interviews occurred up to three years after the death of their child. FINDINGS Seventy-three percent (83/113) of eligible study participants were enrolled, of whom 62/83 (75%) had previously consented to PM examination of their child. Those who previously consented to PM had higher levels of education, were more likely employed, and had more knowledge about certain aspects of autopsies than non-consenters. The majority (97%) of PM consenters did so because they wanted to know the cause of death of their child, and up to a third believed autopsy studies helped advance medical knowledge. Reasons for non-consent to PM examination included: parents felt there was no need for further examination (29%) or they were satisfied with the clinical diagnosis (24%). Overall, only 40% of study participants would have preferred MITS procedures to conventional autopsy. However, 81% of autopsy non-consenters would have accepted PM examination if it only involved MITS techniques. CONCLUSION There is potential to increase autopsy rates by strengthening reasons for acceptance and addressing modifiable reasons for refusals. Although MITS procedures have the potential to improve autopsy acceptance rates, they were not significantly preferred over conventional autopsies in our study population.
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Feroz A, Ibrahim MN, McClure EM, Ali AS, Tikmani SS, Reza S, Abbasi Z, Raza J, Yasmin H, Bano K, Zafar A, Siddiqi S, Goldenberg RL, Saleem S. Perceptions of parents and religious leaders regarding minimal invasive tissue sampling to identify the cause of death in stillbirths and neonates: results from a qualitative study. Reprod Health 2019; 16:53. [PMID: 31077244 PMCID: PMC6509850 DOI: 10.1186/s12978-019-0730-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/01/2019] [Indexed: 11/18/2022] Open
Abstract
Background Recently, the minimal invasive tissue sampling (MITS) procedure has been developed to support determination of the cause of death as an alternate to conventional autopsy, especially in countries where complete diagnostic autopsy is not routine. To assess the feasibility of implementation of the MITS procedure for a study to determine cause of death in premature births and stillbirths in south Asia, we explored the views and perceptions of parents and religious leaders on the acceptability of MITS. Methods A qualitative study was conducted at the National Institute of Child Health (NICH) hospital of Karachi, Pakistan. Focus group discussions (FGDs) were conducted with parents of newborns who visited well-baby clinics of the NICH hospital for post-natal check-ups. Key-informant interviews (KIIs) were conducted with religious leaders. Data were analyzed using NVivo 10 software. Results A total of 13 interviews (FGDs = 8; KIIs = 5) were conducted. Three overarching themes were identified: (I) acceptability of MITS; (II) concerns affecting the implementation of MITS; and (III) religious and cultural perspectives. Participants’ acceptance of MITS was based on personal, religious, cultural and social beliefs. Parents widely recognized the need for this procedure in cases where the couple had experienced multiple stillbirths, neonatal deaths and miscarriages. Counseling of parents was considered vital to address emotional concerns of the parents and the family. Religious leaders indicated acceptability of the MITS procedure from a religious perspective and advised that respect for the deceased and consent of the guardians is mandatory when performing MITS. Conclusions This qualitative study provided a unique opportunity to understand the views of parents and religious leaders towards the use of MITS. Generally, MITS appears to be an acceptable method for identifying the cause of death in neonates and stillbirths, provided that the deceased is respected and buried as soon as possible without any delays and parents are counseled appropriately. Findings from this research are essential in approaching families for consent for MITS.
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Affiliation(s)
- Anam Feroz
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan.
