Background

A primary goal of public health is to prevent early mortality. The pursuit of this goal requires detailed information on the causes of death. The United Nations reported that most of the 48 million deaths registered in the low- and middle-income countries (LMICs) in 2010 occurred without medical attention and thus left the cause of death largely unknown. Accurate, nationally representative statistics on total and cause-specific mortality in LMICs are often lacking due to inadequate routine information systems.

Establishing the cause of death using autopsy examination has an important role in advancing medical knowledge, improving clinical practice and promoting public health. Nevertheless, there has been a progressive decline in complete diagnostic autopsy rates throughout the world, and other methods of examination such as verbal autopsy (VA) and a structured interview of relatives and caretakers of the deceased have had to be considered.

Recently, minimally invasive autopsy (MIA) – using hollow needles to sample a number of organs – has been developed as a promising and possibly more acceptable alternative to clinical autopsy. In most cases, clinical autopsies cannot be performed without the permission of the deceased’s relatives. Although studies show the autopsy rates falling, there is little published work assessing the reasons for refusal or knowledge of the attitudes to autopsy procedures among both the public and health professionals in LMICs.

The low acceptance of post-mortem examinations is multifactorial and complex, with families unconvinced of any benefit, objecting on the grounds of unnecessary disfiguring procedures, burial delays, as well as cultural and religious beliefs. Confronted by such resentment, clinicians are often reluctant to discuss the possibility of an autopsy examination, finding it one of the most unpleasant aspects of being a doctor and not always seeing the value of a post-mortem examination themselves.

Against this background, there is a tangible need to understand how people perceive death, dying and the body and a need to identify the socio-cultural and ethical factors with respect to physicians or researchers discussing research around causes of death with family members or affected parties of the recently deceased.

Aims

We aim to gain a rich understanding of experiences, current perceptions and attitudes toward death, dying and the body from key stakeholders in 3 sites in Vietnam. We also plan to explore the socio-cultural norms and rituals around death, dying, and the body, as well as investigate the perceptions regarding autopsy and minimally invasive autopsy.

Study Design

Qualitative formative research, incorporating in-depth interviews, informal interviews, fieldwork visits, and focus group discussion. This methodology is optimal for collecting data on personal histories, perspectives and experiences.

In addition, if given permission, observations of rituals, traditions, and customs around death will be carried out in the community. Throughout the process, we will adhere to the formal requirements and remain sensitive to the local context.