|Year : 2016 | Volume
| Issue : 2 | Page : 78-84
Knowledge, Attitude, and Perception of Postmortem Examination Among Doctors and Nurses in a Tertiary Hospital of Sokoto, Nigeria
AU Kaoje1, U Mohammed2, A Abdulkarim3, MO Raji1, UM Ango4, BA Magaji5
1 Department of Community Health, Usmanu Danfodiyo University, Sokoto, Nigeria
2 Department of Morbid Anatomy and Forensic Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria
3 Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
4 Department of Medical Services and Public Health, Ministry of Health, Sokoto, Nigeria
5 Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
|Date of Web Publication||16-Jun-2016|
A U Kaoje
Department of Community Health, Usmanu Danfodiyo University, Sokoto
Source of Support: None, Conflict of Interest: None
Postmortem examination is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present. This study aimed to assess the knowledge, attitude, and perception of postmortem examination among doctors and nurses in a tertiary health care of Sokoto state. A cross-sectional study design was used, and a total of 149 doctors and nurses participated in the study. Respondents were recruited into the study using probability proportionate to size followed by a simple random sampling method. Data were obtained through self-administered questionnaires, and the data were analyzed using Statistical Package for Social Sciences Version 17.0. Descriptive statistics, Chi-square test, and multinomial logistic regression analysis were carried out. The mean age of respondents was 31.6 (5.6) years. There were more nurses than doctors (60.4% vs. 39.6%) in the study. More than three-quarter (80%) of the respondents had fair to good knowledge of postmortem examination. While many respondents expressed positive attitudes and perceptions, less than half were willing to accept organs from deceased donors. Respondents' profession influenced both the knowledge (P > 0.001, odds ratio [OR] = 13.95) and attitude (P < 0.04, OR = 2.49) to postmortem examination. Although greater than three-quarter of respondents had fair to good knowledge and many expressed positive attitudes and perceptions with respect to postmortem examination, there is need to create more awareness on medical benefit of postmortem examination.
Keywords: Attitude, health personnel, knowledge, perception, postmortem, Sokoto
|How to cite this article:|
Kaoje A U, Mohammed U, Abdulkarim A, Raji M O, Ango U M, Magaji B A. Knowledge, Attitude, and Perception of Postmortem Examination Among Doctors and Nurses in a Tertiary Hospital of Sokoto, Nigeria. J Forensic Sci Med 2016;2:78-84
|How to cite this URL:|
Kaoje A U, Mohammed U, Abdulkarim A, Raji M O, Ango U M, Magaji B A. Knowledge, Attitude, and Perception of Postmortem Examination Among Doctors and Nurses in a Tertiary Hospital of Sokoto, Nigeria. J Forensic Sci Med [serial online] 2016 [cited 2019 May 22];2:78-84. Available from: http://www.jfsmonline.com/text.asp?2016/2/2/78/181500
| Introduction|| |
Autopsy is derived from a Greek Lexicon “autopsia,” which means “seeing with one's eyes.” It is a postmortem examination to determine the cause and mechanism of death and to reveal the extent of a disease of interest and other related pathologies. Postmortem examination is acknowledged as an essential part of medicine. In addition to establishing and confirming the final diagnosis, the postmortem examination also reveals the connection between the cause of death to the associated pathologies and explains the relationship between the two. The two categories of postmortem examination are the coroner's postmortem and the hospital postmortem. There is no difference in their technical performance though the hospital case may be directed to particular problems.
However, in spite of its great public health benefits and role in evaluating healthcare systems, postmortem examination rates have been decreasing worldwide. Its practice also viewed by many clinicians as a witch-hunting tool used to expose their incompetence and or error. Lack of adequate knowledge on postmortem examination among doctors has been acknowledged and that decline in autopsy rate was due to difficult in obtaining consent from deceased relatives which is reflection of their knowledge. Several studies conducted across the globe exposed declining rate of postmortem practice.,,, The history of postmortem examinations and organ retention showed a sound medical rationale for these practices as they have undoubtedly increased medical knowledge and understanding of human anatomy and human disease for all our benefit.
