Knowledge, attitude and practice of bereaved parents and health care providers towards autopsies in children under five years at Kenyatta National Hospital
Introduction: Knowledge, attitudes, and practices of health care professionals and the public toward autopsy are important as they will give information regarding factors that contribute to the low rate of autopsies in children under 5 years. Objectives: To evaluate the knowledge, attitude and practice of bereaved parents and health care providers towards autopsies in children under 5 years and assess the relationship between parents' practice and socio demographic characteristics. Methods: This was a cross-sectional descriptive survey. Respondents included parents whose children had died aged 0-60 months and health care providers working in Kenyatta National Hospital paediatric wards and newborn unit. Ward mortality records were used to identify potential study participants as well as obtain child's biodata and clinical cause of death. The parents were then approached within 24 - 48 hrs of the child's death, asked to participate in the study, allowing them to provide voluntary informed consent. Participants for the focused group discussion were identified randomly and their contact information obtained from ward records. The parents were contacted and asked to voluntarily participate in the discussion. Written informed consent as well as consent to tape record the discussions was obtained. Health care providers were identified and asked to participate in the study. Those who agreed signed written consent and then filled in a questionnaire. Results: The study enrolled 95 bereaved parents and 95 health care providers. Among the 95 deceased children, 67.4 % did not have an autopsy request. Knowledge on autopsy was high among the bereaved parents (79%) and a positive attitude towards autopsy was found in 55.7%, which was significantly associated with respondent's level of education. Among the 31 parents asked to consent to an ap!opsy, 29% consented and 71 % declined. The main reason for consenting was to confirm cause of. death while those who declined, the main reasons were that religion forbade autopsy and a feeling that diagnosis should have been made before the child's death. Majority (69.5%) of health care providers showed a positive attitude .towards autopsy. Consultants and paeadiatric residents had a more positive attitude compared to interns (p< 0.001) and nurses (p=O.O 11). Clinical experience of > 15 years was associated with a more positive attitude. The main barriers to obtaining consent were lack of formal training in obtaining consent and failure of autopsy results to be availed in a timely manner. Conclusions: Bereaved parents had adequate knowledge of autopsies with a positive attitude being significantly associated with the level of education. Majority of parents were not asked to consent to an autopsy on their deceased child. Of those asked many declined mainly due to religious beliefs. Health care providers had a positive attitude to autopsy which was significantly associated with their cadre and years of experience. The main reasons given for not obtaining consent for autopsy were lack of formal training in obtaining consent and failure to obtain autopsy results in timely manner. Recommendations: Bereaved parents need to be counseled on the need for autopsy on their deceased child and potential barriers to consent. Health care providers should be trained on counseling of parents after death of their child and on how to request an autopsy. Further qualitative and quantitative research, with a larger number of participants, should be performed.