Factors Influencing Acceptance of Post-Mortem Examination of Children at a Tertiary Care Hospital in Nairobi, Kenya

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.

Perceptions of the healthcare providers regarding acceptability and conduct of minimal invasive tissue sampling (MITS) to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study

“…They opined that the acceptance would be more among the parents with past experience of child death or bad obstetric history. These factors were similar to those identified in studies from United Kingdom, Pakistan, Gabon, Kenya, Mali, Mozambique and Kenya [ 13 , 33 – 35 , 38 ].…”

“…They opined that the acceptance would be more among the parents with past experience of child death or bad obstetric history. These factors were similar to those identified in studies from United Kingdom, Pakistan, Gabon, Kenya, Mali, Mozambique and Kenya [13,[33][34][35]38]. The study explored the factors that might influence implementation of MITS in a tertiary care hospital in India.…”

The evolution of minimally invasive tissue sampling in postmortem examination: a narrative review

“…The number of qualitative studies aimed at understanding the facilitators and barriers to implementing MITS in a variety of cultures, religions, and populations, including health care providers, parents, families, and community leaders is relatively balanced in HICs versus LMICs. Of the seven qualitative studies with publication dates between 2011 and 2019, four were conducted in LMICs and three in HICs [ 3 , 49 , 50 , 52 , 58 , 59 , 63 – 65 ].…”

“…However, since the beginning of the mid 1960s, declining rates of CDA have been well documented globally, and this approach to investigate cause of death remains infrequently performed in low- and middle-income countries (LMICs) [ 1 , 2 ]. The reason for the limited use of CDA in LMICs is multifactorial and includes social, cultural, religious, and structural factors such as limited human capacity and financial resources, an overall poor acceptability because of the disfiguring nature of the procedure, and the time required to carry it out, which can interfere with ceremonial and burial practices [ 3 – 5 ]. In high-income countries (HICs), the abundance of clinical records (and their easy accessibility) often allows adequate characterization of events preceding death, and thus, causes of the fatal outcome.…”

The contribution of autopsy in COVID-19 pandemic: Missed opportunity in Sub-Saharan Africa

“…While autopsy practice is slowly growing in the SSA, most of the few reported cases are medico-legal. Clinical autopsy in most hospitals in SSA is still not a routine practice [ 7 ]. Some of the critical factors hindering routine clinical autopsy are the lack of experts and facilities, and a health system that focuses less on postmortem examination.…”