Necropsies in African children: consent dilemmas for parents and guardians
Identifieur interne : 004403 ( Istex/Corpus ); précédent : 004402; suivant : 004404Necropsies in African children: consent dilemmas for parents and guardians
Auteurs : K. Lishimpi ; C. Chintu ; S. Lucas ; V. Mudenda ; J. Kaluwaji ; A. Story ; D. Maswahu ; G. Bhat ; A J Nunn ; A. ZumlaSource :
- Archives of Disease in Childhood [ 0003-9888 ] ; 2001-06-01.
English descriptors
- KwdEn :
- African countries, Ancestral spirits, Autopsy, Child health, Childhood mortality, Clinical diagnosis, Clinical pathology services, Clinical practice, Dead bodies, Dietary supplements, Good index, Infectious diseases, Inpatient wards, International health, Issues avecting, Lusaka, Main reason, Major cause, Medical training, Multilingual recruitment oycer, Ndings, Necropsy, Necropsy consent, Necropsy examination, Necropsy examinations, Necropsy organs, Necropsy rate, Necropsy rates, Necropsy refusal, Necropsy studies, Other family members, Religious beliefs, Respiratory depression, Respiratory disease, Respiratory diseases, Sequential necropsy study, Study period, Toxic evects, Traditional beliefs, University teaching hospital, Validation study, Verbal autopsy, Zambia, Zambia school, Zambian children.
- Teeft :
- African countries, Ancestral spirits, Autopsy, Child health, Childhood mortality, Clinical diagnosis, Clinical pathology services, Clinical practice, Dead bodies, Dietary supplements, Good index, Infectious diseases, Inpatient wards, International health, Issues avecting, Lusaka, Main reason, Major cause, Medical training, Multilingual recruitment oycer, Ndings, Necropsy, Necropsy consent, Necropsy examination, Necropsy examinations, Necropsy organs, Necropsy rate, Necropsy rates, Necropsy refusal, Necropsy studies, Other family members, Religious beliefs, Respiratory depression, Respiratory disease, Respiratory diseases, Sequential necropsy study, Study period, Toxic evects, Traditional beliefs, University teaching hospital, Validation study, Verbal autopsy, Zambia, Zambia school, Zambian children.
Abstract
BACKGROUND Necropsy examination provides a good index of the accuracy of clinical diagnosis and the quality of treatment, but its use in sub-Saharan Africa is limited. AIMS To identify the main reasons for parents'/guardians' refusal of consent for necropsy and to explore the issues affecting their decision. METHODS A sequential necropsy study of Zambian children between 2 months and 15 years dying of respiratory disease. When the parent/guardian refused permission for necropsy, the main reason given was recorded, after encouragement to express their specific concerns in their own words. RESULTS Parents/guardians of 891 of 1181 children (75.4%) refused to give permission, and 290 (24.6%) consented. Of those who refused, 43% did so on the grounds that it would be a “waste of time,” as the diagnosis should have been made in life and the findings would now be of no benefit to them. More than one quarter of those who refused did so because a death certificate had already been issued and arrangements to transport the body had been made and could not be delayed. Traditional beliefs that ancestral spirits forbade the mutilation of dead bodies were cited by 77 (8.6%). Other reasons included the child not being their own or that they must seek permission from other family members who were not available (6%). Religious beliefs were not a major cause of refusal. CONCLUSIONS It is possible to achieve a rate of necropsy consent sufficient to undertake valuable clinical pathology studies on children in sub-Saharan Africa. The wide range of reasons cited for refusal points to the diverse and complex interaction of social and cultural factors affecting attitudes to necropsy examination. Medical staff need training and support to improve the uptake of clinical pathology services. Key messages Worldwide necropsy rates are declining in both adults and children Even in conditions where trained counsellors and rapid access to necropsy examination exist, rates of consent remain low In Zambia, necropsy examination of children is most commonly perceived by parents/guardians as a waste of time and an inconvenience to arrangements for burial
Url:
DOI: 10.1136/adc.84.6.463
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ISTEX:D0C8B2B5F4ED1286A13527D4861256ABE2C94524Le document en format XML