| | | | | | - Anum Shiraz Ali
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | - Shiyam Sunder Tikmani
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | - Sayyeda Reza
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | - Zahid Abbasi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | - Haleema Yasmin
- Jinnah Post-graduate Medical Center, Department of Obstetrics and Gynecology-Department of Pathology and Laboratory Medicine, Karachi, Pakistan
| | - Khadija Bano
- Jinnah Post-graduate Medical Center, Department of Obstetrics and Gynecology-Department of Pathology and Laboratory Medicine, Karachi, Pakistan
| | - Afia Zafar
- Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | - Sameen Siddiqi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
| | | | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Box 3500, Karachi, PO, 74800, Pakistan
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Njuguna HN, Zaki SR, Roberts DJ, Fligner CL, Keating MK, Rogena E, Walong E, Gachii AK, Maleche-Obimbo E, Irimu G, Mathaiya J, Orata N, Lopokoiyit R, Maina J, Emukule GO, Onyango CO, Gikunju S, Owuor C, Kinuthia P, Bunei M, Fields B, Widdowson MA, Mott JA, Chaves SS. Determining the Cause of Death Among Children Hospitalized With Respiratory Illness in Kenya: Protocol for Pediatric Respiratory Etiology Surveillance Study (PRESS). JMIR Res Protoc 2019; 8:e10854. [PMID: 30632968 PMCID: PMC6705666 DOI: 10.2196/10854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/02/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, where the burden of respiratory disease-related deaths is the highest, information on the cause of death remains inadequate because of poor access to health care and limited availability of diagnostic tools. Postmortem examination can aid in the ascertainment of causes of death. This manuscript describes the study protocol for the Pediatric Respiratory Etiology Surveillance Study (PRESS). OBJECTIVE This study protocol aims to identify causes and etiologies associated with respiratory disease-related deaths among children (age 1-59 months) with respiratory illness admitted to the Kenyatta National Hospital (KNH), the largest public hospital in Kenya, through postmortem examination coupled with innovative approaches to laboratory investigation. METHODS We prospectively followed children hospitalized with respiratory illness until the end of clinical care or death. In case of death, parents or guardians were offered grief counseling, and postmortem examination was offered. Lung tissue specimens were collected using minimally invasive tissue sampling and conventional autopsy where other tissues were collected. Tissues were tested using histopathology, immunohistochemistry, and multipathogen molecular-based assays to identify pathogens. For each case, clinical and laboratory data were reviewed by a team of pathologists, clinicians, laboratorians, and epidemiologists to assign a cause of and etiology associated with death. RESULTS We have enrolled pediatric cases of respiratory illness hospitalized at the KNH at the time of this submission; of those, 14.8% (140/945) died while in the hospital. Both analysis and interpretation of laboratory results and writing up of findings are expected in 2019-2020. CONCLUSIONS Postmortem studies can help identify major pathogens contributing to respiratory-associated deaths in children. This information is needed to develop evidence-based prevention and treatment policies that target important causes of pediatric respiratory mortality and assist with the prioritization of local resources. Furthermore, PRESS can provide insights into the interpretation of results using multipathogen testing platforms in resource-limited settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/10854.
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Affiliation(s)
- Henry N Njuguna
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sherif R Zaki
- Infectious Disease Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
| | | | - M Kelly Keating
- Infectious Disease Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | | | | | | | | | | | - Gideon O Emukule
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Clayton O Onyango
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Stella Gikunju
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Collins Owuor
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | | | - Barry Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Joshua A Mott
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sandra S Chaves
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Das MK, Arora NK, Rasaily R, Chellani H, Gaikwad H, Banke K. Exploring family, community and healthcare provider perceptions and acceptability for minimal invasive tissue sampling to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study protocol. Reprod Health 2019; 16:3. [PMID: 30626421 PMCID: PMC6327493 DOI: 10.1186/s12978-019-0665-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Around 5.4 million under-five deaths occur globally annually. Over 2.5 million neonatal deaths and an equivalent stillbirths also occur annually worldwide. India is largest contributor to these under-five deaths and stillbirths. To meet the National Health Policy goals aligned with sustainable development targets, adoption of specific strategy and interventions based on exact causes of death and stillbirths are essential. The current cause of death (CoD) labelling process is verbal autopsy based and subject to related limitations. In view of rare diagnostic autopsies, the minimally invasive tissue sampling (MITS) has emerged as a suitable alternate with comparable efficiency to determine CoD. But there is no experience on perception and acceptance for MITS in north Indian context. This formative research is exploring the perceptions and view of families, communities and healthcare providers regarding MITS to determine the acceptability and feasibility. METHODS The cross-sectional study adopts exploratory qualitative research design. The study will be conducted in New Delhi linked to deaths and stillbirths occurring at a tertiary care hospital. The data from multiple stakeholders will be collected through 53-60 key-informant in-depth interviews (IDIs), 8 focus group discussions (FGDs) and 8-10 death or stillbirth event observations. The IDIs will be done with the parents, family members, community representatives, religious priests, burial site representatives and different health care providers. The FGDs will be conducted with the fathers, mothers, and elderly family members in the community. The data collection will focus on death, post-death rituals, religious practices, willingness to know CoD, acceptability of MITS and decision making dynamics. Data will be analysed following free listing, open coding, selective coding and theme identification. Subsequently 8-10 parents will be approached for consent to conduct MITS using the communication package to be developed using the findings. DISCUSSION The study will provide in-depth understanding of the cultural, social, religious practices related to child death and stillbirth and factors that potentially determine acceptance of MITS. The findings will guide development of communication and counselling package and strategies for obtaining consent for MITS. The pilot experience on obtaining consent for MITS will inform suitable refinement and future practice.
