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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Investigating the Feasibility of Child Mortality Surveillance With Postmortem Tissue Sampling: Generating Constructs
Elizabeth O'Mara Sage1, Khátia R Munguambe2,3, John Blevins4
1Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
Understanding cultural and religious factors is crucial for the success of child mortality surveillance using minimally invasive tissue sampling (MITS). Community engagement and culturally sensitive approaches ensure the feasibility and sustainability of such vital public health initiatives.
Area of Science:
- Global Health
- Epidemiology
- Public Health Surveillance
Background:
- The Child Health and Mortality Prevention Surveillance (CHAMPS) network collects data on child mortality (<5 years) using minimally invasive tissue sampling (MITS).
- MITS implementation faces challenges due to religious, cultural, and ethical considerations impacting feasibility and sustainability.
Purpose of the Study:
- To investigate barriers and facilitators for implementing and sustaining CHAMPS surveillance.
- To understand the influence of cultural and religious factors on MITS acceptability and feasibility in diverse settings.
Main Methods:
- Employed an innovative qualitative methodology with a multimethod grounded theory approach.
- Utilized culturally specific conceptual frameworks for data interpretation across 7 diverse sites in sub-Saharan Africa and South Asia.
- Reduced subjectivity and bias through guided data interpretation and collective analyses.
Main Results:
- Religious factors, including burial timing and terminology, significantly influence consent for MITS procedures.
- Community misperceptions and rumors necessitate consistent information sharing.
- Religious pronouncements, perceived health priorities, and focus on maternal and child health facilitate community acceptance.
Conclusions:
- Findings inform program priorities and guide site-specific adaptations for CHAMPS surveillance.
- Results support the development of effective community sensitization and engagement strategies for sustainable mortality surveillance, including MITS.
- Culturally informed approaches are essential for the successful implementation of child mortality surveillance programs.
Background:
The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to generate reliable data on the causes of death among children aged <5 years using all available information, including minimally invasive tissue sampling (MITS). The sensitive nature of MITS inevitably evokes religious, cultural, and ethical questions influencing the feasibility and sustainability of CHAMPS.
Methods:
Due to limited behavioral studies related to child MITS, we developed an innovative qualitative methodology to determine the barriers, facilitators, and other factors that affect the implementation and sustainability of CHAMPS surveillance across 7 diverse locations in sub-Saharan Africa and South Asia. We employed a multimethod grounded theory approach and analytical structure based on culturally specific conceptual frameworks. The methodology guided data interpretation and collective analyses confirming how to define dimensions of CHAMPS feasibility within the cultural context of each site while reducing subjectivity and bias in the process of interpretation and reporting.
Results:
Findings showed that the approach to gain consent to conduct the MITS procedure involves religious factors associated with timing of burial, use of certain terminology, and methods of transporting the body. Community misperceptions and uncertainties resulted in rumor surveillance and consistency in information sharing. Religious pronouncements, recognition of health priorities, attention to pregnancy, and advancement of child health facilitated community acceptability.
Conclusions:
These findings helped formulate program priorities, guided site-specific adaptations in surveillance procedures, and verified inferences drawn from CHAMPS epidemiological and formative research data. Results informed appropriate community sensitization and engagement activities for introducing and sustaining mortality surveillance, including MITS.
