Journal Article

Healthcare providers' views and perceptions on post-mortem procedures for cause of death determination in Southern Mozambique

Maixenchs, Maria, Carrilho, Carla, Ordi, Jaume, Castillo, Paola, Anselmo, Rui, Sanz, Ariadna, Bassat, Quique, Macete, Eusebio, Munguambe, Khatia, Menendez, Clara

2018

Overview

The minimally invasive autopsy (MIA) is being investigated as an alternative to the complete diagnostic autopsy (CDA), gold standard for CoD determination, in settings where CDA is unfeasible and/or unacceptable. We aimed to explore healthcare providers' views and perceptions on theoretical and factual acceptability of the CDA and the MIA. A qualitative study, combining ethnographic and grounded-theory approaches, was conducted within a project aiming to validate the MIA tool against the CDA for CoD investigation. We present data on in-depth and semi-structured interviews of 33 healthcare providers operating within the formal and informal health services in Southern Mozambique. MIA perception was analysed through the theory of diffusion of innovations. All participants considered CDA useful for CoD determination. CDA was perceived reliable, but the unpleasant nature of the procedure and its associated infection risk were the main perceived disadvantages. Participants considered the MIA simple, easy and quick to perform; likely to meet families' expectations to know the CoD, and able to provide evidence-based knowledge for disease management. Concerns were raised on its reliability compared to the CDA. Family's emotional status and accessibility to decision-makers were mentioned as principal barriers for MIA performance. The main jeopardizing factors for MIA implementation were the shortage of required resources and the significant proportion of people dying at home. Key facilitators for MIA acceptance included the need for the support from community and religious leaders, provision of clear information to the community, and accompaniment to bereaved families. Healthcare providers consider the MIAs potentially more acceptable and feasible than CDAs in places where the latter have shown significant implementation challenges. A clear understanding of healthcare provider's perceived barriers and facilitators for conducting post-mortem procedures in general, and MIAs in particular, will shed light on their future field implementation for more robust mortality surveillance.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acceptability / Adolescent / Adult / Autopsies / Autopsy / Autopsy - methods / Autòpsia / Beliefs, opinions and attitudes / Cause of Death / Causes de la mort / Communities / Consent / Death causes / Diagnostic systems / Disease control / Female / Health care / Health Knowledge, Attitudes, Practice / Health Personnel - psychology / Health risks / Health services / Hospitals / Humans / Innovations / Laws, regulations and rules / Male / Medical personnel / Medicine and Health Sciences / Methods / Middle Aged / Mozambique / Moçambic / Pathology / People and Places / Qualitative research / Risk perception / Social Sciences / Supervision / Young Adult