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Affiliation(s)
- Manoja Kumar Das
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110020, India.
| | - Narendra Kumar Arora
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110020, India
| | - Reeta Rasaily
- Division of Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Harish Chellani
- Department of Pediatrics, Safdarjung Hospital & Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Harsha Gaikwad
- Department of Obstetrics and Gynaecology, Safdarjung Hospital & Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Kathryn Banke
- Global Health, Bill and Melinda Gates Foundation, Seattle, WA, 98109, USA
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Maixenchs M, Anselmo R, Martínez Pérez G, Oruko K, Agnandji ST, Angoissa Minsoko PC, Diarra K, Djiteye M, Bhutta ZA, Zaidi S, Carrilho C, Sanz A, Ordi J, Menendez C, Bassat Q, Munguambe K. Socio-anthropological methods to study the feasibility and acceptability of the minimally invasive autopsy from the perspective of local communities: lessons learnt from a large multi-centre study. Glob Health Action 2019; 12:1559496. [PMID: 30712476 PMCID: PMC6366403 DOI: 10.1080/16549716.2018.1559496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/13/2018] [Indexed: 12/13/2022] Open
Abstract
The minimally invasive autopsy (MIA), an innovative approach for obtaining post-mortem samples of key organs, is increasingly being recognized as a robust methodology for cause of death (CoD) investigation, albeit so far limited to pilot studies and research projects. A better understanding of the real causes of death in middle- and low-income countries, where underlying causes of death are seldom determined, would allow improved health planning, more targeted prioritization of available resources and the implementation of coherent public health policies. This paper discusses lessons learnt from the implementation of a Feasibility and Acceptability (F&A) study evaluating the MIA approach in five countries: Gabon, Kenya, Mali, Mozambique and Pakistan. This article reports the methodological choices made to document sociocultural and religious norms around death, to examine community and relatives' attitudes and perceptions towards MIA, and to identify factors motivating the MIA's acceptance and refusal. We used ethnography, grounded theory and framework method approaches. In-depth and semi-structured interviews and focus group discussions with key informants, including next of kin of deceased individuals and healthcare providers, were conducted. Participant observation and direct observation of procedures and ceremonies around death were organized in all study sites. In Mozambique, MIA procedures were observed and case studies conducted. The implementation of this F&A protocol has provided critical lessons that could facilitate the future implementation of post-mortem procedures for CoD investigation. These include the need for early community engagement, staff training and preparedness, flexibility to adapt the protocol, gathering qualitative data from diverse sources, and triangulation of the data. We have applied a rigorous, effective and culturally sensitive methodological approach to assess the F&A of MIA in resource-constrained settings. We strongly recommend that such an approach is applied in settings where MIAs or similar post-mortem sensitive procedures are to be introduced.