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Zumla</name><affiliation><mods:affiliation></mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Archives of Disease in Childhood</title><title level="j" type="abbrev">Arch Dis Child</title><idno type="ISSN">0003-9888</idno><idno type="eISSN">1468-2044</idno><imprint><publisher>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</publisher><date type="published" when="2001-06-01">2001-06-01</date><biblScope unit="volume">84</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="463">463</biblScope></imprint><idno type="ISSN">0003-9888</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0003-9888</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>African countries</term><term>Ancestral spirits</term><term>Autopsy</term><term>Child health</term><term>Childhood mortality</term><term>Clinical diagnosis</term><term>Clinical pathology services</term><term>Clinical practice</term><term>Dead bodies</term><term>Dietary supplements</term><term>Good index</term><term>Infectious diseases</term><term>Inpatient wards</term><term>International health</term><term>Issues avecting</term><term>Lusaka</term><term>Main reason</term><term>Major cause</term><term>Medical training</term><term>Multilingual recruitment oycer</term><term>Ndings</term><term>Necropsy</term><term>Necropsy consent</term><term>Necropsy examination</term><term>Necropsy examinations</term><term>Necropsy organs</term><term>Necropsy rate</term><term>Necropsy rates</term><term>Necropsy refusal</term><term>Necropsy studies</term><term>Other family members</term><term>Religious beliefs</term><term>Respiratory depression</term><term>Respiratory disease</term><term>Respiratory diseases</term><term>Sequential necropsy study</term><term>Study period</term><term>Toxic evects</term><term>Traditional beliefs</term><term>University teaching hospital</term><term>Validation study</term><term>Verbal autopsy</term><term>Zambia</term><term>Zambia school</term><term>Zambian children</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>African countries</term><term>Ancestral spirits</term><term>Autopsy</term><term>Child health</term><term>Childhood mortality</term><term>Clinical diagnosis</term><term>Clinical pathology services</term><term>Clinical practice</term><term>Dead bodies</term><term>Dietary supplements</term><term>Good index</term><term>Infectious diseases</term><term>Inpatient wards</term><term>International health</term><term>Issues avecting</term><term>Lusaka</term><term>Main reason</term><term>Major cause</term><term>Medical training</term><term>Multilingual recruitment oycer</term><term>Ndings</term><term>Necropsy</term><term>Necropsy consent</term><term>Necropsy examination</term><term>Necropsy examinations</term><term>Necropsy organs</term><term>Necropsy rate</term><term>Necropsy rates</term><term>Necropsy refusal</term><term>Necropsy studies</term><term>Other family members</term><term>Religious beliefs</term><term>Respiratory depression</term><term>Respiratory disease</term><term>Respiratory diseases</term><term>Sequential necropsy study</term><term>Study period</term><term>Toxic evects</term><term>Traditional beliefs</term><term>University teaching hospital</term><term>Validation study</term><term>Verbal autopsy</term><term>Zambia</term><term>Zambia school</term><term>Zambian children</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">BACKGROUND Necropsy examination provides a good index of the accuracy of clinical diagnosis and the quality of treatment, but its use in sub-Saharan Africa is limited. AIMS To identify the main reasons for parents'/guardians' refusal of consent for necropsy and to explore the issues affecting their decision. METHODS A sequential necropsy study of Zambian children between 2 months and 15 years dying of respiratory disease. When the parent/guardian refused permission for necropsy, the main reason given was recorded, after encouragement to express their specific concerns in their own words. RESULTS Parents/guardians of 891 of 1181 children (75.4%) refused to give permission, and 290 (24.6%) consented. Of those who refused, 43% did so on the grounds that it would be a “waste of time,” as the diagnosis should have been made in life and the findings would now be of no benefit to them. More than one quarter of those who refused did so because a death certificate had already been issued and arrangements to transport the body had been made and could not be delayed. Traditional beliefs that ancestral spirits forbade the mutilation of dead bodies were cited by 77 (8.6%). Other reasons included the child not being their own or that they must seek permission from other family members who were not available (6%). Religious beliefs were not a major cause of refusal. CONCLUSIONS It is possible to achieve a rate of necropsy consent sufficient to undertake valuable clinical pathology studies on children in sub-Saharan Africa. The wide range of reasons cited for refusal points to the diverse and complex interaction of social and