Validating a Minimally Invasive Tissue Sampling (MITS) Method in Determining Cause of Death in Stillbirths and Neonates

Complete diagnostic autopsy (CDA) remains the gold standard and a valuable technique for determining cause of death. It is a source of health statistics that can be used to measure health care services’ quality, unraveling important information on disease processes, particularly in emerging and unknown diseases. It can also be a vital tool for medical education and biomedical research. However, autopsy rates have been declining globally. There is an urgent need to develop and validate alternative methods in different settings to provide reliable information on cause of death. In this study, we aimed to determine cause of death (KazCoDe) in neonates and infants using minimally invasive tissue sampling (MITS), and to compare these results with those of CDA. We conducted MITS and CDA sequentially on 24 deceased children at the Pathological Bureau of the Akimat of the city of Nur-Sultan. Clinical data of the study subjects were extracted from their clinical records. During both procedures, brain, liver and lung tissues were collected for pathological diagnosis. Fifteen (62.5%) and nine (37.5%) were stillbirths and neonates, respectively. Eight (33.3%) were females and 16 (66.7%) were males. MITS diagnosis of cause of death was concordant with CDA diagnosis in 83.3% out of the 24 cases when considering the immediate and underlying causes of death and reviewing all the clinical and laboratory test results as part of the diagnostic evaluation to arrive at a cause of death (ICD-PM). We concluded that MITS is a valuable and reliable method for cause of death diagnosis in stillbirths and neonates, which can contribute vital mortality statistics in children in the absence of CDA.

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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 ◽

10.1371/journal.pone.0244552 ◽

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.

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Consent to minimally invasive tissue sampling procedures in children in Mozambique: A mixed-methods study

PLoS ONE ◽

10.1371/journal.pone.0259621 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259621

Author(s):

Khátia Munguambe ◽

Maria Maixenchs ◽

Rui Anselmo ◽

John Blevins ◽

Jaume Ordi ◽

...

Keyword(s):

Decision Making ◽

Mixed Methods ◽

Minimally Invasive ◽

Health Professionals ◽

Financial Burden ◽

Real Case ◽

Tissue Sampling ◽

Hypothetical Scenario ◽

Sampling Procedures ◽

Clinical Records

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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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

Maternal Health Neonatology and Perinatology ◽

10.1186/s40748-019-0112-x ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 2

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.

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Minimally Invasive Tissue Sampling in Preterm Deaths: A Validation Study

Global Pediatric Health ◽

10.1177/2333794x20953263 ◽

2020 ◽

Vol 7 ◽

pp. 2333794X2095326

Author(s):

Rahell Hailu ◽

Tigist Desta ◽

Yonas Bekuretsion ◽

Messele Bezabih ◽

Addisu Alemu ◽

...

Keyword(s):

Minimally Invasive ◽

Cause Of Death ◽

Low Income ◽

Gold Standard ◽

Pulmonary Hemorrhage ◽

Hyaline Membrane Disease ◽

Preterm Neonates ◽

Tissue Sampling ◽

Neonatal Deaths ◽

Multi Center Study

Uncertainty about the causes of neonatal deaths impedes achieving global health targets to reduce mortality. Complete diagnostic autopsy (CDA) is the gold standard to determine cause of death. However, it is often difficult to perform in high-burden, low-income settings. Validations of more feasible methods to determine cause of death are needed. This prospective, multi-center study in Ethiopia assessed the validity of the minimally invasive tissue sampling (MITS) approach to contribute to causes of death in preterm neonates compared to CDA. The MITS and CDA of 105 cases were reviewed. The MITS sampling success for lungs and liver was 100% and 84%, respectively. The kidney and brain had sampling successes of 58% each. MITS showed good agreement with CDA for the diagnosis of hyaline membrane disease (kappa = 0.78), and moderate to substantial agreement for pneumonia and pulmonary hemorrhage (kappa = 0.59 and 0.68, respectively). Even though CDA is the gold standard in identifying the cause of death, we believe that the MITS method can be a useful alternative method in supporting determination of cause of death in low-resource settings.

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EPIDEMIOLOGÍA Y COMPLICACIONES DE LAS FRACTURAS FACIALES: UN ESTUDIO RETROSPECTIVO DE 5 AÑOS

Revista Facultad de Odontología ◽

10.17533/udea.rfo.v30n2a6 ◽

2019 ◽

Vol 30 (2) ◽

Author(s):

Maria Cristina Zindel Deboni ◽

Guillermo Lanas ◽

Fernando Paredes ◽

Kleber Vallejo ◽

Andrea Lanas

Keyword(s):

Health Care Services ◽

Epidemiological Data ◽

Epidemiological Studies ◽

Definitive Treatment ◽

Facial Trauma ◽

Trauma Patients ◽

Time Intervals ◽

Care Services ◽

Clinical Records ◽

Fracture Types

Introduction: regional epidemiological studies involving facial trauma are needed to develop more efficient ways of providing health care services. The time elapsed from the occurrence of facial trauma to its definitive treatment can affect clinical outcomes in terms of interventions, resolution, and complications. The aim of this study was to verify if there is a relationship between the different fracture types, their treatments or time intervals for clinical resolution and the onset of complications. Methods: a retrospective study was conducted by means of the clinical records of the Eugenio Espejo Hospital in Quito, verifying the epidemiological data on the clinical evolution of facial trauma patients between 2012 and 2016, and registering data such as age, gender, fracture type, time elapsed until its definitive treatment, and onset of complications. Clinical records lacking these data were excluded. Results: most cases occurred outside Quito (64%). There was no relationship between harmful habits, fracture displacement, type of access or fixation, or presence of comorbidities and the onset of complications. The odds ratio (95% confidence interval) for complications was OR = 0.301(0.170-0.536), so there is a 70% increased chance of developing some complications if treatment is performed one week after trauma occurs. Conclusion: reducing facial fractures before a week can decrease the onset of complications and sequelae.

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