Influenza Program, IHRC, Nairobi, KE.
Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Kisumu, KE.
Ann Glob Health. 2019 Jul 3;85(1):95. doi: 10.5334/aogh.2504.
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.
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.
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.
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.
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.
临床解剖通常不作为常规护理的一部分，尽管其在明确死因方面发挥着作用。事实上，全球范围内的解剖率有所下降，尤其是在撒哈拉以南非洲地区。
我们旨在确定影响五岁以下儿童死亡的父母接受儿科解剖的因素，并检查在死后（PM）检查期间对微创组织取样（MITS）程序的局部偏好。
从 2016 年 12 月到 2017 年 9 月，我们联系了 113 位父母/近亲，他们之前曾被邀请同意对其已故孩子进行 PM 检查，这是肯尼亚关于死因的研究的一部分。访谈是在孩子去世后长达三年进行的。
符合条件的研究参与者中有 73%（83/113）被纳入研究，其中 62/83（75%）之前同意对其孩子进行 PM 检查。那些之前同意 PM 的人受过更高的教育，更有可能就业，并且对解剖的某些方面的了解程度高于不同意者。大多数（97%）PM 同意者这样做是因为他们想知道孩子的死因，多达三分之一的人认为解剖研究有助于推进医学知识。不同意 PM 检查的原因包括：父母认为没有进一步检查的必要（29%）或他们对临床诊断感到满意（24%）。总体而言，只有 40%的研究参与者会更喜欢 MITS 程序而不是传统的解剖。然而，如果仅涉及 MITS 技术，81%的解剖不同意者会接受 PM 检查。
通过加强接受解剖的理由和解决可改变的拒绝理由，有可能提高解剖率。尽管 MITS 程序有可能提高解剖接受率，但在我们的研究人群中，它们并没有明显优于传统解剖。
