Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: results from a qualitative study

Abstract

BackgroundPakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of MITS, it is important to understand health professionals’ attitudes and perceptions related to MITS.MethodsA qualitative study was conducted at the National Institute of Child Health (NICH), Karachi, Pakistan. Focus group discussions (FGDs) and Key-informant interviews (KIIs) were conducted with health professionals including doctors, nurses, trainees, clinicians, bioethics experts and public health experts to explore their perceptions and views on acceptability of MITS. Data were analyzed using NVivo 10 software.ResultsA total of 12 interviews (FGDs = 4; KIIs = 8) were conducted. Four overarching themes were identified: (I) acceptability of MITS; (II) perceived benefits of the MITS procedure; (III) factors facilitating the implementation of MITS; and (IV) health system requirements for implementing the MITS procedure. Generally, MITS was considered as a positive development for the health system. Diagnostic accuracy and identification of less common causes of death were highlighted as two main benefits of the MITS procedure. The study highlighted a number of facilitators for the acceptability of MITS including effective counseling, building trust with parents, fast procedure time, and approaching families within a few hours of death. In addition, lack of skilled staff, poorly equipped healthcare facilities and the potential high cost to conduct MITS were identified as challenges for the implementation of MITS.ConclusionsThis formative research provided a unique opportunity to explore health professionals’ views and attitudes towards the MITS procedure. Such insights are crucial to ensure successful implementation and integration of a new technique into the existing health system. The research identified the factors influencing the acceptability of MITS among health professionals in Pakistan. The study also informed factors that could help facilitate the implementation of the MITS procedures in the context of Pakistan and similar settings.

Perceptions of the healthcare providers regarding acceptability and conduct of minimal invasive tissue sampling (MITS) to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study

“…However some professionals felt that MITS should be reserved for patients with no or incomplete diagnosis. These observations were similar to the observations from other studies [34,35].…”

“…The trust on healthcare providers and hospital, effective counseling and promptness in conducting MITS were identified as the influencing factors for the acceptance. The participants also opined that appropriate healthcare providers should be identified for training in MITS to retain interest [34]. These observations were similar to the findings from our study.…”

“…They opined that the acceptance would be more among the parents with past experience of child death or bad obstetric history. These factors were similar to those identified in studies from United Kingdom, Pakistan, Gabon, Kenya, Mali, Mozambique and Kenya [13,[33][34][35]38]. The study explored the factors that might influence implementation of MITS in a tertiary care hospital in India.…”

“…The formative researchers and early implementation experiences have revealed positive theoretical acceptability for MITS among parents, community members and religious leaders [28][29][30][31][32]. Acceptance for MITS among the healthcare providers at facility and community levels have been encouraging [33][34][35][36]. The acceptance of MITS among the families and community may vary across the countries due to the sociocultural and religious contexts.…”

A comparison of MITS counseling and informed consent processes in Pakistan, India, Bangladesh, Kenya, and Ethiopia

“…Key informant interviews with researchers were conducted to describe the characteristics and backgrounds of counsellors, the environment and timing of consent and perceived facilitators and barriers encountered during the consent process. It should be noted that each MITS project conducted their own formative assessments and those results informed the design and implementation of their consent process, described in detail elsewhere [ 5 , 8 – 10 ].…”