An In-Depth Examination of Reasons for Autopsy Acceptance and Refusal in Northern Tanzania

Abstract

Uncertainty about the causes of death (COD) in low-and middle-income countries (LMICs) has been recognized as a constraint to global health and development. Although complete diagnostic autopsy (CDA) is the best way to assess COD, it is uncommon in LMICs because of low investment priority and assumptions about poor acceptability. Social science research was conducted from May 2016 through July 2017 to examine issues related to acceptability of CDAs in northern Tanzania where autopsy was being offered in two referral hospitals to assess COD associated with febrile illness. Initial formative research entailed 29 key informant interviews, seven observations of burial practices, and four group discussions. In-depth interviews were conducted with families of deceased, including nine families that accepted and 11 families that refused CDA. The formative research identified concepts related to death, understandings of CDA, and cultural practices and psychosocial considerations associated with death that informed the authorization process. Most families who accepted CDA cited the desire to get clarity regarding the COD as a primary reason for acceptance. An unexpected finding was that CDA is perceived as a means to determine witchcraft involvement, a common explanation for COD and a common reason for postmortem acceptance. Death resulting from chronic illness or conditions presumed to have a clinical diagnosis were reasons for CDA to be viewed as unnecessary. The timing, way families were approached, and content of information shared during authorization influenced acceptance and refusal of CDA. Findings show that CDAs can be acceptable in settings where traditional disease models prevail.

Community perceptions of postmortem examination and minimally invasive tissue sampling in neonates:a qualitative study in South India

“…Adverse media attention especially, in retaining organs, is another reason for the refusal of autopsy [28]. Studies across the world also find similar reasons for refusing autopsy, which was observed in our study [29][30][31][32]. Age, sex, and occupation did not alter participants' opinions on postmortem examination; however, participants from the Hindu religion felt that performing customary burial rites for the deceased was more challenging in conventional postmortem.…”

Knowledge and attitudes toward complete diagnostic autopsy and minimally invasive autopsy: A cross-sectional survey in Hanoi, Vietnam

“…Research conducted in Tanzania with multiple participant groups demonstrated that autopsy was accepted and religious factors were facilitators to the acceptance, not barriers. Conducting CDA in this context was often done to learn the cause of death thus being able to determine if witchcraft was involved, which were sourced from local religious beliefs, especially in case of sudden death of a person who had no illness history [22].…”

Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS), December 2016 –December 2021

“…The gold standard for obtaining accurate causes of death information is a complete diagnostic autopsy, more often, the procedure is not even suggested as it is not typically feasible in LMICs because of the expense, required expertise and, in some settings many families decline the procedure for personal, socio-cultural, and religious reasons [8][9][10][11]. During the past decade, use of post-mortem specimens collected through minimally invasive tissue sampling (MITS) has shed light on the sequence of events leading to deaths in children [12,13].…”