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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 103-109

Knowledge, attitude, and practice regarding voluntary whole-body donation among medicos in Northeast India


1 Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
2 Department of Anatomy, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India

Date of Submission04-Apr-2019
Date of Decision26-Jun-2019
Date of Acceptance10-Oct-2019
Date of Web Publication8-Oct-2020

Correspondence Address:
Kaushik Nag
Assistant Professor, Department of Community Medicine, Tripura Medical College & Dr. BRAM Teaching Hospital, Hapania, P.O. - ONGC, Agartala-799014
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_41_19

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  Abstract 


Background: Voluntary whole-body donation is an important source of cadavers for anatomical study and research. As the medicos are intimately related to this, they should play vital role in the body and organ donation. Objective: The objective of the study was to assess knowledge, attitude, and practice (KAP) regarding voluntary whole-body donation among medicos in Northeast India. Methodology: This cross-sectional study was conducted among 361 medicos in Northeast India from March 2018 to June 2018. A pretested, semi-structured questionnaire was used to collect the required information on KAP regarding voluntary whole-body donation. The collected data were entered in SPSS version 16.0 and represented in proportions, and P < 0.05 was considered as statistically significant. Results: Most of the medicos (88.1%) knew about voluntary whole-body donation, and 60.7% of the respondents even replied that body should be brought to medical institute within specific time after death. Half of them (50.1%) got information from mass media, 10.8% from nongovernmental organizations, and 35.2% from doctors. Maximum (83.7%) agreed that body donation is useful for society, whereas 6.4% did not agree. Only 24.4% of the respondents had seen “donor card pledge form,” whereas only 7.5% (n = 27) were currently registered as a voluntary body donor. Conclusion: We found poor knowledge and attitude regarding various facets of voluntary whole-body donation; practice was even dismal among participants. Media and doctors being major source of information should spread the idea of voluntary whole-body donation that it is better to donate body after death, for research in medical education rather than cremation.

Keywords: Cadaver, death, education, India, mass media


How to cite this article:
Karmakar N, Chakraborty T, Datta A, Nag K, Das S, Bhattacharjee P. Knowledge, attitude, and practice regarding voluntary whole-body donation among medicos in Northeast India. CHRISMED J Health Res 2020;7:103-9

How to cite this URL:
Karmakar N, Chakraborty T, Datta A, Nag K, Das S, Bhattacharjee P. Knowledge, attitude, and practice regarding voluntary whole-body donation among medicos in Northeast India. CHRISMED J Health Res [serial online] 2020 [cited 2020 Oct 24];7:103-9. Available from: https://www.cjhr.org/text.asp?2020/7/2/103/297579




  Introduction Top


A sound knowledge of anatomy is an integral part of medical education, and availability of human cadaver plays a very crucial role in gaining in-depth knowledge and perception through cadaveric dissection by medical students in their early career.[1],[2]

Voluntary whole-body donation and unclaimed bodies of the deceased in hospitals and medical teaching institution and those obtained by the police are the principal means by which universities acquire bodies for dissection, anatomical examination, and other similar purposes in India.[3],[4],[5] India experienced the act of body donation for the first time in 1956 when the body of Pandurang Sridhar Apte was donated to B. J. Medical College, Pune.[6]

In India, so many medical colleges are there but till today no means of smooth availability of sufficient cadavers for teaching purpose. The most important reason for low rate of body donation in India is lack of awareness (only 22% general population is aware); ignorance, culture, religious belief, and fear that the body may not be treated with respect and dignity were some other causes.[4],[7] Medicos, in addition, cannot accept the concept of dissection of their own body, and even idea of donating bodies to medical science was decreased significantly from 31.5% to 19.6% among medical students after exposure to dissection.[7],[8]

Moreover, mushrooming of medical institutions along with increasing medical seats in recent years in India results in increasing demand of cadavers for anatomy dissection which has worsened the scenario further.[9] The cadaver-to-medical/dental students ratio in various teaching institutes of India is 1:25, optimal being 1:10.[5]

