Minimally invasive tissue sampling (MITS) is providing high-accuracy data on infant mortality in Karachi, Pakistan, by identifying causes of death in cases where researchers draw on polymerase chain reactions (PCRs), chromatography, and every other test available. Led by the Aga Khan University (AKU) under the Gates Foundation’s CHAMPS programme, the project utilizes fine-needle organ sampling to bypass the cultural barriers associated with traditional autopsies.
How MITS Works Without Traditional Autopsies
MITS involves collecting tiny amounts of tissue and fluid from the brain, heart, lungs, and kidneys using needles no larger than a pen tip. According to Dr. Momin Kazi, the study’s lead researcher, the procedure is as comprehensive as a full surgical autopsy. The samples, alongside cerebrospinal fluid and various swabs, allow a panel of 12 to 13 experts to systematically eliminate potential causes of death.
The technique was developed to address a critical data gap in Pakistan, where religious convictions often prevent traditional post-mortems. Researchers at AKU engaged with local community leaders, resulting in at least 28 fatwas and significant grassroots efforts to gain family consent. Despite initial resistance—where 60 to 70 per cent of households refused outright—the program now operates in neighborhoods like Bhains Colony, Ibrahim Hyderi, and Ali Akbar Shah.
Identifying Hidden Pathogens and Preventable Deaths
The data collected by the CHAMPS programme reveals that many infant deaths are linked to factors previously misunderstood or misattributed. For example, a case study involving a newborn named Rafiya initially suggested kidney failure. However, MITS analysis indicated the actual cause was acute gastroenteritis, likely triggered by prelacteal feeding—the practice of giving newborns substances like qehva (green tea) or unpasteurized milk during their first three days.
Dr. Vinod Kumar of The Indus Hospital notes that these practices, combined with hospital-acquired infections, create a unique profile of neonatal sepsis in Pakistan. Unlike Western neonatal units dominated by Group B Streptococcus, the Karachi sites frequently record drug-resistant superbugs such as Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. These pathogens often thrive in overcrowded wards with limited nursing staff.
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The CHAMPS programme uses a network of local stakeholders—including coffin makers, ambulance drivers, and religious figures—to identify mortalities in real-time, as many deaths occur at home and are not logged by hospitals.
Future Implications for Public Health Policy
While the current sample size is not yet large enough for policy, the study provides granular evidence for health interventions. Researchers have identified that Streptococcus pneumoniae occurred exclusively at home, pointing to a lack of routine immunizations. Conversely, hospital-acquired infections suggest a need for improved sterilization and infection control protocols in clinical settings.
By shifting the focus from speculative causes to verified biological evidence, the project offers families closure and provides the government with a roadmap to tackle preventable deaths. The ability to identify specific local strains and hidden underlying conditions marks a shift in how neonatal mortality is addressed.
Frequently Asked Questions
- What is MITS?
MITS stands for Minimally Invasive Tissue Sampling. It is a post-mortem technique that uses fine needles to collect small tissue samples from major organs to determine the cause of death without performing a traditional open autopsy. - Why is this technique important in Pakistan?
Due to religious beliefs that discourage invasive autopsies, the cause of many infant deaths in Pakistan remains unknown. MITS offers a culturally sensitive alternative that provides accuracy in identifying causes of death. - What has the research revealed so far?
Data shows a clear distinction between home-based deaths, often linked to a lack of immunization, and hospital-acquired infections caused by drug-resistant superbugs like Acinetobacter baumannii.
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