Experience on postmortem minimally invasive tissue sampling to ascertain the cause of death determination in South African children: A case for implementing as standard of care

Authors

  • J du Toit South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • K Storath South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • I Dunn South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • P Makekeng South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • M Moosa South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • K Mothibi South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • N Umuneza South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • C A Rees Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, USA; Department of Emergency Medicine, Children’s Healthcare of Atlanta, USA
  • D Blau Global Health Center, US Centers for Disease Control and Prevention, Atlanta, USA
  • S Lala Office for Teaching and Learning; and Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • Y Adam Department of Obstetrics and Gynaecology, University of the Witwatersrand, and Chris Hani Baragwanath Academic HospitalJohannesburg, South Africa
  • S Velaphi Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
  • M Hale Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • P Swart Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • J Wadula epartment of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
  • L Mothibi Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
  • A Wise Rahima Moosa Mother and Child Hospital, Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
  • V Baba Department of Obstetrics and Gynaecology, University of the Witwatersrand, and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
  • P Jaglal Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
  • S Mahtab South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • S Madhi South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • Z Dangor South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i2.1538

Keywords:

Paediatric, Infectious diseases, Postmoterm

Abstract

Determining the death burden for prioritising public health interventions necessitates detailed data on the causal pathways to death. Postmortem minimally invasive tissue sampling (MITS), incorporating histology, molecular and microbial culture diagnostics, enhances cause-of-death attribution, particularly for infectious deaths. MITS proves a valid alternative to full diagnostic autopsies, especially in low- and middle-income countries. In Soweto, South Africa (SA), the Child Health and Mortality Prevention Surveillance (CHAMPS) programme has delineated over 1 000 child and stillbirth deaths since 2017. This SA CHAMPS site supports advocating for the use of postmortem MITS as routine practice, for more granular insights into under-5 mortality causes. This knowledge is crucial for SA’s pursuit of Sustainable Development Goal 3.2, targeting reduced neonatal and under-5 mortality rates. This commentary explores the public health advantages and ethicolegal considerations surrounding implementing MITS as standard of care for stillbirths, neonatal and paediatric deaths in SA. Furthermore, based on the data from CHAMPS, we present three pragmatic algorithmic approaches to the wide array of testing options for cost-effectiveness and scalability of postmortem MITS in South African state facilities.

Author Biographies

  • K Storath, South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Clincial associate, Wits VIDA

  • I Dunn, South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Masters of Public Health candidate

  • P Makekeng, South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Clinical associate - Wits Vida

  • M Moosa, South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Clinical associate - Wits Vida

  • K Mothibi, South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Clinical associate - Wits Vida

  • N Umuneza, South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Clinical associate - Wits Vida

  • C A Rees, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, USA; Department of Emergency Medicine, Children’s Healthcare of Atlanta, USA

    Assistant Professor of Pediatrics and Emergency Medicine, Emory University School of Medicine 

    Research Director, Pediatric Emergency Medicine Fellowship, Emory University School of Medicine 

    Attending Physician, Children's Healthcare of Atlanta

    Pediatric Research Scientist, CHAMPS, U.S. Program Office 

  • D Blau, Global Health Center, US Centers for Disease Control and Prevention, Atlanta, USA

    Senior Director for Science at Centres for Disease Control and Prevention (CDC)

    Laboratory and Diagnostics Lead for CHAMPS

  • S Lala, Office for Teaching and Learning; and Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    MBBCh, PhD

  • Y Adam, Department of Obstetrics and Gynaecology, University of the Witwatersrand, and Chris Hani Baragwanath Academic HospitalJohannesburg, South Africa

    MBBCh, FCOG(SA)

  • S Velaphi, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa

    Paediatric Head of Department, Chris Hani Baragwanath Hospital

    MBChB, PhD

  • S Mahtab, South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Senior Program Manager for CHAMPS at Wits Vida

    MBBS, MPH, PhD

  • S Madhi, South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    MBBCh, PhD

    Dean: Faculty of Health Sciences | University of the Witwatersrand, Johannesburg

    Professor of Vaccinology

    Director: Vaccines & Infectious Diseases Analytics Research Unit (Wits-VIDA)

    Co-Director: African Leadership in Vaccinology Expertise (ALIVE)

  • Z Dangor, South African Medical Research Council Vaccines and Infectious Diseases Analytics Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    MBBCh, PhD

    Research Director: Wits VIDA

    Paediatric Pulmonologist: Department of Paediatrics and Child Health

    University of the Witwatersrand

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Published

2024-02-13

Issue

Vol. 114 No. 2 (2024)

Section

Research

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Copyright (c) 2024 J du Toit, K Storath, I Dunn, P Makekeng, M Moosa, K Mothibi, N Umuneza, C A Rees, D Blau, S Lala, Y Adam, S Velaphi, M Hale, P Swart, J Wadula, L Mothibi, A Wise, V Baba, P Jaglal, S Mahtab, S Madhi, Z Dangor

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How to Cite

1.
du Toit J, Storath K, Dunn I, Makekeng P, Moosa M, Mothibi K, et al. Experience on postmortem minimally invasive tissue sampling to ascertain the cause of death determination in South African children: A case for implementing as standard of care. S Afr Med J [Internet]. 2024 Feb. 13 [cited 2025 Mar. 23];114(2):e1538. Available from: https://samajournals.co.za/index.php/samj/article/view/1538

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