A survey in the Indian state of Maharashtra showed a gross insufficiency of cadavers in 90.90% of medical colleges. The pools of these cadavers were unclaimed bodies brought by the police, whereas the proportion of voluntary body donation is less. In 63.63% of these colleges, a number of cadavers available were less than half of the requirements during 2006–2010.[10] These institutes have to rely on the unclaimed bodies, which are a poor source of cadavers, and this scarcity cannot be replenished with unclaimed bodies alone.[6],[10] Body donation being a voluntary process, the awareness among people is must; willed body donation programs are still in their infancy in our country. Hence, organized efforts are needed to raise the awareness and change the mindset of our society and medicos in particular, toward voluntary whole-body donation. With this background, this study was conducted to assess knowledge, attitude, and practice (KAP) regarding voluntary whole-body donation among medicos (medical students and internees) in Northeast India.


  Methodology Top


This epidemiological study with cross-sectional design was conducted among medicos in Northeast India from March 2018 to June 2018. Medicos included were undergraduate medical students and internees* who were present on the day of the survey and gave consents to participate, excluding those who did not fill up the questionnaire.

Sampling technique

There are totally eight states in the Northeastern part of India; from the list, the Indian state of Tripura was selected by simple random sampling using the lottery method. There are two medical colleges in Tripura; both are in the capital city of Agartala, of which one medical college (Tripura Medical College and Dr. BRAM Teaching Hospital, Hapania) was chosen randomly. Then, a complete list of all the currently enrolled medicos (undergraduate medical students and internees) was prepared, which was the sampling frame. Finally, the study participants were selected by census method using that list as reference.

Study tool

A questionnaire was prepared by researchers in consultation with faculties reviewing previous literature; covering socio-demographic characteristics, questions related to KAP in different aspects of voluntary whole body donation. It was pilot tested among ten randomly selected medicos in the presence of one researcher to address any difficulty while answering any terms or dimensions in the questionnaire. The questionnaire was thus tested for clarity as well as time for response; finalization was done with some minor modification by experts after this pretesting.[4],[5],[11],[12],[13],[14]

Data collection

The methodology and purpose of this study were explained in detail, confidentiality was assured, and informed consent was taken in written from all the participants, before participation in the study. Among all the medicos (a total of 488 medicos available currently, considering four professional MBBS students' batches and existing *internees' batch) who gave informed consent to participate in this study were approached (exclusion – those returned incomplete questionnaires, students unavailable due to their supplementary examination, and absenteeism). Using complete enumeration method and after discarding persons who fulfilled exclusion criteria as mentioned above, finally, 361 medicos (overall response rate: 74%) were included as the study sample. (*Interns were UG medical students who had just passed their 3rd professional MBBS examination [final year] Part II and were currently undergoing 365 days of stipendiary, compulsory rotational training program).

Scoring

The dependent variable was “good and poor knowledge,” “positive and negative attitude,” and “appropriate and inappropriate practice.” The independent variables were age, gender, religion, caste, type of family, and education status.

Knowledge score

A total of five questions were asked to assess respondents' knowledge about body donation. Two marks were awarded for every correct answer and one for every wrong answer. Later, score below or equal to median value and above median value, respectively, was categorized as having “poor” or “good” knowledge (median score: 9).

Attitude score

A total of six questions were asked to assess respondents' attitude about body donation. Three marks were awarded for every correct answer: two for “no response” and one mark for every negative answer. Later, score below or equal to median value and above median value, respectively, was categorized as “negative” or “positive” attitude (median score: 14).

Practice score

A total of four questions were used to assess respondents' practice about body donation. Two marks were given for every correct answer and one for every wrong answer. Later, score below or median value and above median value, respectively, was categorized as having “appropriate” and “inappropriate” practice (median value: 6).

Data analysis

Data were entered in Microsoft Excel and analyzed with the help of SPSS software version 16.00 SPSS software version 16.0 (IBM Corp, Newyork, USA). Data were represented using appropriate tables and charts in the form of frequencies and percentages. Chi-square test was applied to find statistical association as required, and P < 0.05 was considered as statistically significant.


