Abstract
BackgroundGlobally, around 2.6 million neonatal deaths occur world-wide every year and the numbers of stillbirths is almost similar. Pakistan is ranked among the highest countries in the world for neonatal mortality. In 2016, for every 1000 babies born in Pakistan, 46 died before the end of the first month of life. Also, Pakistan had the highest rate of stillbirths (43.1/1000 births) in 2015. To meet sustainable development (SDG) targets of reducing neonatal mortality and stillbirths, it is essential to gain understanding about the causes of neonatal death and stillbirths. In Pakistan, full autopsies are conducted only in medico-legal cases and are very rarely performed to identify a definitive cause of death (CoD) and because of cost and insufficient staff are generally not feasible. Recently, minimally invasive tissue sampling (MITS) has been used to determine CoD in neonates and stillbirths as it addresses some of the socio-cultural and religious barriers to autopsy. However, it is not known how families and communities will perceive this procedure; therefore, exploring family and healthcare professionals’ perceptions regarding MITS is essential in determining acceptable and feasible approaches for Pakistan.MethodsThe study will employ an exploratory qualitative research design. The study will be conducted at the National Institute of Child Health (NICH) hospital of Karachi. The data collection method will consist of key-informant interviews (KIIs) and focus group discussions (FGDs). FGDs will be conducted with the families and relatives of newborns who are visiting the outpatient department (OPD) and well-baby clinics of NICH hospital. KIIs will be conducted with the NICH - medical director, healthcare providers, professionals involved in proceedings related to death and dying, religious leaders, health sector representatives from the government, public health experts, maternal and child health (MCH) specialists, obstetricians and neonatologists and experts from the bioethics committee. Study data will be analyzed using NVivo 10 software.DiscussionThe research will help explore specific cultural, religious and socio-behavioral factors that may increase or decrease the acceptability of MITS for identifying COD in neonates and stillbirths. The findings of the qualitative study will provide a better understanding of parents’ and healthcare professionals’ attitudes towards the use of MITS on neonatal deaths and stillborns.
Highlights
MethodsThe study will employ an exploratory qualitative research design
Around 2.6 million neonatal deaths occur world-wide every year and the numbers of stillbirths is almost similar
Plain English summary Pakistan is ranked among the highest countries in the world for neonatal mortality
Summary
Study design This formative research will employ an exploratory qualitative research design using semi-structured interviews and a purposive sampling approach. The data collection methods for this formative research will involve key-informant interviews (KIIs) and focus group discussions (FGDs). Study participants Key-informant interviews (KIIs) We will invite ‘key informants’ such as the medical director-NICH, healthcare providers (doctors, nurses/ midwives), religious leaders, health sector representatives from the government, public health experts, obstetricians, neonatologists, members of the ethics review committee and professionals involved in proceedings related to death and dying (mortuary attendants/ body preparers) to understand their views and acceptability of the MITS procedure (Table 1). Key informants’ such as the medical director-NICH, healthcare providers (Doctors, nurses/ midwives), religious leaders, health sector representatives from the Government, public health expert, obstetrician, neonatologist, member of ethics review committee and professionals involved in proceedings related to death and dying (mortuary attendants’/ body preparers) who are willing to give consent to participate in the study. To ensure the credibility of the research, study data will be triangulated by the data sources (parents, mothers, fathers, relatives, healthcare providers, clinicians, public health expert, bioethics expert) and data collection methods (FGDs and KIIs), to compare alternative perspective and reveal any inconsistencies [13]
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