Pediatric death audit with special emphasis on autopsy at the University of Uyo Teaching Hospital, Uyo, Nigeria: a 6-year review

Abstract

Background and Objectives: Paediatric autopsies are useful in the establishment of diagnosis, quality assurance and research. They are relevant in guiding genetic counseling and helping families that are grieving. Despite these uses and applications, autopsy rates have declined globally. This study was undertaken to identify the autopsy rate in the Department of Paediatrics at the University of Uyo Teaching Hospital (UUTH), Uyo, Nigeria. Materials and Methods:The current report is a descriptive, cross-sectional and retrospective review of all the deaths among the hospitalized children from 1st January 2009 to 31st December 2014. Relevant information was extracted from case files of all inpatient deaths during the period under review. Results: A total of 772 paediatric deaths were recorded during the period under review, of which 453 (58.7%) were males and 319 (41.3%) were females. Two hundred and twelve [212 (37.5%)] deaths occurred within 24 hours of admission. No autopsy was conducted (0%) on any of the cases. Conclusion: Despite the importance, paediatric autopsies are not routinely performed in this centre, and in many others. This should not be the case. Paediatric autopsy rates can be improved by making consistent autopsy requests by the attending clinicians. Advocacy and enlightenment campaigns should be conducted at facility and community levels to educate everyone concerned about the benefits of paediatric autopsies.Despite these well documented uses and applications, autopsy rates have declined globally [4,7]. The reasons for this decline are varied and complex [5,8,9]. They include dearth of qualified personnel, inadequate resources and constraints in capacity [6], attitude among health care workers, family concerns about delays, disfigurement and, objections on religious grounds [5]. Other reasons include fear of litigation due to incorrect diagnosis (among the healthcare workers), and the cost implication of the autopsy [8,10].Another reason for the low rate of autopsy are the recent advances in modern medicine. Despite modern medical advances, nothing can validate or correct the death certificate like autopsy. Without an autopsy the cause of death can be wrong in as many as 30% of

The invisible body work of ‘last responders’ – ethical and social issues faced by the pathologists in the Global South

“…This finding resonates with earlier studies that have made a case for improving this knowledge, especially in medical settings. It has been suggested that clinicians should receive training on the value of autopsy for their clinical practice so that they request it more frequently (Echo et al, 2015 ; Lishimpi et al, 2001 Pawar & Pawar, 2012 ;). The literature agrees that clinicians may be reluctant to request autopsy procedures because they anticipate a difficult conversation with bereaved family members and a refusal to consent.…”

“…Relatives fear the mutilation or disfigurement of the dead body and therefore reject the autopsy procedure (Oluwasola et al, 2009 , Charlier et al, 2013 ). Some of the other reasons provided for unwillingness to give consent for autopsy were explained by a perception that the body is being commodified (Banyini et al, 2013 ), the body is being desecrated (Charlier et al, 2012 ), or there have been expressions of religious and cultural factors as the basis of objections to post-mortem procedures (Banyini et al, 2013 ; Echey et al, 2015 ; Yawson et al, 2014 ). Against this background, an autopsy is a sensitive issue for many people, and consenting to it has been described as psychologically distressing for grieving families (Mfutso-Bengu & Taylor, 2002 ).…”