Doctors particularly and nurses are expected to provide information to the public so that they can have in-depth understanding of what a postmortem examination entails and why it may be necessary or advisable in particular circumstances. They are also expected to establish a relationship with the family and provide an option of postmortem examination in order to establish the actual cause of death. This study was therefore conducted in order to assess their knowledge, attitude, and perception of postmortem examination.
| Materials and Methods|| |
There are three tertiary hospitals in Sokoto, namely, Usmanu Danfodiyo University Teaching Hospital located in Wamakko Local Government Area, Specialist Hospital located in Sokoto North Local Government Area, and Federal Neuropsychiatry Hospital in Kware Local Government Area. The study population comprised all the doctors and nurses working in Usmanu Danfodiyo University Teaching Hospital. The eligibility criteria were being a doctor or a nurse working in the study center, expressed willingness to participate in the study and being present at the time of data collection. All pathologist and nurses from the Pathology Department were excluded from this study. A cross-sectional study design was used, and required sample size was determined using formula for descriptive study design for population <10,000, an optimum sample size of 150 was obtained after adjusting for attrition. Doctors and nurses from different departments of the hospital were recruited into the study using a probability proportionate to size, thereafter a simple random sampling method was used to select the required number of study respondents. A close-ended questionnaire was used, and data were obtained by means of self-interview. The questionnaires were pretested on fifteen doctors and nurses who were later excluded from the main study. The data were entered into and analyzed using IBM Statistical Package for Social Sciences Version 20.0. for windows (2011) (IBM Corporation, Armonk, New York, United state).
The mean and standard deviation were calculated for the continuous data whereas the categorical variables were expressed in frequency and percentages.
Scoring and grading of responses
Each correct response to a question on knowledge of postmortem examination was scored 1 mark whereas 0 was awarded to wrong answers and no-response. The respondents' knowledge was graded as good, fair, or poor knowledge. Scores of >50% were graded as poor knowledge, scores of 50–69% were graded as fair knowledge, and scores of 70–100% were graded as good knowledge. Respondents' attitude was categorized as either negative or positive. An appropriate response to attitude was awarded 1 mark whereas inappropriate response was awarded 0 mark. An aggregate score of <50% and that equal to or >50% was adjudged as negative and positive attitude, respectively. At the end of scoring, the mean knowledge scores of the respondents and also the proportion of respondents with good, fair, or poor knowledge, positive or negative attitude were determined.
Chi-square test of association was carried out to determine the presence or otherwise of statistical association between respondents' sociodemographic characteristics and knowledge, attitude of postmortem examination. Since the outcome variable had three level factors: poor, fair, and good knowledge, a multinomial logistic regression was used to identify respondents' characteristics that are potential predictors of observed level of knowledge. Binary logistic regression analysis was carried out to identify predictors of respondents' attitude to postmortem examination. For all the bivariate and multivariate analysis, the level of statistical significance (alpha error) was set at 5%. Ethical clearance was obtained from the Usmanu Danfodiyo University Teaching Hospital Research Ethics Committee. In addition, individual informed consent was obtained from the respondents before the questionnaires were administered.
| Results|| |
[Table 1] shows respondents' mean age was 31.6 ± 5.6 years. Respondents aged between 25 and 34 years accounted for 68.5% of study population while those 45 years and above were the least (2.7%). The proportion of respondents was almost equal by gender (male 49.7% and female 50.3%). A large proportion of respondents (69.4%) were married whereas the singles and never married constituted 30.6%. There were more nurses than medical doctors in the study (60.4% vs. 39.6%).
[Figure 1] shows that 55% of respondents demonstrated good knowledge of postmortem examination whereas 20% had poor knowledge and 25% had fair knowledge.
[Table 2] shows that only 62% of the respondents were aware that postmortem examination is performed at the study center, but nearly all of them knew that postmortem examination is the examination of body after death and that it is performed for legal or medical purposes. A cross section of the respondents knew the objectives of performing postmortem examination but the most recognized objective of postmortem examination was to determine the cause of death by (96%), very few respondents, 9% and 6%, respectively, said the examination is performed by surgeons and scientists.
