Minimally invasive autopsies in lower-income countries: Reliability, acceptability

High concordance rates were observed between diagnoses obtained using a simplified minimally invasive autopsy method and those determined from complete autopsies in a series of deceased adult patients in Mozambique, according to research published in PLOS Medicine by Jaume Ordi and colleagues from ISGlobal, Universitat de Barcelona, Barcelona, Spain. In a linked research article, Khátia Munguambe and colleagues from the Centro de Investigação em Saúde da Manhiça, Universidade Eduardo Mondlane, Maputo, Mozambique, observed that the hypothetical acceptability of the minimally invasive autopsy and willingness to know the cause of death were high across five settings in Gabon, Kenya, Mali, Mozambique, and Pakistan.

While complete autopsies are considered the gold standard for the determination of cause of death, they are poorly accepted and difficult to perform in low- and middle- income countries. The simplified minimally invasive autopsy, which consists of histological and microbiological analyses of blood samples, cerebrospinal fluid samples, and tissue samples from solid organs using biopsy needles, could be an alternative method to the complete autopsy. In the first study, the researchers compared the cause of death identified in 112 deceased adult patients using a minimally invasive method with the cause of death identified from a complete autopsy. They observed 75.9% concordance rates between the diagnosis obtained with the minimally invasive autopsy and the gold standard diagnosis, with a particularly high agreement for infectious diseases.

In the second study, a mixed-methods approach was used to conduct 504 interviews with different informants, including those who had recently lost a family member, in five different countries. They found that 75% of the participants would be willing to know the cause death of a relative and that the overall hypothetical acceptability of minimally invasive autopsy on a relative was 73%.

Overall, these two studies provide support for the feasibility and validity of the minimally invasive autopsy method to be used in low-and middle-income settings to allow reliable estimates of cause of death.

In a linked Perspective, Peter Byass of Umeå University, Umeå, Sweden reflects on the potential challenges for minimally invasive autopsies to become routinely used for determining cause of death in low- and middle-income countries. He says "MIA shows signs of being an important addition to the world's available range of cause-of-death assignment methods."

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Funding: The CaDMIA research project (Validation of the minimally invasive autopsy tool for cause of death investigation in developing countries) is funded by the Bill & Melinda Gates Foundation (Global Health grant number OPP1067522) and by the Spanish Instituto de Salud Carlos III (FIS, PI12/00757). QB has a fellowship from the program Miguel Servet of the ISCIII (Plan Nacional de I+D+I 2008-2011, grant number: CP11/00269). ML is a 1D researcher from CNPq. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: CM is a member of the Editorial Board of PLOS Medicine.

Citation: Castillo P, Martínez MJ, Ussene E, Jordao D, Lovane L, Ismail MR, et al. (2016) Validity of a Minimally Invasive Autopsy for Cause of Death Determination in Adults in Mozambique: An Observational Study. PLoS Med 13(11): e1002171. doi:10.1371/journal.pmed.1002171

Author Affiliations: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil
Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002171

Funding: This study was conducted as part of the project "Validation of the Minimally Invasive Autopsy (MIA) tool for cause of death investigation in developing countries", funded by the Bill and Melinda Gates Foundation (OPP1067522) and the Fondo de Investigaciones Sanitarias (FIS) program (ISCIII, PI12/00757). QB has a fellowship from the program Miguel Servet of the ISCIII (Plan Nacional de I+D+I 2008-2011, grant number: CP11/00269). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: ZAB and CM are members of the Editorial Board of PLOS Medicine.

Citation: Maixenchs M, Anselmo R, Zielinski-Gutiérrez E, Odhiambo FO, Akello C, Ondire M, et al. (2016) Willingness to Know the Cause of Death and Hypothetical Acceptability of the Minimally Invasive Autopsy in Six Diverse African and Asian Settings: A Mixed Methods Socio-Behavioural Study. PLoS Med 13(11): e1002172. doi:10.1371/journal.pmed.1002172

Author Affiliations: Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
Centers for Disease Control and Prevention (CDC-Kenya), Nairobi, Kenya
Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002172

Funding: No specific funding was received for this work.

Competing Interests: PB is a member of the Editorial Board of PLOS Medicine.

Citation: Byass P (2016) Minimally Invasive Autopsy: A New Paradigm for Understanding Global Health? PLoS Med 13(11): e1002173. doi:10.1371/journal.pmed.1002173

Author Affiliations: WHO Collaborating Centre for Verbal Autopsy, Epidemiology & Global Health, Dept. of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002173