  Results Top


[Table 1] shows that, of 361 respondents, more than half (54.0%) were from the age group of 21–25 years, followed by 36.8% in 20 years and below, whereas least number of respondents (1.5%) were above 30 years. Females slightly outnumbered males (51.8% vs. 48.2%). Maximum were Hindu (84.2%), followed by Christian (5.8%), Muslim (4.2%), and Buddhist (3.3%), whereas only 1 (0.3%) belongs to Jain. Majority of the participants belong to general caste (60.4%), whereas least were from Other backward class (OBC) category (9.4%). Majority were from 1st professional MBBS (28.8%), one-fifth (19.7%) internees, whereas least (10.8%) were from 3rd professional MBBS Part II. Majority of the participants were residents of urban areas (83.9%) and belonged to nuclear families (83.4%).
Table 1: Distribution of study population according to their sociodemographic characteristics (n=361)

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[Table 2] shows that most of the respondents (318, 88.1%) know the concept of body donation, whereas 60.7% of the medicos know that family members should bring the body to medical institute within specific time (preferably in 3–5 h) after death. Majority (79.5%) of the respondents knew that a person has to fill up requisite forms for voluntary body donation when alive. On further evaluation, 39.3% of the medicos replied that family members bear the expenses of transport of body, followed by government (25.5%) and medical institute (31%), whereas least (4.2%) opined about nongovernmental organizations (NGOs). Majority (60.7%) knew that both unclaimed and donated bodies were procured for dissection; few participants knew that only unclaimed bodies (10.8%), only donated bodies (15.8%) was used whereas 12.7% did not have any idea. Half of them (50.1%) got information in this regard from mass media (TV, newspaper, and magazines), 10.8% came to know from NGOs, 35.2% from doctors, and 13.9% from seminars. Interestingly, few participants (14.7%) were self-motivated and 28.8% knew from family members and relatives.
Table 2: Distribution of study population according to their knowledge Attitude, and Practice regarding body donation (n=361)

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Attitude

Majority of the respondents (83.7%) agreed that voluntary whole-body donation is useful for our society as a whole, whereas 10% had no response and 6.4% do not agree. Majority (65.9%) opined that whole-body donation and organ donation were different. Only 24.1% agreed that family member should bear the expenses to bring donated body to the medical institution, whereas more than half (53.5%) disagreed.

Nearly half (45.4%) of them agreed that dead bodies were handled properly by medical institutions, whereas 21.6% did not agree with that. Similarly, 46.5% agreed that bodies with removed organs (except eyes) can be used for dissection, whereas 37.7% disagreed and 15.8% gave no response. Majority of the medicos (82%) agreed about the need of educating people regarding benefits of body donation for improving medical education and research in India.

Practice

Only 24.4% of the medicos had seen “donor card pledge form” for voluntary body donation, whereas only 7.5% (n = 27) were currently registered as a voluntary body donor. When further enquired among currently unregistered participants (n = 334), 65.3% (n = 218) of the medicos were willing to register or would think about body donation in near future, whereas 34.7% (n = 116) would not register for body donation. Majority (64.3%) would encourage their family members, relatives, and friends for voluntary body donation, whereas 17.7% had religious beliefs for not donating body.

[Figure 1] shows the reasons behind willingness (n = 245*, those who already registered and were willing to register in near future) and unwillingness (n = 116*, those who were not registered currently and will never consider to register in near future) for voluntary body donation among medicos.
Figure 1: Distribution of study participants according to the reason behind willingness (n = 245*) and unwillingness for body donation (n = 116*)

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Various reasons for willingness found were- Majority (59.6%) wanted to facilitate medical teaching, followed by 43.3% to save other needy people's life, avoid unnecessary wastage of body by cremation (17.8%), to live after death in other person's body (16.8%), to avoid environmental pollution (13.9%) and least (9.6%) wanted to donate body to save economy by avoiding cremation.

Some reasons for unwillingness elicited were as follows: majority (28.4%) did not want their body to dissect, followed by objection from family (20.2%), psychological anxiety (20.2%), misused/abuse of organs (19.7%), organ wastage (9.6%), and miscellaneous (34.9%).

