Minimally Invasive Autopsy: A New Paradigm for Understanding Global Health?

Public health visionaries have long sought good data on mortality patterns in communities.John Graunt published his "Bills of Mortality" for the city of London in the mid-17th century (Fig 1).By the mid-18th century, Pehr Wargentin had instituted national civil registration in Sweden and published mortality analyses [1].Nevertheless, in the 21st century, mortality patterns for the majority of the world's population remain unrecorded, representing a major constraint on global health and development [2].Now, Bill Gates has taken up this challenge through a Bill & Melinda Gates Foundation (BMGF) project encouraging the development of minimally invasive autopsy (MIA) to fill this gap [3].Current developments in MIA (sometimes also referred to as minimally invasive tissue sampling, or MITS) are the focus of two new research articles published this week in PLOS Medicine that are a part of a wider project funded by the BMGF.As with any new approach in medical science, enthusiasm for the MIA concept has to be tested against criteria for validity, feasibility, acceptability, and cost-effectiveness before MIA can be considered as a mainstream tool.Research articles from the project will seek to address these criteria, starting with an assessment by Castillo and colleagues on the validity of MIA among adults in Mozambique [4].Although this was a relatively small study (112 cases) in one location, an encouraging degree of agreement between MIA and conventional autopsies was found.A qualitative study from Maixenchs and colleagues investigated how people regarded the hypothetical possibility of undertaking MIAs and getting feedback on causes of death in Gabon, Kenya, Mali, Mozambique, and Pakistan [5].Although discussing hypothetical procedures may not necessarily reflect feelings that could arise about conducting actual MIAs, nevertheless, the possibility of MIAs was not regarded unfavourably.Future papers will examine other relevant aspects of MIA implementation.