Establishing and evaluating minimally invasive autopsy to determine cause of death from infectious disease in Vietnam

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Pathology is the science of the causes and effects of diseases, especially the branch of medicine that deals with the laboratory examination of samples of body tissue for diagnostic or forensic purposes that have been obtained from an affected part of the body while the patient is alive (biopsy) or dead (necropsy or autopsy). In medicine, pathologic examination of tissues from patients who have died can be helpful to establish the cause of death. Knowledge of cause of death is of importance for prioritizing and distribution of public health resources. In Vietnam pathology is not part of routine diagnostics of patients and is not routinely used to establish cause of death. Knowledge of cause of death in Vietnam is therefore limited, also due to limited diagnostic capacity and inadequate national recording and reporting systems. In infectious diseases, which are the cause of death of around 10-15% of all people who die, the cause of death is only known in a minority of cases.In the proposed project we aim to do three things.1. To explore the attitudes towards postmortem investigations2. To build pathology capacity in two large infectious diseases hospitals3. To evaluate the use of a novel way of doing autopsies by only taking small samples using hollow needles from different sites of the human body. This is called minimally invasive autopsy (MIA). Attitudes: A social scientist will explore the attitudes and perceptions towards postmortem investigations and sampling among a) the general public by inviting people to complete an online survey in a press release in national newspapers and b) healthcare professionals, religious leaders and patients relatives during focus group discussions. We will discuss postmortem investigations and sampling in general, and full autopsy and MIA in particular. We will show a video of both full and minimally invasive autopsies and ask participants to comment, to discuss their perceptions and beliefs regarding both procedures on a professional and personal level.Capacity: Simultaneously, we will build capacity for pathology in the National Hospital for Tropical Diseases and Bach Mai Hospital in Hanoi. This will include purchase of necessary equipment and consumables for taking and analysing biopsy and MIA samples, training of Vietnamese clinical and laboratory staff by UK based pathologists and enabling implementation of pathology in routine clinical diagnostics, e.g. liver biopsy in infectious diseases of the liverEvaluation: Evaluate the contribution of MIA to establish the cause of death in patients who have died from one of three infectious clinical syndromes: infection of the central nervous system (brain and spinal cord), of the lungs (pneumonia) and of the bloodstream (sepsis/septic shock). After obtaining permission from relatives, we will use the validated MIA protocols - adapted to be acceptable locally using information from the Attitude phase - to take samples from the deceased patient and we will use general and pathogen specific pathologic examination and highly sensitive molecular techniques that detect genetic information of almost all known infectious agents (next generation sequencing) to establish cause of death. We will do this on a total of 100 patients. All OUCRU's work is made available in open-access publications, and will be presented at (inter)national conferences and at policy groups. Public Engagement (PE) activities will be designed and coordinated by the very active OUCRU PE team, working with project researchers and health workers in each site to implement and communicate these activities.