Published in PLOS One on 2026-05-22, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Laura-Lynne Brandt, Gift Mathebula, Zokwane Lucky Mondlane, Sara Jewett, Kathleen Kahn, Ryan Gregory Wagner, Jessica Price
Source: PLOS One • DOI 10.1371/journal.pone.0345107
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Minimally invasive tissue sampling (MITS) has been used to determine cause of death in various low- and middle-income countries. However, information on the acceptability of this procedure in community-based deaths is limited; most studies have focused on facility-based deaths among children. This qualitative study describes factors affecting the prospective acceptability of MITS for community deaths across all ages in a rural South African community and reviews the utility of the Theoretical Framework for Acceptability (TFA).
This qualitative study was conducted in the rural Agincourt Health and socio-Demographic Surveillance System (HDSS) site in Mpumalanga, South Africa. Thematic analysis was conducted on 20 in-depth interviews with residents who had experienced a death within the previous 2 years and 6 focus group discussions (FGDs) with key stakeholders. FGD groups included community members, healthcare workers, traditional healers, religious leaders and mortuary workers.
MITS was considered acceptable by interviewees, who posited that bereaved families had a strong desire to know cause of death, which would drive participation. Limited manipulation of the body and minimal disruption of burial practices were conditions that would make MITS more readily acceptable. Facilitators of participation included engaging with local traditional leaders, rigorous community education, transparency and openness regarding MITS activities, and the provision of emotional and psychological support to the bereaved. Whilst local beliefs did not forbid participation in MITS, acceptability was limited for deaths in traditional healers and infants as it would disrupt burial in these groups. Rumours of organ-trafficking during autopsies made some participants wary of the MITS and a lack of trust in the research team could discourage participation.
In Agincourt, MITS is an acceptable procedure among community members that are interested in knowing cause of death. Thorough community engagement, open communication and an empathetic approach to bereaved families are crucial for building community support for the implementation of MITS. The TFA provides a valuable outline for the assessment of acceptability but failed to account for trust dynamics between providers and participants. We propose the modification of the TFA to include the domain “trust in providers”.
Introduction
Despite the value of detailed cause of death information in managing health system resources only 42% of all deaths globally are registered with an informative cause of death recorded [1]. In South Africa, whilst 96% of deaths were registered in 2017, only 63% of registered deaths had a medically certified cause of death recorded [2]. In rural areas, the paucity of cause of death data is often even more pronounced as many deaths occur outside of health-facilities [3]. The lack of reliable cause of death data for community deaths and deaths from more remote areas result in the exclusion of these deaths from key health policy discussions, which can result in public health issues going unnoticed and unaddressed.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Laura-Lynne Brandt, Gift Mathebula, Zokwane Lucky Mondlane, Sara Jewett, Kathleen Kahn, Ryan Gregory Wagner, Jessica Price. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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