cultural factors affecting attitudes to necropsy examination. Medical staff need training and support to improve the uptake of clinical pathology services. Key messages Worldwide necropsy rates are declining in both adults and children Even in conditions where trained counsellors and rapid access to necropsy examination exist, rates of consent remain low In Zambia, necropsy examination of children is most commonly perceived by parents/guardians as a waste of time and an inconvenience to arrangements for burial</div></front></TEI><istex><corpusName>bmj</corpusName><keywords><teeft><json:string>necropsy examination</json:string><json:string>necropsy</json:string><json:string>zambia</json:string><json:string>lusaka</json:string><json:string>ndings</json:string><json:string>necropsy rates</json:string><json:string>ancestral spirits</json:string><json:string>respiratory disease</json:string><json:string>university teaching hospital</json:string><json:string>religious beliefs</json:string><json:string>traditional beliefs</json:string><json:string>clinical pathology services</json:string><json:string>main reason</json:string><json:string>zambian children</json:string><json:string>necropsy examinations</json:string><json:string>clinical diagnosis</json:string><json:string>child health</json:string><json:string>necropsy consent</json:string><json:string>autopsy</json:string><json:string>major cause</json:string><json:string>respiratory depression</json:string><json:string>infectious diseases</json:string><json:string>international health</json:string><json:string>good index</json:string><json:string>african countries</json:string><json:string>clinical practice</json:string><json:string>necropsy studies</json:string><json:string>childhood mortality</json:string><json:string>zambia school</json:string><json:string>respiratory diseases</json:string><json:string>issues avecting</json:string><json:string>necropsy refusal</json:string><json:string>dead bodies</json:string><json:string>other family members</json:string><json:string>inpatient wards</json:string><json:string>multilingual recruitment oycer</json:string><json:string>study period</json:string><json:string>necropsy organs</json:string><json:string>medical training</json:string><json:string>sequential necropsy study</json:string><json:string>verbal autopsy</json:string><json:string>validation study</json:string><json:string>toxic evects</json:string><json:string>dietary supplements</json:string><json:string>necropsy rate</json:string></teeft></keywords><author><json:item><name>K Lishimpi</name><affiliations><json:null></json:null></affiliations></json:item><json:item><name>C Chintu</name><affiliations><json:null></json:null></affiliations></json:item><json:item><name>S Lucas</name><affiliations><json:null></json:null></affiliations></json:item><json:item><name>V Mudenda</name><affiliations><json:null></json:null></affiliations></json:item><json:item><name>J Kaluwaji</name><affiliations><json:null></json:null></affiliations></json:item><json:item><name>A Story</name><affiliations><json:null></json:null></affiliations></json:item><json:item><name>D Maswahu</name><affiliations><json:null></json:null></affiliations></json:item><json:item><name>G Bhat</name><affiliations><json:null></json:null></affiliations></json:item><json:item><name>A J Nunn</name><affiliations><json:null></json:null></affiliations></json:item><json:item><name>A Zumla</name><affiliations><json:null></json:null></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Pathology</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Clinical diagnostic tests</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Research and publication ethics</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>children</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>necropsy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>consent</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Africa</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>BACKGROUND Necropsy examination provides a good index of the accuracy of clinical diagnosis and the quality of treatment, but its use in sub-Saharan Africa is limited. AIMS To identify the main reasons for parents'/guardians' refusal of consent for necropsy and to explore the issues affecting their decision. METHODS A sequential necropsy study of Zambian children between 2 months and 15 years dying of respiratory disease. When the parent/guardian refused permission for necropsy, the main reason given was recorded, after encouragement to express their specific concerns in their own words. RESULTS Parents/guardians of 891 of 1181 children (75.4%) refused to give permission, and 290 (24.6%) consented. Of those