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Affiliation(s)
- Maria Maixenchs
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Rui Anselmo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Kelvin Oruko
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
- Kenya Medical Training College, Nairobi, Kenya
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
- Institut fϋr Tropenmedizin, Universitätsklinikum Tϋbingen, Tϋbingen, Germany
| | | | - Kounandji Diarra
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | - Mahamane Djiteye
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | - Zulfiqar A. Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shujaat Zaidi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Ariadna Sanz
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Clara Menendez
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Paediatric Infectious Diseases Unit, Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Khatia Munguambe
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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Feroz A, Ibrahim MN, Tikmani SS, Reza S, Abbasi Z, Raza J, Yasmin H, Bano K, Zafar A, McClure EM, Goldenberg RL, Saleem S. Perceptions of parents and healthcare professionals regarding minimal invasive tissue sampling to identify the cause of death in stillbirths and neonates: a qualitative study protocol. Reprod Health 2018; 15:179. [PMID: 30348179 PMCID: PMC6198378 DOI: 10.1186/s12978-018-0626-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Globally, around 2.6 million neonatal deaths occur world-wide every year and the numbers of stillbirths is almost similar. Pakistan is ranked among the highest countries in the world for neonatal mortality. In 2016, for every 1000 babies born in Pakistan, 46 died before the end of the first month of life. Also, Pakistan had the highest rate of stillbirths (43.1/1000 births) in 2015. To meet sustainable development (SDG) targets of reducing neonatal mortality and stillbirths, it is essential to gain understanding about the causes of neonatal death and stillbirths. In Pakistan, full autopsies are conducted only in medico-legal cases and are very rarely performed to identify a definitive cause of death (CoD) and because of cost and insufficient staff are generally not feasible. Recently, minimally invasive tissue sampling (MITS) has been used to determine CoD in neonates and stillbirths as it addresses some of the socio-cultural and religious barriers to autopsy. However, it is not known how families and communities will perceive this procedure; therefore, exploring family and healthcare professionals’ perceptions regarding MITS is essential in determining acceptable and feasible approaches for Pakistan. Methods The study will employ an exploratory qualitative research design. The study will be conducted at the National Institute of Child Health (NICH) hospital of Karachi. The data collection method will consist of key-informant interviews (KIIs) and focus group discussions (FGDs). FGDs will be conducted with the families and relatives of newborns who are visiting the outpatient department (OPD) and well-baby clinics of NICH hospital. KIIs will be conducted with the NICH - medical director, healthcare providers, professionals involved in proceedings related to death and dying, religious leaders, health sector representatives from the government, public health experts, maternal and child health (MCH) specialists, obstetricians and neonatologists and experts from the bioethics committee. Study data will be analyzed using NVivo 10 software. Discussion The research will help explore specific cultural, religious and socio-behavioral factors that may increase or decrease the acceptability of MITS for identifying COD in neonates and stillbirths. The findings of the qualitative study will provide a better understanding of parents’ and healthcare professionals’ attitudes towards the use of MITS on neonatal deaths and stillborns.
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Affiliation(s)
- Anam Feroz
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan.
| | | | - Shiyam Sunder Tikmani
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Sayyeda Reza
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Zahid Abbasi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | - Haleema Yasmin
- Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Khadija Bano
- Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Afia Zafar
- Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
| | | | | | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan
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Lewis C, Latif Z, Hill M, Riddington M, Lakhanpaul M, Arthurs OJ, Hutchinson JC, Chitty LS, Sebire NJ. "We might get a lot more families who will agree": Muslim and Jewish perspectives on less invasive perinatal and paediatric autopsy. PLoS One 2018; 13:e0202023. [PMID: 30092056 PMCID: PMC6085003 DOI: 10.1371/journal.pone.0202023] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 07/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background Perinatal and paediatric autopsy rates are at historically low levels with declining uptake due to dislike of the invasiveness of the procedure, and religious objections particularly amongst Muslim and Jewish parents. Less invasive methods of autopsy including imaging with and without tissue sampling have been shown to be feasible alternatives. We sought to investigate attitudes including religious permissibility and potential uptake amongst members of the Muslim and Jewish communities in the United Kingdom. Methods Semi-structured interviews with religious and faith-based authorities (n = 16) and bereaved parents from the Jewish community (n = 3) as well as 10 focus groups with community members (60 Muslim participants and 16 Jewish participants) were conducted. Data were analysed using thematic analysis to identify key themes. Findings Muslim and Jewish religious and faith-based authorities agreed that non-invasive autopsy with imaging was religiously permissible because it did not require incisions or interference with the body. A minimally invasive approach was less acceptable as it still required incisions to the body, although in those circumstances where it was required by law it was more acceptable than a full autopsy. During focus group discussions with community members, the majority of participants indicated they would potentially consent to a non-invasive autopsy if the body could be returned for burial within 24 hours, or if a family had experienced multiple fetal/pregnancy losses and the information gained might be useful in future pregnancies. Minimally invasive autopsy was less acceptable but around half of participants might consent if a non-invasive autopsy was not suitable, with the exception of the Jewish Haredi community who unanimously stated they would decline this alternative. Conclusions Our research suggests less invasive autopsy offers a viable alternative to many Muslim and Jewish parents in the UK who currently decline a full autopsy. The findings may be of importance to other countries with significant Muslim and/or Jewish communities as well as to other religious communities where concerns around autopsy exist. Awareness-raising amongst religious leaders and community members will be important if these methods become routinely available.
