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Cause of Death Study at Tertiary Hospital in Northern Tanzania (EMECaD)

In Tanzania, many people are born, live, and die without leaving any records. In particular, the deaths of patients that occur shortly after hospital admission are unlikely to be accurately documented because the hospital’s medical team likely did not have enough time to perform a comprehensive investigation of the patient’s illness, including histopathology, microbiology, or imaging.

To address this gap, the EMECaD project is exploring whether minimally invasive tissue sampling (MITS) can effectively establish cause of death among patients who die within three days of being admitted to hospital.

Dr. Alex Mremi, head of pathology at Kilimanjaro Christian Medical Centre (KCMC), a tertiary hospital in Northern Tanzania, is leading EMECaD. He first became interested in MITS when he was exposed to various autopsy techniques, including MITS, during an autopsy study that he was part of from 2016 to 2019.

“Before this study, very few autopsies were done at our hospital and almost all of them were forensic. But through the study, autopsy and particularly MITS had been demonstrated to be very useful and helpful,” says Dr. Mremi. “I learned that MITS is simple, requires less resources and personnel, is highly acceptable among people and is a nearly equal potential alternative to complete diagnostic autopsy.”

The MITS Surveillance Alliance awarded an incentive grant to EMECaD in 2019. The funding will provide financial and material support for the project’s implementation and will facilitate training and workshops to ensure the team can carry out the study as effectively as possible. EMECaD’s findings are expected by the end of 2020.

“Identifying the knowledge gap in terms of actual pathologic, evidence-based cause of death among patients with a short-term hospitalization will provide vital information to health care stakeholders, such as medical teams and policy makers, who can positively influence treatment outcomes for patients,” says Dr. Mremi. “And the study’s results may encourage clinicians in other health facilities in low- and middle-income countries to adopt the MITS technique and hence potentially improve their mortality data and improve patient management.”

Project Name

Effectiveness of MITS in Establishing the Cause of Death among patients after short-term hospitalizations at a tertiary hospital in northern Tanzania


Kilimanjaro, Tanzania

Team Members

Alex Mremi, Patrick Amsi, Ronald Mbwasi, Elichilia Shao, Cristina Costales and Matthew Rubach; Kilimanjaro Christian Medical Centre

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