who refused, 43% did so on the grounds that it would be a “waste of time,” as the diagnosis should have been made in life and the findings would now be of no benefit to them. More than one quarter of those who refused did so because a death certificate had already been issued and arrangements to transport the body had been made and could not be delayed. Traditional beliefs that ancestral spirits forbade the mutilation of dead bodies were cited by 77 (8.6%). Other reasons included the child not being their own or that they must seek permission from other family members who were not available (6%). Religious beliefs were not a major cause of refusal. CONCLUSIONS It is possible to achieve a rate of necropsy consent sufficient to undertake valuable clinical pathology studies on children in sub-Saharan Africa. The wide range of reasons cited for refusal points to the diverse and complex interaction of social and cultural factors affecting attitudes to necropsy examination. Medical staff need training and support to improve the uptake of clinical pathology services. Key messages Worldwide necropsy rates are declining in both adults and children Even in conditions where trained counsellors and rapid access to necropsy examination exist, rates of consent remain low In Zambia, necropsy examination of children is most commonly perceived by parents/guardians as a waste of time and an inconvenience to arrangements for burial</abstract><qualityIndicators><score>6.58</score><pdfVersion>1.1</pdfVersion><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>7</keywordCount><abstractCharCount>2153</abstractCharCount><pdfWordCount>3580</pdfWordCount><pdfCharCount>23227</pdfCharCount><pdfPageCount>5</pdfPageCount><abstractWordCount>340</abstractWordCount></qualityIndicators><title>Necropsies in African children: consent dilemmas for parents and guardians</title><pmid><json:string>11369557</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>Archives of Disease in 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xml:id="author-0008"><persName><forename type="first">A J</forename><surname>Nunn</surname></persName><affiliation></affiliation></author><author xml:id="author-0009"><persName><forename type="first">A</forename><surname>Zumla</surname></persName><affiliation></affiliation></author><idno type="istex">D0C8B2B5F4ED1286A13527D4861256ABE2C94524</idno><idno type="ark">ark:/67375/NVC-P7T92BBZ-4</idno><idno type="DOI">10.1136/adc.84.6.463</idno><idno type="href">archdischild-84-463.pdf</idno><idno type="PMID">11369557</idno><idno type="local">archdischild;84/6/463</idno></analytic><monogr><title level="j">Archives of Disease in Childhood</title><title level="j" type="abbrev">Arch Dis Child</title><idno type="pISSN">0003-9888</idno><idno type="eISSN">1468-2044</idno><idno type="publisher-id">adc</idno><idno type="PublisherID-hwp">archdischild</idno><idno type="PublisherID-nlm-ta">Arch Dis Child</idno><imprint><publisher>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</publisher><date type="published" when="2001-06-01"></date><biblScope unit="volume">84</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="463">463</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2001-06-01</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>BACKGROUND Necropsy examination provides a good index of the accuracy of clinical diagnosis and the quality of treatment, but its use in sub-Saharan Africa is limited. AIMS To identify the main reasons for parents'/guardians' refusal of consent for necropsy and to explore the issues affecting their decision. METHODS A sequential necropsy study of Zambian children between 2 months and 15 years dying of respiratory disease. When the parent/guardian refused permission for necropsy, the main reason given was recorded, after encouragement to express their specific concerns in their own words. RESULTS Parents/guardians of 891 of 1181 children (75.4%) refused to give permission, and 290 (24.6%) consented. Of those who refused, 43% did so on the grounds that it would be a “waste of time,” as the diagnosis should have been made in life and the findings would now be of no benefit to them. More than one quarter of those who refused did so because a death certificate had already been issued and arrangements to transport the body had been made and could not be delayed. Traditional beliefs that ancestral spirits forbade the mutilation of dead bodies were cited by 77 (8.6%). Other reasons included the child not being their own or that they must seek permission from other family members who were not available (6%). Religious beliefs were not a major cause of refusal. CONCLUSIONS It is possible to achieve a rate of necropsy consent sufficient