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Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- * E-mail:
| | - Zahira Latif
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Megan Riddington
- Department of Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Monica Lakhanpaul
- Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Community Paediatrics, Whittington Health NHS Trust, London, United Kingdom
| | - Owen J. Arthurs
- Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - John C. Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Lyn S. Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Neil J. Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Maixenchs M, Anselmo R, Zielinski-Gutiérrez E, Odhiambo FO, Akello C, Ondire M, Zaidi SSH, Soofi SB, Bhutta ZA, Diarra K, Djitèye M, Dembélé R, Sow S, Minsoko PCA, Agnandji ST, Lell B, Ismail MR, Carrilho C, Ordi J, Menéndez C, Bassat Q, Munguambe K. Willingness to Know the Cause of Death and Hypothetical Acceptability of the Minimally Invasive Autopsy in Six Diverse African and Asian Settings: A Mixed Methods Socio-Behavioural Study. PLoS Med 2016; 13:e1002172. [PMID: 27875532 PMCID: PMC5119724 DOI: 10.1371/journal.pmed.1002172] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The minimally invasive autopsy (MIA) is being investigated as an alternative to complete diagnostic autopsies for cause of death (CoD) investigation. Before potential implementation of the MIA in settings where post-mortem procedures are unusual, a thorough assessment of its feasibility and acceptability is essential. METHODS AND FINDINGS We conducted a socio-behavioural study at the community level to understand local attitudes and perceptions related to death and the hypothetical feasibility and acceptability of conducting MIAs in six distinct settings in Gabon, Kenya, Mali, Mozambique, and Pakistan. A total of 504 interviews (135 key informants, 175 health providers [including formal health professionals and traditional or informal health providers], and 194 relatives of deceased people) were conducted. The constructs "willingness to know the CoD" and "hypothetical acceptability of MIAs" were quantified and analysed using the framework analysis approach to compare the occurrence of themes related to acceptability across participants. Overall, 75% (379/504) of the participants would be willing to know the CoD of a relative. The overall hypothetical acceptability of MIA on a relative was 73% (366/504). The idea of the MIA was acceptable because of its perceived simplicity and rapidity and particularly for not "mutilating" the body. Further, MIAs were believed to help prevent infectious diseases, address hereditary diseases, clarify the CoD, and avoid witchcraft accusations and conflicts within families. The main concerns regarding the procedure included the potential breach of confidentiality on the CoD, the misperception of organ removal, and the incompatibility with some religious beliefs. Formal health professionals were concerned about possible contradictions between the MIA findings and the clinical pre-mortem diagnoses. Acceptability of the MIA was equally high among Christian and Islamic communities. However, in the two predominantly Muslim countries, MIA acceptability was higher in Mali than in Pakistan. While the results of the study are encouraging for the potential use of the MIA for CoD investigation in low-income settings, they remain hypothetical, with a need for confirmation with real-life MIA implementation and in populations beyond Health and Demographic Surveillance System areas. CONCLUSIONS This study showed a high level of interest in knowing the CoD of a relative and a high hypothetical acceptability of MIAs as a tool for CoD investigation across six distinct settings. These findings anticipate potential barriers and facilitators, both at the health facility and community level, essential for local tailoring of recommendations for future MIA implementation.
