scholarly journals Why parents agree or disagree for minimally invasive tissue sampling (MITS) to identify causes of death in under-five children and stillbirth in North India: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Manoja Kumar Das ◽  
Narendra Kumar Arora ◽  
Pradeep Debata ◽  
Harish Chellani ◽  
Reeta Rasaily ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Minimally Invasive ◽  
Causes Of Death ◽  
Child Death ◽  
Family Members ◽  
North India ◽  
Care Hospital ◽  
Tissue Sampling ◽  
Negative Experience ◽  
Under Five

Abstract Background Information on exact causes of death and stillbirth are limited in low and middle income countries. Minimally invasive tissue sampling (MITS) is increasingly practiced in place of autopsy across several settings. A formative research documented the experiences of counselling and consenting for MITS in north India. Methods This exploratory qualitative study was conducted at a tertiary care hospital in Delhi. During the early implementation of MITS, observations of the counselling and consenting process (n = 13) for under-five child death and stillbirths were conducted. In-depth interviews with MITS team members (n = 3) were also conducted. Observation and interview data were transcribed and inductively analysed using thematic content analysis to identify emerging themes and codes. Results The MITS team participated in daily ward rounds for familiarisation with parents/families. Following death declaration the counselling was done in counselling corner of the ward or adjacent corridor. Mostly the counselling was targeted at the father and family members present, using verbal explanation and the consent document in local language. The key concerns raised by parents/family were possible disfigurement, time needed and possible benefits. Most of the parents consulted family members before consent. Among those who consented, desire for next pregnancy, previous pregnancy or neonatal loss and participation of treating senior doctor were the key factors. The negative experience of hospital care, poor comprehension and distance from residence were the factors for consent refusal. Lesser number of parents of deceased children consented for MITS compared to the neonates and stillbirths. Conclusions The initial experiences of obtaining consent for MITS were encouraging. Consent for MITS may be improved with active involvement of the treating doctors and nurses, better bereavement support, private counselling area along with improvement in quality of care and communication during hospitalisation. Special efforts and refinement in counselling are needed to improve consent for MITS in older children.

scholarly journals 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 ◽  
Vol 16 (1) ◽  
pp. e0244552
Author(s):  
Md Saiful Islam ◽  
Abdullah Al-Masud ◽  
Maria Maixenchs ◽  
Saquina Cossa ◽  
Rui Guilaze ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cause Of Death ◽  
Low Income ◽  
Child Death ◽  
The Body ◽  
Low Income Countries ◽  
Tissue Sampling ◽  
Middle Income ◽  
Additional Information ◽  
Tissue Specimens

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.

scholarly journals 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

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Anam Feroz ◽  
Anum Shiraz Ali ◽  
Mohsina Noor Ibrahim ◽  
Elizabeth M. McClure ◽  
Shiyam Sunder Tikmani ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Minimally Invasive ◽  
Health System ◽  
Cause Of Death ◽  
Health Professionals ◽  
Positive Development ◽  
Successful Implementation ◽  
Tissue Sampling ◽  
Healthcare Facilities ◽  
Fast Procedure

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.

scholarly journals A Systematic Review on The Leading Causes of Death Among Under-Five Children in Iran

2020 ◽  
Author(s):  
Badrye Karami ◽  
Mahya Abbasi ◽  
Maryam Tajvar
Keyword(s):  
Systematic Review ◽  
Child Mortality ◽  
Congenital Malformations ◽  
Causes Of Death ◽  
Chromosomal Abnormalities ◽  
Child Death ◽  
Age Groups ◽  
Cross Sectional ◽  
Under Five ◽  
Under Five Children

Abstract Background: Child mortality is one of the most important indicators of population health. No systematic review has explored the leading causes of death among under-five children in Iran. This study reviewed the causes of child death by different age groups on the basis of ICD-10. Methods: A systematic search in seven electronic databases and two search engines of all the studies that identified causes of child mortality in any part of Iran or in the whole country were included, without any restriction of time or language of studies. To identify the studies, a combination of hand searching, gray literatures and bibliographies was also conducted. These sources and citations yielded a total of 817 articles; nevertheless, finally 30 articles fulfilled the inclusion criteria, then were reviewed and analyzed. Results: Amongst the 30 studies published between 2000 and 2019 in Iran, 25 studies were cross-sectional and 19 published in Farsi language. Overall, 71244 child deaths in different age ranges were reviewed in this study. The most common causes of “neonatal mortality” were prenatal conditions (57.8%), congenital malformations, deformations, and chromosomal abnormalities (17%) and disorders of length of gestation and fetal growth (5.9%). “Infant mortalities” were also mainly happened as a result of congenital malformations (22.8%), remainder of prenatal condition (21.2%) and remainder of diseases of the respiratory system (9%). In the age range of 28 days to 5 years, transport accidents (21.1%), congenital malformations (18.1%) and neoplasms (9.3%) were common leading causes of’ deaths. Overall, certain conditions originating in the perinatal period (29.3%), all other disease (26.1%) and external diseases (5.6%) were the leading cause of death in under-five children. Conclusions: This study, provided an updated summary of evidences on the causes of child death in Iran, which is highly critical for the development of interventions and reduction of the burden of under 5 mortality and morbidities.

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