Introducing Minimally Invasive Tissue Sampling to Ascertain Cause of Death in Children and Stillbirths in Central Mozambique
Year: 2026
Type: article
Abstract: Minimally invasive tissue sampling (MITS) has been used as an alternative to complete autopsy to track causes of death (CoDs) in South Asia and sub-Saharan Africa as part of the Child Health and Mortality Prevention Surveillance program. However, community acceptance, rapid identification of deaths, and adequate functional laboratory infrastructures (e.g., pathology, conventional microbiology, and molecular microbiology) are critical for successful implementation. We describe the experience of implementing MITS in an urban district with socioeconomic and cultural diversity in Zambézia Province, central Mozambique. For successful implementation of mortality surveillance using MITS, high-level advocacy involving the Provincial Government and all stakeholders as well as engagement and sensitization of all segments of the communities, including traditional healers, community leaders, and mass media, were critical for the acceptability of the procedure. Additionally, social and behavior studies were conducted to assess perceptions, sociocultural factors, acceptability, and feasibility of the MITS procedure. These studies helped adapt the MITS protocol to the local context to minimize the risk of misunderstanding the mortality surveillance using MITS procedures. There was significant investment in capacity building, including financial support for laboratory equipment acquisition and maintenance, reagents, and consumables required for microbiological screening protocols of MITS and to support the needs for diagnostics of patients with severe disease seeking care. Experiences from Quelimane and other sites and data generated in the Countrywide Mortality Surveillance for Action to support evidence-based decision-making processes on health policy were critical for the community to understand the benefit of determining young children CoD to guide future interventions.
Authors: Inácio Mandomando, Anélsio Cossa, Augusto Messa, António Sitoe, Pio Vitorino, Amílcar Magaço, Rita Mabunda, Alexandre Macanze, Judice Miguel, Izete Figueiredo, Agbessi Amouzou, Robert Black, Almamy Malick Kante, Elísio Xerinda, Sergio Massora, Marcelinio Garrine, Percina Chirinda, Placido Assane, Ivalda Macicame, Dercio Jordao, Ladino Suade, Celisa Mendonça de Assis, Arsénia Massinga, Maria Maixenchs, Ariel Nhacolo, Khatia Munguambe, Portia Mutevedzi, Robert F. Breiman, Cynthia G. Whitney, Diana M. Blau, Mischka Garel, Jaume Ordi, Natalia Rakislova, Quique Bassat
Institutions: Manhiça Health Research Centre, Instituto Nacional de Saúde, Barcelona Institute for Global Health, Universidade Nova de Lisboa, Universitat de Barcelona, Johns Hopkins University, Emory University, Emory Global Health Institute, Centers for Disease Control and Prevention, Institució Catalana de Recerca i Estudis Avançats, Hospital Clínic de Barcelona
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7127274125
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