Child mortality in Eastern Ethiopia: acceptability of Postmortem minimally invasive tissue sampling in a predominantly muslim community.

Background: It is crucial to consider cultural, religious, and socio-behavioural factors that may influence the acceptability of Minimally Invasive Tissues Sampling (MITS). MITS is being used to understand the causes of child death and conducted in nine countries within Africa and South Asia with the highest child mortality. Progress has been made in the development of laboratory infrastructures and training for physicians to do MITS, but many communities are concerned about the religious acceptability of taking samples from deceased children. This paper explores the acceptability of MITS in a predominantly Muslim community.

Methods: A qualitative study was conducted in Kersa and Harar, in Eastern Ethiopia between April 23, 2018 and April 21, 2019 where high child mortality rates have been recorded. The study involved interviews and focus groups with 76 participants, including mothers, elders, and religious leaders. In addition, observations were conducted at burial ceremonies and in grieving families' homes. Grounded theory framework is used in this article to understand the acceptability of postmortem MITS.

Results: We explore cultural, religious, and socio-behavioural barriers and facilitators that may influence the acceptability of minimally invasive tissue sampling. We identify three themes relating to the acceptability of MITS: (1) Perceptions and rituals related to child death (2), Religious acceptance of post-mortem investigation, and (3) Fears and suspicions of organ theft and body mutilation. Most participants hypothetically accepted MITS, but suggested that the procedure consider religious practices. Religious leaders and parents stated that they would accept the procedure if it would help reduce child deaths. Acceptance is inconsistent and differs across time and place. Some villages accepted the procedure swiftly, only to change their views when they became aware of suspicions from other villages about the procedure disfiguring the body. Parents of deceased children were concerned that taking samples from the children's bodies would delay the burial.

Conclusions: Mortality surveillance requires a thorough understanding of the cultural, religious, and sociocultural aspects that may affect the acceptability of MITS. MITS research should be conducted close to communities, involving community members, incorporating religious perspectives, and promoting health outreach campaigns to facilitate sociocultural perceptions of the research activities.