[Table 3] showed the association between Knowledge, attitude, and practice of participants with socio-demographic characteristics.
Table 3: Association of knowledge, attitude, and practice among medicos and their sociodemographic characteristics (n=361)

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Knowledge

Forty percent of the medicos aged >30 years had good knowledge regarding body donation, followed by 22.1% between 21 and 25 years, 21.4% between 26 and 30 years, and least (11.3%) <20 years, and the difference in good knowledge with respect to various age groups was found statistically significant (χ2 = 7.985, P = 0.046). More male medicos (19.8%) had good knowledge than females (16.7%) but not statistically significant (P > 0.05).

Urban residents had good knowledge than (19.8% vs. 10.3%) those from rural area (P > 0.05). More medicos were from higher classes (21.1% and 20.5% from 3rd professional MBBS Part I and II and 25.4% of internees), whereas only 10.6% and 17.5% students of 1st and 2nd professional MBBS, respectively, had good knowledge regarding body donation (P > 0.05).

Attitude

Majority of the medicos aged <20 years and students between 21 and 25 years (39.8%[53] and 39.0%[76] each) and only 7.1% (2) of the medicos between 26 and 30 years had positive attitude toward body donation which was found to be statistically significant (P < 0.05). More number of males (72, 38.5%) had positive attitude than females (60, 34.5%) regarding body donation (P > 0.05). Majority (43.4%) of the SC and 38.1% of the general category medicos had positive attitude (P > 0.05). More urban medicos (37.3% vs. 32.8%) had positive attitude toward body donation than students from rural area (P > 0.05). Majority of the medicos (45, 43.3%) from 1st professional MBBS, 42.2% from 3rd professional MBBS-I, 15 (38.5%) from 3rd professional MBBS-II, 36.8% from 2nd professional MBBS, and 18.3% of internees had right attitude toward body donation (P > 0.05).

Practice

About 12.05% (16) of the medicos <20 years, 17.4% (34) between 21 and 25 years, 25% (7) in 26–30 years, and 40% (2) >30 years had appropriate practice regarding different aspects of body donation (P > 0.05). More number of males (36, 19.3%) than females (23, 13.2%) had appropriate practice regarding different aspects of voluntary whole-body donation (P > 0.05).

Majority (26.5%, n = 9) of OBC, 16.5% (n = 36) of general, and 20.8% (n = 11) of SC category medicos have appropriate practice regarding various aspects of voluntary whole-body donation (P < 0.05). Only 16.2% (n = 49) and 17.2% (n = 10) from urban and rural area, respectively, had appropriate practice of body donation (P > 0.05). Finally, 13.5% (n = 14) from 1st professional MBBS, 7.0% (n = 4) from 2nd professional MBBS, 20.0% (n = 18) from 3rd professional MBBS-I, 15.4% (n = 69) from 3rd professional MBBS-II students, and 23.9% (n = 17) of internees have appropriate practice of body donation (P > 0.05).


  Discussion Top


In this cross-sectional study, of 361 medicos participated, 54% were in the age group of 21–25 years, followed by 36.8% 20 years and below, whereas least (1.5%) were above 30 years; female participants slightly outnumbered males (51.8% vs. 48.2%). More male participants (65% and 62%, respectively) were found in studies by Vaishaly et al. in Pune[15] and Anyanwu et al. in Nigeria.[16]

In the present study, 88.1% are aware of body donation, almost similar (92% aware) to that of Ballala et al. in Manipal.[11] In our study, the source of information about body donation was mass media (50.1%), NGOs (10.8%), self-motivation (14.7%), seminars (13.9%), and family members and relatives (28.8%). Previous studies also showed similar findings but minor role from doctors in promoting body donation for medical education and research,[11],[15] whereas in our study, doctors' role was a bit higher (35.2%).