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Affiliation(s)
- Maria Maixenchs
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Rui Anselmo
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
| | | | - Frank O. Odhiambo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Clarah Akello
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Maureen Ondire
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - S. Shujaat H. Zaidi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A. Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kounandji Diarra
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | - Mahamane Djitèye
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | | | - Samba Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | | | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Mamudo R. Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- * E-mail:
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Autopsy in Islam: Considerations for Deceased Muslims and Their Families Currently and in the Future. Am J Forensic Med Pathol 2016; 37:29-31. [PMID: 26505228 DOI: 10.1097/paf.0000000000000207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Religious beliefs and cultures have influenced treatment of dead bodies in different ways by nations throughout history, and attitudes toward the deceased individuals have changed across time and so has the role and mechanism of autopsy. Islam has been a part of Europe for a long time; therefore, we would like to emphasize the important issues for Muslims and their families regarding death, autopsy, and funeral and to describe international perspectives of Muslim autopsies. Muslims have expressed their views on autopsy publically and internationally, and there have been claims of violation of the deceased, delays in burial, and nonconsideration of their religious beliefs. In this article, we aim to increase awareness and understanding of doctors about the religious and ethical issues important to Muslims and their families, so that appropriate considerations may be made where possible with regard to respectful treatment of deceased loved ones to decrease tensions presently being faced. Forensic medicine doctors could assist by undertaking autopsy without delay, in a private room by those of the same sex, and covering parts of the body not being worked on at that time.
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Al-Saif D, Al-Faraidy M, Madadin M, Al-Bayat M, Al-Sowayigh K, Al-Shamsi G, Aldossary M, Al-Madani O, Kharoshah M. The attitude of people with an Arabic Islamic cultural background toward medico-legal autopsy. AUST J FORENSIC SCI 2015. [DOI: 10.1080/00450618.2015.1110200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Integrated cluster- and case-based surveillance for detecting stage III zoonotic pathogens: an example of Nipah virus surveillance in Bangladesh. Epidemiol Infect 2014; 143:1922-30. [PMID: 25342551 PMCID: PMC4456770 DOI: 10.1017/s0950268814002635] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper explores the utility of cluster- and case-based surveillance established in government hospitals in Bangladesh to detect Nipah virus, a stage III zoonotic pathogen. Physicians listed meningo-encephalitis cases in the 10 surveillance hospitals and identified a cluster when ⩾2 cases who lived within 30 min walking distance of one another developed symptoms within 3 weeks of each other. Physicians collected blood samples from the clustered cases. As part of case-based surveillance, blood was collected from all listed meningo-encephalitis cases in three hospitals during the Nipah season (January–March). An investigation team visited clustered cases’ communities to collect epidemiological information and blood from the living cases. We tested serum using Nipah-specific IgM ELISA. Up to September 2011, in 5887 listed cases, we identified 62 clusters comprising 176 encephalitis cases. We collected blood from 127 of these cases. In 10 clusters, we identified a total of 62 Nipah cases: 18 laboratory-confirmed and 34 probable. We identified person-to-person transmission of Nipah virus in four clusters. From case-based surveillance, we identified 23 (4%) Nipah cases. Faced with thousands of encephalitis cases, integrated cluster surveillance allows targeted deployment of investigative resources to detect outbreaks by stage III zoonotic pathogens in resource-limited settings.
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Banyini AV, Rees D, Gilbert L. "Even if I were to consent, my family will never agree": exploring autopsy services for posthumous occupational lung disease compensation among mineworkers in South Africa. Glob Health Action 2013; 6:19518. [PMID: 23364088 PMCID: PMC3556717 DOI: 10.3402/gha.v6i0.19518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 11/14/2022] Open
Abstract
Context In the South African mining sector, cardiorespiratory-specific autopsies are conducted under the Occupational Diseases in Mines and Works Act (ODMWA) on deceased mineworkers to determine eligibility for compensation. However, low levels of autopsy utilisation undermine the value of the service. Objective To explore enablers and barriers to consent that impact on ODMWA autopsy utilisation for posthumous monetary compensation. Methods In-depth interviews were conducted with mineworkers, widows and relatives of deceased mineworkers as well as traditional healers and mine occupational health practitioners. Results A range of socio-cultural barriers to consent for an autopsy was identified. These barriers were largely related to gendered power relations, traditional and religious beliefs, and communication and trust. Understanding these barriers presents opportunities to intervene so as to increase autopsy utilisation. Conclusions Effective interventions could include engagement with healthy mine-workers and their families and re-evaluating the permanent removal of organs. The study adds to our understanding of utilisation of the autopsy services.
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