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
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
复制标题
DOI：
10.1371/journal.pmed.1002172
复制
发表时间：
2016-11-01
期刊：
影响因子：
15.8
通讯作者：
Munguambe, Khatia
中科院分区：
文献类型：
--
作者：
Maixenchs, Maria;Anselmo, Rui;Munguambe, Khatia
研究背景微创尸检(MIA)是一种替代完整尸检进行死因调查的方法。在尸检程序不常见的情况下实施MIA之前，有必要对其可行性和可接受性进行彻底评估。方法和发现我们在社区层面进行了一项社会行为研究，以了解当地对死亡的态度和看法，以及在加蓬、肯尼亚、马里、莫桑比克和巴基斯坦六个不同环境中进行MIA的假设可行性和可接受性。共进行了504次访谈(135名关键信息提供人、175名保健提供者[包括正规保健专业人员和传统或非正式保健提供者]，以及194名死者亲属)。本研究采用框架分析的方法，量化并分析了“愿意知道编码的意愿”和“假设的可接受性”两个概念，以比较不同被试之间与可接受性相关的主题的出现情况。MIA对亲属的总体假设可接受性为73%(366/504)。MIA的想法是可以接受的，因为它被认为是简单和快速的，特别是因为它不会“肢解”身体。此外，MIA被认为有助于预防传染病、解决遗传病、澄清鳕鱼，并避免巫术指控和家庭内部冲突。关于这一程序的主要关切包括可能违反鳕鱼的保密性、对器官切除的误解以及与一些宗教信仰的不相容。正式的卫生专业人员担心MIA的调查结果与临床尸检诊断之间可能存在矛盾。基督教和伊斯兰社区对MIA的接受度同样很高。然而，在这两个以穆斯林为主的国家，MIA在马里的可接受性高于在巴基斯坦。尽管研究结果鼓励将MIA用于低收入环境下的COD调查，但这些结果仍然是假设的，需要与现实生活中MIA的实施以及健康和人口监测系统地区以外的人群进行确认。结论本研究显示出对了解亲属的COD的高度兴趣，以及MIA作为一种工具在六个不同环境下进行COD调查的高假设可接受性。这些发现预测了卫生设施和社区层面的潜在障碍和促进者，这些障碍和促进者对于当地为未来的MIA实施制定建议至关重要。
BackgroundThe 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 FindingsWe 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.ConclusionsThis 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.