[Figure 2] shows that three out five respondents (60%) demonstrated positive attitude to postmortem examination whereas 40% showed negative attitude.
[Table 3] results showed 53% of the respondents felt the conduct of postmortem examination is necessary whereas 27% adjudged it to be very necessary and 20% reported that it was unnecessary. Sixty-nine percent support the practice of postmortem examination, and 82% support the need to improve public awareness on the benefit of postmortem examination, but only 59% said they will consent to postmortem examination of the corpse of their family member or relative.
[Table 4] results on the perception of postmortem examination showed that 72% perceived it (postmortem examination) to be of no benefit to the dead and need not to be conducted whereas 75% perceived it to be of benefit to the living and one-quarter believed it has no benefit to the living. Almost half (49%) of the respondents felt the dead should not be mutilated for any reason, whereas 74% believed postmortem examination will only cause further distress and anguish to a grieving family.
|Table 4: Respondents' perception on some aspects of postmortem examination|
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[Table 5] shows that age group (Fisher exact test = 14.62, P = 0.02*); sex (χ2 = 14.14, degree of freedom [df] = 2, P < 0.001*); profession (χ2 = 26.91, df = 2, P > 0.001*) had statistically significant association with respondents' knowledge of postmortem examination. Duration of practice also showed statistically significant association with knowledge (Fisher exact test = 23.56, P = 0.001).
|Table 5: Relationship between sociodemographic characteristics, duration of practice, and knowledge score on postmortem examination|
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In [Table 6], the multinomial logistic regression analysis showed that respondents' age did not significantly predict whether they had poor or fair knowledge; age: b = −0.16, Wald χ2 (1) = 3.10, P > 0.08, odds ratio (OR) = 0.85. The OR indicates that for a unit increase in the age, changes in the odds of having fair knowledge (rather than poor knowledge) is 0.85, thus as the age increases, the more likely they will have poor knowledge than fair knowledge. Similarly, duration of practice also did not significantly predict whether they have poor or fair knowledge of postmortem examination, b = −0.04, Wald χ2 (1) = 0.20, P > 0.67, OR = 0.96. The OR indicates that for a unit increase in the duration of practice, changes in the odds of having fair knowledge (rather than poor knowledge) is 0.96, thus the more the duration increases, the more likely they will have poor knowledge than fair knowledge. Hence, also respondents' profession did not predict whether they had poor or fair knowledge, b = 1.33, Wald χ2 (1) = 2.67, P > 0.10, OR = 3.78. The odds of having fair knowledge (rather than poor knowledge) was 3.78, who are medical doctors, are more likely to have fair rather than poor knowledge.
|Table 6: Determinant of respondents' knowledge of postmortem examination|
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Sex, marital status, religion, and ethnicity
Sex, marital status, religion and ethnicity were predictors of poor and fair knowledge of postmortem examination: sex: b = −1.42, Wald χ2 (1) = 4.23, P < 0.001, OR = 0.24; marital status: b = 1.95, Wald χ2 (1) = 5.28, P < 0.02, OR = 7.04; religion: b = 2.79, Wald χ2 (1) = 4.70, P < 0.03, OR = 16.31; and ethnicity, E1: b = −20.92, Wald χ2 (1) = 137.08, P < 0.001, OR = 8.18; E2: b = −19.17, Wald χ2 (1) = 171.24, P < 0.001, OR = 4.75; b = −17.33, Wald χ2 (1) = 314.12, P < 0.001, OR = 2.97. Male respondents were more likely to have poor knowledge than fair knowledge whereas respondents, who are either married, Muslim or of an ethnic group of Hausa/Fulani, Igbo, and Yoruba, were more likely to have fair knowledge of postmortem examination than poor knowledge.
Profession and ethnicity
Respondents' profession significantly predicted whether they have poor or good knowledge of postmortem examination, b = 2.64, Wald χ2 (1) = 13.15, P > 0.001. The odds of having good knowledge rather than poor knowledge was 13.95 (respondents who are medical doctors, were more likely to have good knowledge than poor knowledge of postmortem examination). Ethnicity also predicted whether they had poor or good knowledge. Hausa/Fulani, b = −21.56, Wald χ2 (1) = 161.15, P < 0.001, OR = 4.32; Yoruba: b −19.50, Wald χ2 (1) = 230.71, P < 0.001, OR = 3.39. Respondents who are Hausa/Fulani or Yoruba were more likely to have good knowledge of postmortem examination.
