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1. Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia

Author

Khatia Munguambe, Quique Bassat, Mahbubur Rahman, Sibone Mocumbi, Cynthia G Whitney, Amy Wise, Shams El Arifeen, Meerjady Sabrina Flora, Soter Ameh, Emily S Gurley, Mustafizur Rahman, Ariel Nhacolo, Cheick Bougadari Traore, Inacio Mandomando, Clara Menendez, Janet Agaya, Jane Juma, Shabir A Madhi, Tadesse Gure, George Aol, Hennie Lombaard, Ziyaad Dangor, James Bunn, Samba O Sow, Amara Jambai, Dickson Gethi, Sanwarul Bari, Natalia Rakislova, Tacilta Nhampossa, Maria Maixenchs, Mohammed Kamal, Joseph Oundo, Lola Madrid, Tahmina Shirin, Ikechukwu Udo Ogbuanu, Addisu Alemu, Hailemariam Legesse, Awa Traore, Portia C Mutevedzi, Helina Heluf, Victor Akelo, Dickens Onyango, Richard Omore, Yasmin Adam, Peter Otieno, Margaret Mannah, Karen L Kotloff, Milagritos D Tapia, Rima Koka, Mohammad Zahid Hossain, Dickens Kowuor, Tom Sesay, James Squire, Francis Moses, Kitiezo Aggrey Igunza, Andrew Moseray, Afruna Rahman, Nana Kourouma, Seydou Sissoko, Rosauro Varo, Sana Mahtab, Martin Hale, Jeanie du Toit, Zachary J Madewell, Dianna M Blau, Fatima Solomon, Gillian Sorour, Jeannette Wadula, Karen Petersen, Sanjay G Lala, Sithembiso Velaphi, Richard Chawana, Nellie Myburgh, Shahana Parveen, Mahbubul Hoque, Saria Tasnim, Ferdousi Islam, Farida Ariuman, Mohammad Mosiur Rahman, Dilruba Ahmed, Fikremelekot Temesgen, Melisachew Mulatu Yeshi, Mahlet Abayneh Gizaw, Stian MS Orlien, Solomon Ali, Peter Nyamthimba Onyango, Richard Oliech, Joyce Akinyi Were, Thomas Misore, Harun Owuor, Christopher Muga, Christine Ochola, Ashka Mehta, Brigitte Gaume, Adama Mamby Keita, Diakaridia Kone, Diakaridia Sidibe, Doh Sanogo, Kounandji Diarra, Tiéman Diarra, Kiranpreet Chawla, Zara Manhique, Fatmata Bintu Tarawally, Martin Seppeh, Ronald Mash, Julius Ojulong, Babatunde Duduyemi, Alim Swaray-Deen, Okokon Ita, Cornell Chukwuegbo, Sulaiman Sannoh, Princewill Nwajiobi, Erick Kaluma, Oluseyi Balogun, Carrie Jo Cain, Solomon Samura, Samuel Pratt, Joseph Kamanda Sesay, Osman Kaykay, Binyam Halu, Francis Smart, Sartie Kenneh, Ferdousi Begum, Priya Mehta-Gupta Das, Ogony Benard Oluoch, Caleb K Sagam, Ronita Luke, Milton Kincardett, Elisio G Xerinda, Markus Roos Breines, Ketema Degefa, J. Anthony G Scott, Kazi Munisul Islam, Parminder S Suchdev, Nelesh P. Govender, Peter J. Swart, Nawshad Uddin Ahmed, Alexander M. Ibrahim, Sharon M. Tennant, Carol L. Greene, J. Kristie Johnson, Karen D. Fairchild, Uma U. Onwuchekwa, and Joseph Bangura

Subjects
Medicine (General), R5-920, Infectious and parasitic diseases, RC109-216
Abstract

Introduction Malnutrition contributes to 45% of all childhood deaths globally, but these modelled estimates lack direct measurements in countries with high malnutrition and under-5 mortality rates. We investigated malnutrition’s role in infant and child deaths in the Child Health and Mortality Prevention Surveillance (CHAMPS) network.Methods We analysed CHAMPS data from seven sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa) collected between 2016 and 2023. An expert panel assessed each death to determine whether malnutrition was an underlying, antecedent or immediate cause or other significant condition. Malnutrition was further classified based on postmortem anthropometry using WHO growth standards for underweight (z-scores for weight-for-age

Published
2024
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2. Clinicopathological discrepancies in the diagnoses of childhood causes of death in the CHAMPS network: An analysis of antemortem diagnostic inaccuracies