In the present study, 60.7% knew that body should be donated as early as possible after death, slightly lower (77.86%) than findings from Solapur.[12] In our study, males had better knowledge (19.8% vs. 16.7%, respectively) and attitude (38.5% vs. 34.5%, respectively) toward body donation than females (P > 0.05); overall one-third (36.6%) of the students expressed their positive attitude. Anubha Saha in Kolkata found that majority (82%) had positive attitude; males showed strongly positive attitude, whereas females needed persuasion (P = 0.0014).[17]

In our study, 24.4% had seen donor card pledge form of voluntary body donation, whereas only 7.5% currently registered as voluntary body donor. Prameela et al. showed that only one student has filled up donor card and only eight of them asked for donor cards.[13] Another study found that only 22% of the respondents were willing to donate their own body.[11]

Sehirli et al.[18] in Turkey found that 15.7% of the respondents may donate and 63.9% would not consider donating his/her body, whereas in the present study, 65.3% of the medicos were willing to register or would think about body donation in near future, whereas 34.7% would not register. These comparative data indicated the need of hour to motivate medicos to donate their body for education and research as well as to be a role model for others.

Boulware et al. reported that respondents' race/ethnicity, religion, and education contributed most to willingness toward body donation.[19] Perry and Ettarh mentioned that age influenced whole-body donation.[14] In the present study, 39.8% of the medicos ≤20 years had positive attitude toward body donation, whereas positive attitude among medicos of 30 years or more was only 20% (P < 0.05).

In the present study, 28.4% do not want their body to be cut into pieces, 20.2% have psychological anxiety, 17.7% had religious beliefs for not donating body, and 23.9% were prevented by family members. Previous researches also elicited thought of his/her body being dissected, psychologically not ready, anxiety of unrespectful behaviors, and religious beliefs as major factors discouraging body donation.[3],[7],[10]

Saritha et al. in Mehboobnagar[20] showed that 80% of the medicos believed that donated bodies were misused and they are not ready to donate their bodies, whereas the present study found misused/organ abuse (19.7%) and organ wastage (9.6%) as reasons for unwillingness.

In the present study, willingness for donating their bodies among participants was based on the following perceptions: to live after death in other person's body (16.8%), to avoid unnecessary wastage of body by cremation (17.8%), to save other needy people's life (43.3%), to facilitate medical teaching (59.6%), to save economy by avoiding cremation in poor socioeconomic people (9.6%), and to avoid environmental pollution (13.9%). Sophie B in The Netherlands found that motivations were to advance medical education (29.7%), contribution to medical science (22.0%), to be useful (18.8%), and to help others (15.8%); few respondents wanted to donate for the sake of their offspring, especially their grandchildren or, more generally, future generations (1.9%).[21]

Limitations

Our study possesses some limitations regarding its relevance to overall society as we only included medicos (undergraduate medical students and internees) who were sensitized to the purpose of donated bodies, and further results only revealed the notion of youths as we included the students between 18 and 30 years; middle-aged and elderly persons were not included.


  Conclusion Top


We found poor knowledge and attitude regarding various facets of voluntary body donation with negligible practice among medicos. Media and NGOs being major source of information about body donation can spread the message of body donation among both medicos and population. Even, there is a need for reviewing medical curricula to focus on voluntary organ and whole-body donation keeping in mind role of doctors, so that there will be an altruistic changes in attitude of future medical professionals. This study will certainly have some role in creating a wave of instigation to the authorities to spread the awareness toward the generous act of body donation for medical education and research which is of utmost necessity for imparting quality medical education in the country.

Acknowledgment

The authors would like to thank all the study participants and college authorities for their cooperation and contribution in conducting this research work. We would like to acknowledge the medical social workers and staffs in the department of community medicine for conducting this study.

Author Contributions

NK1- Concept and design of study, Review of the literature, Data Collection, Data analysis and interpretation of data, manuscript writing, final approval of the version to be published. TC2- Data collection, manuscript writing and final approval of the version to be published. AD3- Data collection, Data analysis and interpretation of data, critical revision of the manuscript for important intellectual content, final approval of the version to be published. KN4- Data collection, Critical revision of the manuscript for important intellectual content, final approval of the version to be published. SD5- Review of the literature, critical revision of the manuscript for important intellectual content, final approval of the version to be published. PB6- Field level supervision, Final approval of the version to be published.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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