Necropsies in African children: consent dilemmas for parents and guardians

Background-Necropsy examination provides a good index of the accuracy of cl inical diagnosis and the quality of treatment, but its use in sub-Saharan A frica is limited. Aims-To identify the main reasons for parents'/guardians' refusal of consen t for necropsy and to explore the issues affecting their decision. Methods-A sequential necropsy study of Zambian children between 2 months an d 15 years dying of respiratory disease. When the parent/guardian refused p ermission for necropsy, the main reason given was recorded, after encourage ment to express their specific concerns in their own words. Results-Parents/guardians of 891 of 1181 children (75.4%) refused to give p ermission, and 290 (24.6%) consented. Of those who refused, 43% did so on t he 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. Mor e 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 mad e and could not be delayed. Traditional beliefs that ancestral spirits forb ade the mutilation of dead bodies were cited by 77 (8.6%). Other reasons in cluded the child not being their own or that they must seek permission from other family members who were not available (6%). Religious beliefs were n ot a major cause of refusal. Conclusions-It is possible to achieve a rate of necropsy consent sufficient to undertake valuable clinical pathology studies on children in sub-Sahara n 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 improv e the uptake of clinical pathology services.