Hypothetical acceptability of hospital-based post-mortem pediatric minimally invasive tissue sampling in Malawi: The role of complex social relationships.
Hypothetical acceptability of hospital-based post-mortem pediatric minimally invasive tissue sampling in Malawi: The role of complex social relationships.
复制标题
马拉维的基于医院后的小儿小儿侵入性组织采样的假设可接受性：复杂的社会关系的作用。
DOI：
10.1371/journal.pone.0246369
复制
发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Desmond N
中科院分区：
文献类型：
--
作者：
Lawrence S;Namusanya D;Hamuza A;Huwa C;Chasweka D;Kelley M;Molyneux S;Voskuijl W;Denno DM;Desmond N
在资源匮乏的环境中，儿童死亡率仍然高得令人无法接受。死亡原因（CoD）通常是未知的。微创组织取样（MITS）-使用活检针获得死后样本-用于组织病理学和微生物研究，越来越多地被推广，以提高儿童和成人的死因归因。“马拉维的MITS”是儿童急性疾病和营养网络的一项子研究，旨在确定因急性疾病或营养不良住院的幼儿的生物和社会经济死亡风险因素。马拉维的MITS采用标准的MITS和一种新的死后内窥镜肠道采样方法，以更好地了解住院期间死亡的急性疾病和/或营养不良儿童的CoD。了解可能影响MITS可接受性的因素，并告知在马拉维住院期间死亡的急性疾病或营养不良儿童中引入CoD的程序。我们与主要医院工作人员和社区成员（宗教领袖和5岁以下儿童的父母）进行了8次焦点小组讨论，以探讨在马拉维开始MITS研究之前对MITS和知情同意过程的态度。我们使用的主题内容分析绘制的概念框架，从新兴的主题和MITS的可接受性文献。在医院和家庭内的决策权的感觉，在卫生系统的信任，以及开放和尊重的卫生工作者与父母沟通的MITS的可接受性的重要方面。其他促进因素包括MITS添加CoD信息的潜力，以帮助理解死亡，并有助于医学知识和新的干预措施。可接受性的潜在障碍包括担心器官和血液采集，身体毁容以及运输和埋葬计划的中断。医疗系统和家庭内部的社会关系和权力动态是MITS可接受性的关键组成部分，特别是考虑到死亡和尸检的敏感性。
Child mortality rates remain unacceptably high in low-resource settings. Cause of death (CoD) is often unknown. Minimally invasive tissue sampling (MITS)–using biopsy needles to obtain post-mortem samples–for histopathological and microbiologic investigation is increasingly being promoted to improve child and adult CoD attribution. “MITS in Malawi” is a sub-study of the Childhood Acute Illness & Nutrition (CHAIN) Network, which aims to identify biological and socioeconomic mortality risk factors among young children hospitalized for acute illness or undernutrition. MITS in Malawi employs standard MITS and a novel post-mortem endoscopic intestinal sampling approach to better understand CoD among children with acute illness and/or malnutrition who die during hospitalization. To understand factors that may impact MITS acceptability and inform introduction of the procedure to ascertain CoD among children with acute illness or malnutrition who die during hospitalization in Malawi. We conducted eight focus group discussions with key hospital staff and community members (religious leaders and parents of children under 5) to explore attitudes towards MITS and inform consent processes prior to commencing the MITS in Malawi study. We used thematic content analysis drawing on a conceptual framework developed from emergent themes and MITS acceptability literature. Feelings of power over decision-making within the hospital and household, trust in health systems, and open and respectful health worker communication with parents were important dimensions of MITS acceptability. Other facilitating factors included the potential for MITS to add CoD information to aid sense-making of death and contribute to medical knowledge and new interventions. Potential barriers to acceptability included fears of organ and blood harvesting, disfigurement to the body, and disruption to transportation and burial plans. Social relationships and power dynamics within healthcare systems and households are a critical component of MITS acceptability, especially given the sensitivity of death and autopsy.
登录
查看更多内容
影响因子：
7.1
作者：
Breeze, A. C. G.;Jessop, F. A.;Lees, C. C.
通讯作者：
Lees, C. C.
影响因子：
2.9
作者：
Gidman, Wendy;Ward, Paul;McGregor, Lesley
通讯作者：
McGregor, Lesley
影响因子：
2.5
作者：
Crawley, Esther;Mills, Nicola;Montgomery, Alan
通讯作者：
Montgomery, Alan
影响因子：
2.8
作者：
Das, Manoja Kumar;Arora, Narendra Kumar;Meena, K. R.
通讯作者：
Meena, K. R.
影响因子：
2.2
作者：
Fan, Joe K. M.;Tong, Daniel K. H.;Law, Wai Lun
通讯作者：
Law, Wai Lun