New approaches to investigate cause of death in poor countries
In spite of large efforts and generous investments, mortality statistics and cause of death estimates from poor countries remain, as of today, still unreliable. In these settings, where the majority of preventable deaths still occur, models utilized to build estimates have shown many flaws, and discrepancies in cause-attributable disease figures have evidenced the shortfall of current methods, predominantly based on data derived from verbal autopsy or clinical records. With efforts targeting the improvement of civil and vital registration systems, counting the dead has become progressively easier, but establishing the cause of death for each person remains a major challenge, particularly among children. Routine and cause-specific disaggregated mortality data are however critical at the local level to help policy makers make rational health planning and prioritisation decisions.
Pathological autopsies are generally considered the gold standard methodology to investigate cause of death, but their practice is globally decreasing, and in the majority of poor settings their routine use and acceptability is severely limited. In the last years, we have developed and validated a less invasive, but similarly informative methodology that, using fine needle biopsies, can sample key tissues and organs after death, thus providing rich pathological and microbiological samples to investigate the cause of death.
We have also demonstrated that such a method is readily acceptable at the community level, even in rural African settings, and that it can be utilized “in the field” to conduct robust mortality surveillance. The Minimally invasive autopsy will surely contribute, as no other method has made until now, to increase our understanding of the major determinants of preventable mortality, and the enormous inequities that surround survival in resource-constrained settings.