to undertake valuable clinical pathology studies on children in sub-Saharan Africa. The wide range of reasons cited for refusal points to the diverse and complex interaction of social and cultural factors affecting attitudes to necropsy examination. Medical staff need training and support to improve the uptake of clinical pathology services. Key messages Worldwide necropsy rates are declining in both adults and children Even in conditions where trained counsellors and rapid access to necropsy examination exist, rates of consent remain low In Zambia, necropsy examination of children is most commonly perceived by parents/guardians as a waste of time and an inconvenience to arrangements for burial</p></abstract><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>children</term></item><item><term>necropsy</term></item><item><term>consent</term></item><item><term>Africa</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Pathology</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Clinical diagnostic tests</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Research and publication ethics</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2001-06-01">Created</change><change when="2001-06-01">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/D0C8B2B5F4ED1286A13527D4861256ABE2C94524/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">archdischild</journal-id><journal-id journal-id-type="nlm-ta">Arch Dis Child</journal-id><journal-id journal-id-type="publisher-id">adc</journal-id><journal-title>Archives of Disease in Childhood</journal-title><abbrev-journal-title abbrev-type="publisher">Arch Dis Child</abbrev-journal-title><abbrev-journal-title>Arch Dis Child</abbrev-journal-title><issn pub-type="ppub">0003-9888</issn><issn pub-type="epub">1468-2044</issn><publisher><publisher-name>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</publisher-name></publisher></journal-meta><article-meta><article-id>001173</article-id><article-id pub-id-type="other">archdischild;84/6/463</article-id><article-id pub-id-type="doi">10.1136/adc.84.6.463</article-id><article-id pub-id-type="pmid">11369557</article-id><article-id pub-id-type="other">463</article-id><article-id pub-id-type="other">adc.84.6.463</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Pathology</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Clinical diagnostic tests</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Research and publication ethics</subject></subj-group></article-categories><title-group><article-title>Necropsies in African children: consent dilemmas for parents and guardians</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Lishimpi</surname><given-names>K</given-names></name><xref rid="tO1001" ref-type="aff">a</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Chintu</surname><given-names>C</given-names></name><xref rid="tO1001" ref-type="aff">a</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Lucas</surname><given-names>S</given-names></name><xref rid="tO1003" ref-type="aff">c</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mudenda</surname><given-names>V</given-names></name><xref rid="tO1001" ref-type="aff">a</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kaluwaji</surname><given-names>J</given-names></name><xref rid="tO1001" ref-type="aff">a</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Story</surname><given-names>A</given-names></name><xref rid="tO1002" ref-type="aff">b</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Maswahu</surname><given-names>D</given-names></name><xref rid="tO1001" ref-type="aff">a</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Bhat</surname><given-names>G</given-names></name><xref rid="tO1001" ref-type="aff">a</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Nunn</surname><given-names>A J</given-names></name><xref rid="tO1004" ref-type="aff">d</xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Zumla</surname><given-names>A</given-names></name><xref rid="tO1002" ref-type="aff">b</xref></contrib></contrib-group><aff id="O1001"><target id="tO1001" target-type="aff"><sup>a</sup>The UNZA–UCLMS (University of Zambia–University College London Medical School Tuberculosis/HIV Research and Training Project), University of Zambia School of Medicine, Lusaka, Zambia, </target><target id="tO1002" target-type="aff"><sup>b</sup>Centre for Infectious Diseases and International Health, Department of Medicine, Royal Free and University College London Medical School, London, UK, </target><target id="tO1003" target-type="aff"><sup>c</sup>Department of Pathology, UMDS of St Thomas's, King's, and Guys Hospital Medical Schools, London, UK, </target><target id="tO1004" target-type="aff"><sup>d</sup>MRC