Duration of practice and other respondents' sociodemographic characteristics such as age, sex, marital status, and religion did not significantly predict whether they have poor or good knowledge of postmortem examination.
[Table 7] shows the Chi-square test of association between the respondents sociodemographic characteristics and attitude to postmortem examination, gender (χ2 = 8.64, df = 1, P < 0.001), marital status (χ2 = 4.90, df = 1, P < 0.03), religion (χ2 = 6.05, df = 1, P < 0.001), ethnicity (χ2 = 13.03, df = 3, P < 0.01), profession (χ2 = 16.13, df = 1, P < 0.001), and duration of practice (χ2 = 9.30, df = 2, P < 0.01) showed statistically significance association with attitude to postmortem examination, however age did not (Fisher exact test = 2.06, P = 0.63).
|Table 7: Relationship between sociodemographic characteristics and attitude on postmortem examination|
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In [Table 8], binary logistic regression analysis shows that respondents' gender (P < 0.02, OR = 2.73) and profession (P < 0.04, OR = 2.49) were the predictors of attitude toward postmortem examination. This indicates that males were more likely to have positive attitude to postmortem examination (OR = 2.73). Similarly, respondents who are medical doctors were more likely to have positive attitude to postmortem examination compared with nondoctors (P < 0.04, OR = 2.49).
|Table 8: Predictors of respondents' attitude towards postmortem examination|
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| Discussion|| |
Health personnel particularly doctors and nurses are fundamental in the process of postmortem examination. Doctors in particular represent highly educated and trained healthcare providers, as such their input should influence whether the entire process is acceptable or not. The attitudes and perceptions of these healthcare workers can in addition influence positively the public opinion on postmortem examination as a scientific method of establishing and confirming diagnosis by examining organs of dead body.
Although this study revealed that a greater proportion of the respondents had fair to good knowledge of postmortem examination, one in every five had poor knowledge. Similarly, the study also revealed that three out of every five respondents demonstrated positive attitude than negative attitude to postmortem examination. This may be due to the fact that postmortem examinations are familiar to most people inside of the medical profession. The above findings are in agreement with findings of several studies earlier conducted.,,
This study also demonstrated that many of the respondents support the practice of postmortem examination and majority support the need to improve public awareness on the benefit of postmortem examination but only 59% reported they will consent to postmortem examination of the corpse of their family member or relative. This highlights a big gap between our respondents' knowledge, attitude, and intended practice of postmortem examination (as the demonstrated knowledge in not likely to translate into action). In University College Hospital, Ibadan, Nigeria, the study findings showed that greater proportion of respondents displayed positive attitude toward postmortem examination and approved of its practice with almost half of the respondents willing to consent to postmortem examination of themselves. Similarly, nearly all respondents agreed that there is need to improve public awareness of the benefit of postmortem examination. The concordance in the findings is likely to be due to the facts that the study was also conducted among doctors in a tertiary hospital, who have similar professional training and exposures.
Profession and ethnicity were the key factors found by this study to have potential influence on knowledge. Similarly, profession and gender were also found to influence attitude to postmortem examination. This is not surprising as postmortem process and procedure is not new to doctors as they were more likely to have been exposed to postmortem examination during their undergraduate training. Findings from Southwest Nigeria showed that respondents' duration of work experience, level of their experience in the profession, their sex and religion were the key determinants of knowledge and attitude to postmortem examination. The two studies only concurred with respect to professional training, they however differ with respect to other predictors. It is worthy to note that the two study centers differ in their duration of practice of postmortem examination, frequency of conduct of the examination, and thus respondents' varying degree of exposure to its conduct.
