‘Now we know why our children are dying’: community and health authorities perspectives on minimally invasive tissue sampling and verbal autopsy for mortality surveillance in Mozambique

Abstract Background The performance of Civil Registration and Vital Statistics (CRVS) systems is sub-optimal in many Sub-Saharan African countries resulting in lack of timely and reliable mortality and cause of death (CoD) information. Mozambique has introduced mortality surveillance initiatives to address these gaps and inform health policies. However, their effectiveness depends on their acceptance and integration into the health system. This study aimed to examine the perspectives of individuals, families, community leaders, and health authorities on the adoption of innovative methods such as Minimally Invasive Tissue Sampling (MITS) and Verbal Autopsy (VA) to produce mortality data in Mozambique. Methods This qualitative case study was conducted in the districts of Manhiça and Quelimane in Mozambique. Twenty-eight semi-structured interviews and ten focus group discussions were conducted in two phases: before and during the introduction of mortality surveillance. Audio data were transcribed, coded, and analysed thematically using a combination of inductive and deductive approaches, guided by the five constructs of the Diffusion of Innovation theory. Results Community members, local leaders, and health authorities regarded MITS and VA as valuable tools for strengthening mortality surveillance in Mozambique, particularly in areas where deaths frequently go undocumented. Participants noted that these procedures are aligned with local needs and priorities, particularly the desire to understand the CoD. This increases the perceived usefulness of these procedures and the likelihood that the information can serve as a basis for meaningful action. Although some concerns about cultural and religious sensitivities remained, many participants expressed growing acceptance of the MITS and VA procedures once they were clearly explained, including their advantages and how they align with local needs. Conclusion Participants perceived MITS as providing credible and clinically useful CoD information that could dispel rumours. However, its acceptability depended on respectful body handling and timely return for burial, while its scalability was considered more feasible in better-equipped urban settings. VA was viewed as more practical, adaptable, and culturally acceptable, particularly in remote areas. Participants regarded both approaches as complementary, with wider implementation requiring community trust, cultural sensitivity, adequate infrastructure and training, and sustainable integration with existing CRVS and health information systems.