“It is the Will of God:” Religion’s Influence on Minimally Invasive Tissue Sampling (MITS) through the CHAMPS Network in Bangladesh and Sierra Leone
First Name Ashley
Last Name Meehan
Terminal Degree(s) Master of Public Health
Institution/Organization Emory University

Introduction: 85% of under-five deaths occur in Africa and South Asia, where causes of deaths are often misreported. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network seeks to improve cause of death (CoD) determination and reporting through the use of Minimally Invasive Tissue Sampling (MITS). To describe feasibility of MITS in Bangladesh and Sierra Leone, religious beliefs and practices about death and burial must be explored in each context. This study aims to: identify beliefs about causes of child death; document the enactment of religious beliefs surrounding death and burial; and determine how religious beliefs and practices influence acceptability and feasibility of MITS implementation by CHAMPS. CHAMPS conducted formative research in Bangladesh and Sierra Leone before implementing MITS. Healthcare workers (4), religious leaders (6), parents of deceased children (18 mothers, 16 fathers), and traditional healers and birth attendants (5) were recruited using nomination and snowball sampling techniques beginning with community advisory boards. Methods: Secondary thematic analysis was performed on 8 interviews in Bangladesh and 10 interviews and 4 focus groups in Sierra Leone, all of which were transcribed, translated, and de-identified by local sites. Emergent themes were anlayzed in light of CHAMPS' feasibility framework. IRB approval was received from Emory University, CDC, and local review committees in both countries. A determination by Emory University concluded the secondary analysis did not require a review. Findings: Analysis revealed that religion influences beliefs about CoD, practices related to burial, and desires to learn CoD. Participants in both countries hold spiritual and non-spiritual beliefs about CoD, the most prominent belief that death is “the will of God.” Using Shariah as justification for rituals differed between the two contexts, as well as perceived acceptability of MITS. Desire to learn CoD depends on beliefs about CoD and desire to prevent future deaths. Timing of MITS is the most notable consideration in both countries due to fear of interference with important burial rituals. Discussion: Beliefs about CoD are not limited to a biomedical or a spiritual paradigm, but are often a mix of both. Religion in both countries was influenced by other cultural and local belief systems, requiring CHAMPS to develop different approaches to community engagement. Future global health work should conduct formative research to understand the complex nuances of religious experiences to ensure more effective community engagement. One limitation is the inability to determine saturation. During data collection, saturation was assessed around CHAMPS' central questions, but saturation related to secondary analysis is out of the researcher's control.