Although more than half of the healthcare personnel expressed willingness to consent to postmortem examination on the corpse of their family member, only 45% were willing to accept organs from deceased donors, and less than one-third were willing to consent to organs removed postmortem (doctors 65% vs. nurses 35%). There were more doctors compared to nurses who expressed willingness to accept organs from deceased donors (66% vs. 34%). The difference in knowledge (doctors vs. nurses, 58% vs. 42%) of postmortem process and organ donation between the two groups may be responsible. A similar study in Malaysia also revealed that less than half of the health professionals were willing to donate their organs, although doctors were more willing to donate compared with the other health professionals and their attitude to organ donation was not different from general public. Rumsey et al. have shown that individuals including patients will have more “positive” attitude toward organ donation if they know that the doctors are also willing to be organ donors.
Both studies' findings are in agreement and additionally this study showed that being a doctor is more likely to have good knowledge and this in turn positively influence attitude to postmortem examination. Thus, some stronger factors other than knowledge influence positive attitude to organ donation which seems to cut across international borders. What this mean is that there is need for further study that will explore holistically factors that promote positive attitude to postmortem examination among health personnel.
| Conclusion|| |
The study found that greater proportion of respondents had fair to good knowledge on postmortem examination whereas two out of every five had negative attitude to postmortem examination with only less than a third expressed willingness and intention to donate their organs and removed postmortem. Respondents' profession and gender were found to influence their attitude whereas their knowledge status was influenced also by their profession and ethnicity.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest
| References|| |
Tedishi TE. Property of the dead body in forensic. Medicine 1997;II: 971.
Costache M, Lazaroiu AM, Contolenco A, Costache D, George S, Sajin M, et al.
Clinical or postmortem? The importance of the autopsy; a retrospective study. Maedica (Buchar) 2014;9:261-5.
Deirdre M. Not Just Body Parts and Tissues - Organ Retention, Consent and the Role of Families. Socio-Legal Studies Review 2012;1:1-22.
Shojania KG, Burton EC, McDonald KM, Goldman L. Changes in rates of autopsy-detected diagnostic errors over time: A systematic review. JAMA 2003;289:2849-56.
Abidin ZL, Ming WT, Loch A, Hilmi I, Hautmann O. Are health professionals responsible for the shortage of organs from deceased donors in Malaysia? Transpl Int 2012;25:187-92.
Hoyert DL. The changing profile of autopsied deaths in the United States, 1972-2007. NCHS Data Brief 2011;67:1-8.
Royal College of Pathologists of Australasia Autopsy Working Party. The decline of the hospital autopsy: A safety and quality issue for healthcare in Australia. Med J Aust 2004;180:281-5.
Oluwasola AO, Fawole OI, Otegbayo JA, Ayede IA, Ogun GO, Ukah CO, et al.
Trends in clinical autopsy rate in a Nigerian tertiary hospital. Afr J Med Med Sci 2007;36:267-72.
Dan EM, Kunle AE, Nneka UI, Abraham OI. An audit of medical autopsy: Experience at the University of Uyo Teaching Hospital (UUTH), Niger Delta region, Nigeria. Indian J Med Sci 2011;65:502-9.
Government of Ireland. Post Mortem Practice and Procedures, a Report of Dr. Deirdre Madden Presented to Mary Harney T.D., Tánaiste and Minister for Health and Children on 21st
December 2005, Republic of Ireland; 2006. p. 25-6.
Ibrahim MT. Research Methodology and Dissertation Writing for Health and Allied Health Professionals. Abuja: Cress Global Link Limited; 2009. p. 74-5.
Oluwasola OA, Fawole OI, Otegbayo AJ, Ogun GO, Adebamowo CA, Bamigboye AE. The autopsy: Knowledge, attitude, and perceptions of doctors and relatives of the deceased. Arch Pathol Lab Med 2009;133:78-82.
Loch A, Hilmi IN, Mazam Z, Pillay Y, Choon DS. Differences in attitudes towards cadaveric organ donation: Observations in a multiracial Malaysian society. Hong Kong J Emerg Med 2010;17:236.
Rumsey S, Hurford DP, Cole AK. Influence of knowledge and religiousness on attitudes toward organ donation. Transplant Proc 2003;35:2845-50.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]