Introducing Minimally Invasive Tissue Sampling to Ascertain Cause of Death in Children and Stillbirths in Central Mozambique

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.