Article
Necropsies in African children: consent dilemmas for parents and
guardians
K Lishimpia, C Chintua, S Lucasc, V Mudendaa, J Kaluwajia, A Storyb, D Maswahua, G Bhata, A J Nunnd, A Zumlab
a 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, b Centre for Infectious Diseases and International
Health, Department of Medicine, Royal Free and University College
London Medical School, London, UK, c Department of Pathology, UMDS of St Thomas's,
King's, and Guys Hospital Medical Schools, London, UK, d MRC
Clinical Trials Unit, London, UK
Correspondence to: 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: a.zumla{at}ucl.ac.uk
Accepted 7 March 2001
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.
AIMSTo identify the
main reasons for parents'/guardians' refusal of consent for necropsy
and to explore the issues affecting their decision.
METHODSA 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.
RESULTSParents/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.
CONCLUSIONSIt 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.
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Keywords: children; necropsy; consent; Africa
© 2001 by Archives of Disease in Childhood
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