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Sreenivas A, Jaihind Jothikaran TA, Lewis L, Mathew M. Community perceptions of postmortem examination and minimally invasive tissue sampling in neonates:a qualitative study in South India. BMC Pregnancy Childbirth 2023; 23:804. [PMID: 37990299 PMCID: PMC10664656 DOI: 10.1186/s12884-023-06123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Postmortem examination is the gold standard for establishing the cause of death. Minimally Invasive Tissue Sampling (MITS) of organs is a novel approach that can be used as an alternative to postmortem examination. In this study, the community perceptions in two states in South India towards neonatal postmortem and the acceptance towards the MITS technique is studied. METHODS In-depth interviews were conducted among the participants from Kerala and Karnataka to understand the perception towards postmortem and the acceptance of the novel MITS technique. The interviews were audio recorded, and a thematic analysis was done to identify the overarching themes and codes. RESULTS The knowledge and attitude of participants on conventional and MITS postmortem techniques, reasons for refusal, and the need for raising awareness were identified in the study. Participants favored the MITS techniques as it was less disfiguring and less time-consuming. The major concerns for refusal of conventional postmortem were that the procedure was disfiguring, time-consuming, and caused emotional stress to the parents. CONCLUSIONS Participants favored the MITS approach over conventional postmortem as it caused less disfigurement and was conducive to the religious practice of burial of the body.
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Affiliation(s)
- Athira Sreenivas
- Department of Pathology, Centre for Foetal and Perinatal Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Teddy Andrews Jaihind Jothikaran
- Department of Social and Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Leslie Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mary Mathew
- Department of Pathology, Centre for Foetal and Perinatal Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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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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A comparison of MITS counseling and informed consent processes in Pakistan, India, Bangladesh, Kenya, and Ethiopia. Reprod Health 2020; 17:120. [PMID: 32787868 PMCID: PMC7425595 DOI: 10.1186/s12978-020-00969-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
Globally, more than 5 million stillbirths and neonatal deaths occur annually. For many, the cause of death (CoD) is unknown. Minimally invasive tissue sampling (MITS) has been increasingly used in postmortem examinations for ascertaining the CoD in stillbirths and neonates. Our study compared the counseling and consent methods used in MITS projects in five countries in Africa and south Asia. Key informant interviews were conducted with researchers to describe the characteristics and backgrounds of counselors, the environment and timing of consent and perceived facilitators and barriers encountered during the consent process. Counselors at all sites had backgrounds in social science, psychology and counseling or clinical expertise in obstetrics/gynecology or pediatrics. All counsellors received training about techniques for building rapport and offering emotional support to families; training duration and methods differed across sites. Counselling environments varied significantly; some sites allocated a separate room, others counselled families at the bedside or nursing stations. All counsellors had a central role in explaining the MITS procedure to families in their local languages. Most sites did not use visual aids during the process, relying solely on verbal descriptions. In most sites, parents were approached within one hour of death. The time needed for decision making by families varied from a few minutes to 24 h. In most sites, extended family took part in the decision making. Because many parents wanted burial as soon as possible, counsellors ensured that MITS would be conducted promptly after receiving consent. Barriers to consent included decreased comprehension of information due to the emotional and psychological impact of grief. Moreover, having more family members engaged in decision-making increased the complexity of counselling and achieving consensus to consent for the procedure. While each site adapted their approach to fit the context, consistencies and similarities across sites were observed.
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Feroz A, Ali AS, Ibrahim MN, McClure EM, Tikmani SS, Reza S, Abbasi Z, Raza J, Yasmin H, Bano K, Zafar A, Siddiqi S, Goldenberg RL, Saleem S. Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: results from a qualitative study. Matern Health Neonatol Perinatol 2019; 5:17. [PMID: 31666979 PMCID: PMC6814094 DOI: 10.1186/s40748-019-0112-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of MITS, it is important to understand health professionals’ attitudes and perceptions related to MITS. Methods A qualitative study was conducted at the National Institute of Child Health (NICH), Karachi, Pakistan. Focus group discussions (FGDs) and Key-informant interviews (KIIs) were conducted with health professionals including doctors, nurses, trainees, clinicians, bioethics experts and public health experts to explore their perceptions and views on acceptability of MITS. Data were analyzed using NVivo 10 software. Results A total of 12 interviews (FGDs = 4; KIIs = 8) were conducted. Four overarching themes were identified: (I) acceptability of MITS; (II) perceived benefits of the MITS procedure; (III) factors facilitating the implementation of MITS; and (IV) health system requirements for implementing the MITS procedure. Generally, MITS was considered as a positive development for the health system. Diagnostic accuracy and identification of less common causes of death were highlighted as two main benefits of the MITS procedure. The study highlighted a number of facilitators for the acceptability of MITS including effective counseling, building trust with parents, fast procedure time, and approaching families within a few hours of death. In addition, lack of skilled staff, poorly equipped healthcare facilities and the potential high cost to conduct MITS were identified as challenges for the implementation of MITS. Conclusions This formative research provided a unique opportunity to explore health professionals’ views and attitudes towards the MITS procedure. Such insights are crucial to ensure successful implementation and integration of a new technique into the existing health system. The research identified the factors influencing the acceptability of MITS among health professionals in Pakistan. The study also informed factors that could help facilitate the implementation of the MITS procedures in the context of Pakistan and similar settings.
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Affiliation(s)
- Anam Feroz
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Anum Shiraz Ali
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | | | | | - Shiyam Sunder Tikmani
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Sayyeda Reza
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Zahid Abbasi
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Jamal Raza
- 2National Institute of Child Health, Karachi, Pakistan
| | - Haleema Yasmin
- 4Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Khadija Bano
- 4Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Afia Zafar
- 5Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Sameen Siddiqi
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Robert L Goldenberg
- 6Department of Obstetrics and Gynecology, Columbia University, New York, USA
| | - Sarah Saleem
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
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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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