Clinical Trials Unit, London, UK</target></aff><author-notes><corresp>Professor A Zumla, Centre for Infectious Diseases and International Health, UCL Windeyer Institute of Medical Sciences Room G41, 46 Cleveland Street, London W1P 4JF, UK email: <email xlink:type="simple">a.zumla@ucl.ac.uk</email></corresp></author-notes><pub-date pub-type="ppub"><day>1</day><month>6</month><year>2001</year></pub-date><pub-date pub-type="epub"><day>1</day><month>6</month><year>2001</year></pub-date><volume>84</volume><volume-id pub-id-type="other">84</volume-id><volume-id pub-id-type="other">84</volume-id><issue>6</issue><issue-id pub-id-type="other">archdischild;84/6</issue-id><issue-id pub-id-type="other">6</issue-id><issue-id pub-id-type="other">84/6</issue-id><fpage>463</fpage><history><date date-type="accepted"><day>7</day><month>3</month><year>2001</year></date></history><permissions><copyright-statement>Royal College of Paediatrics and Child Health</copyright-statement><copyright-year>2001</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="archdischild-84-463.pdf"></self-uri><abstract><sec><title>BACKGROUND</title><p>Necropsy examination provides a good index of the accuracy of clinical diagnosis and the quality of treatment, but its use in sub-Saharan Africa is limited.</p></sec><sec><title>AIMS</title><p>To identify the main reasons for parents'/guardians' refusal of consent for necropsy and to explore the issues affecting their decision.</p></sec><sec sec-type="methods"><title>METHODS</title><p>A sequential necropsy study of Zambian children between 2 months and 15 years dying of respiratory disease. When the parent/guardian refused permission for necropsy, the main reason given was recorded, after encouragement to express their specific concerns in their own words.</p></sec><sec><title>RESULTS</title><p>Parents/guardians of 891 of 1181 children (75.4%) refused to give permission, and 290 (24.6%) consented. Of those who refused, 43% did so on the grounds that it would be a “waste of time,” as the diagnosis should have been made in life and the findings would now be of no benefit to them. More than one quarter of those who refused did so because a death certificate had already been issued and arrangements to transport the body had been made and could not be delayed. Traditional beliefs that ancestral spirits forbade the mutilation of dead bodies were cited by 77 (8.6%). Other reasons included the child not being their own or that they must seek permission from other family members who were not available (6%). Religious beliefs were not a major cause of refusal.</p></sec><sec><title>CONCLUSIONS</title><p>It is possible to achieve a rate of necropsy consent sufficient to undertake valuable clinical pathology studies on children in sub-Saharan Africa. The wide range of reasons cited for refusal points to the diverse and complex interaction of social and cultural factors affecting attitudes to necropsy examination. Medical staff need training and support to improve the uptake of clinical pathology services.</p><p><boxed-text position="float"><sec><title>Key messages</title><list list-type="simple"><list-item><p>Worldwide necropsy rates are declining in both adults and children</p></list-item><list-item><p>Even in conditions where trained counsellors and rapid access to necropsy examination exist, rates of consent remain low</p></list-item><list-item><p>In Zambia, necropsy examination of children is most commonly perceived by parents/guardians as a waste of time and an inconvenience to arrangements for burial</p></list-item></list></sec></boxed-text></p></sec></abstract><kwd-group><kwd>children</kwd><kwd>necropsy</kwd><kwd>consent</kwd><kwd>Africa</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Necropsies in African children: consent dilemmas for parents and guardians</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Necropsies in African children: consent dilemmas for parents and guardians</title></titleInfo><name type="personal"><namePart type="given">K</namePart><namePart type="family">Lishimpi</namePart><affiliation></affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">C</namePart><namePart type="family">Chintu</namePart><affiliation></affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S</namePart><namePart type="family">Lucas</namePart><affiliation></affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">V</namePart><namePart type="family">Mudenda</namePart><affiliation></affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J</namePart><namePart type="family">Kaluwaji</namePart><affiliation></affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Story</namePart><affiliation></affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D</namePart><namePart type="family">Maswahu</namePart><affiliation></affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">G</namePart><namePart type="family">Bhat</namePart><affiliation></affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A J</namePart><namePart type="family">Nunn</namePart><affiliation></affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Zumla</namePart><affiliation></affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</publisher><dateIssued encoding="w3cdtf">2001-06-01</dateIssued><dateCreated encoding="w3cdtf">2001-06-01</dateCreated><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract>BACKGROUND Necropsy examination provides a good index of the accuracy of clinical diagnosis and the quality of treatment, but its use in sub-Saharan Africa is limited. AIMS To identify the main reasons for parents'/guardians' refusal of consent for necropsy and to explore the issues affecting their decision. METHODS A sequential necropsy study of Zambian children between 2 months and 15 years dying of respiratory disease. When the parent/guardian refused permission for necropsy, the main reason given was recorded, after encouragement to express their specific concerns in their own words. RESULTS Parents/guardians of 891 of 1181 children (75.4%) refused to give permission, and 290 (24.6%) consented. Of those who refused, 43% did so on the grounds that it would be a “waste of time,” as the diagnosis should have been made in life and the findings would now be of no benefit to them. More than one quarter of those who refused did so because a death certificate had already been issued and arrangements to transport the body had been made and could not be delayed. Traditional beliefs that ancestral spirits forbade the mutilation of dead bodies were cited by 77 (8.6%). Other reasons included the child not being their own or that they must seek permission from other family members who were not available (6%). Religious beliefs were not a major cause of refusal. CONCLUSIONS It is possible to achieve a rate of necropsy consent sufficient to undertake valuable clinical pathology studies on children in sub-Saharan Africa. The wide range of reasons cited for refusal points to the diverse and complex interaction of social and cultural factors affecting attitudes to necropsy examination. Medical staff need training and support to improve the uptake of clinical pathology services. Key messages Worldwide necropsy rates are declining in both adults and children Even in conditions where trained counsellors and rapid access to necropsy examination exist, rates of consent remain low In Zambia, necropsy examination of children is most commonly perceived by parents/guardians as a waste of time and an inconvenience to arrangements for burial</abstract><subject><genre>keywords</genre><topic>children</topic><topic>necropsy</topic><topic>consent</topic><topic>Africa</topic></subject><relatedItem type="host"><titleInfo><title>Archives of Disease in Childhood</title></titleInfo><titleInfo type="abbreviated"><title>Arch Dis Child</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>hwp-journal-coll</genre><topic>Pathology</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Clinical diagnostic tests</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Research and publication ethics</topic></subject><identifier type="ISSN">0003-9888</identifier><identifier type="eISSN">1468-2044</identifier><identifier type="PublisherID">adc</identifier><identifier type="PublisherID-hwp">archdischild</identifier><identifier type="PublisherID-nlm-ta">Arch Dis Child</identifier><part><date>2001</date><detail type="volume"><caption>vol.</caption><number>84</number></detail><detail type="issue"><caption>no.</caption><number>6</number></detail><extent unit="pages"><start>463</start></extent></part></relatedItem><identifier type="istex">D0C8B2B5F4ED1286A13527D4861256ABE2C94524</identifier><identifier type="ark">ark:/67375/NVC-P7T92BBZ-4</identifier><identifier type="DOI">10.1136/adc.84.6.463</identifier><identifier type="href">archdischild-84-463.pdf</identifier><identifier type="PMID">11369557</identifier><identifier type="local">archdischild;84/6/463</identifier><accessCondition type="use and reproduction" contentType="copyright">Royal College of Paediatrics and Child Health</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-7M42M2QJ-2">bmj</recordContentSource><recordOrigin>Royal College of Paediatrics and Child Health</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/D0C8B2B5F4ED1286A13527D4861256ABE2C94524/metadata/json</uri></json:item></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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