Author

Khatia Munguambe, Quique Bassat, Robert F Breiman, Mahbubur Rahman, Sibone Mocumbi, Cynthia G Whitney, Amy Wise, Shams El Arifeen, Meerjady Sabrina Flora, Soter Ameh, Emily S Gurley, Mustafizur Rahman, Ariel Nhacolo, Carla Carrilho, Cheick Bougadari Traore, Lucy Liu, Inacio Mandomando, Clara Menendez, Chris A Rees, Janet Agaya, Jane Juma, Tadesse Gure, George Aol, Hennie Lombaard, Ziyaad Dangor, Shabir Madhi, James Bunn, Samba O Sow, Dickson Gethi, Sanwarul Bari, Jeffrey P Koplan, Natalia Rakislova, Fabiola Fernandes, Tacilta Nhampossa, Maria Maixenchs, Mohammed Kamal, Nega Assefa, Joseph Oundo, Lola Madrid, Tahmina Shirin, Nelesh P Govender, Addisu Alemu, Hailemariam Legesse, Uma U Onwuchekwa, Awa Traore, Portia C Mutevedzi, Victor Akelo, Sammy Khagayi, Dickens Onyango, Richard Omore, Yasmin Adam, Peter Otieno, Margaret Mannah, Vicky Baillie, Karen L Kotloff, John Blevins, Milagritos D Tapia, Rima Koka, Mohammad Zahid Hossain, Dickens Kowuor, Tom Sesay, James Squire, Francis Moses, Haleluya Leulseged, Christine Bethencourt, Kitiezo Aggrey Igunza, Ikechukwu U Ogbuanu, Andrew Moseray, Ima-Abasi Bassey, Afruna Rahman, Muntasir Alam, Yasir Y Abdullahi, Nana Kourouma, Seydou Sissoko, Rosauro Varo, Sana Mahtab, Martin Hale, Jeanie du Toit, Zachary J Madewell, Dianna M Blau, Roosecelis B Martines, Fatima Solomon, Gillian Sorour, Jeannette Wadula, Karen Petersen, Peter J Swart, Sanjay G Lala, Sithembiso Velaphi, Richard Chawana, Ashleigh Fritz, Nellie Myburgh, Pedzisai Ndagurwa, Cleopas Hwinya, Shahana Parveen, ASM Nawshad Uddin Ahmed, Mahbubul Hoque, Saria Tasnim, Ferdousi Islam, Farida Ariuman, Mohammad Mosiur Rahman, Ferdousi Begum K Zaman, Dilruba Ahmed, Alexander M Ibrahim, Fikremelekot Temesgen, Melisachew Mulatu Yeshi, Mahlet Abayneh Gizaw, Stian MS Orlien, Solomon Ali, Peter Nyamthimba Onyango, Richard Oliech, Joyce Akinyi Were, Thomas Misore, Harun Owuor, Christopher Muga, Bernard Oluoch, Christine Ochola, Sharon M Tennant, Carol L Greene, Ashka Mehta, J Kristie Johnson, Brigitte Gaume, Adama Mamby Keita, Karen D Fairchild, Diakaridia Kone, Diakaridia Sidibe, Doh Sanogo, Kounandji Diarra, Tiéman Diarra, Kiranpreet Chawla, Zara Manhique, Fatmata Bintu Tarawally, Martin Seppeh, Ronald Mash, Julius Ojulong, Babatunde Duduyemi, Alim Swaray-Deen, Joseph Bangura Amara Jambai, Okokon Ita, Cornell Chukwuegbo, Sulaiman Sannoh, Princewill Nwajiobi, Erick Kaluma, Oluseyi Balogun, Carrie Jo Cain, Solomon Samura, Samuel Pratt, Joseph Kamanda Sesay, Osman Kaykay, Binyam Halu, Francis Smart, Sartie Kenneh, Jana Ritter, Tais Wilson, Jonas Winchell, Jakob Witherbee, Navit T Salzberg, Margaret Basket, Ashutosh Wadhwa, Kyu Han Lee, Roosecelis Martines, Shamta Warang, Maureen Diaz, Jessica Waller, Shailesh Nair, Courtney Bursuc, Kristin LaHatte, Sarah Raymer, Solveig Argeseanu, Kurt Vyas, and Manu Bhandari

Subjects
Pediatrics, RJ1-570
Abstract

Introduction Determining aetiology of severe illness can be difficult, especially in settings with limited diagnostic resources, yet critical for providing life-saving care. Our objective was to describe the accuracy of antemortem clinical diagnoses in young children in high-mortality settings, compared with results of specific postmortem diagnoses obtained from Child Health and Mortality Prevention Surveillance (CHAMPS).Methods We analysed data collected during 2016–2022 from seven sites in Africa and South Asia. We compared antemortem clinical diagnoses from clinical records to a reference standard of postmortem diagnoses determined by expert panels at each site who reviewed the results of histopathological and microbiological testing of tissue, blood, and cerebrospinal fluid. We calculated test characteristics and 95% CIs of antemortem clinical diagnostic accuracy for the 10 most common causes of death. We classified diagnostic discrepancies as major and minor, per Goldman criteria later modified by Battle.Results CHAMPS enrolled 1454 deceased young children aged 1–59 months during the study period; 881 had available clinical records and were analysed. The median age at death was 11 months (IQR 4–21 months) and 47.3% (n=417) were female. We identified a clinicopathological discrepancy in 39.5% (n=348) of deaths; 82.3% of diagnostic errors were major. The sensitivity of clinician antemortem diagnosis ranged from 26% (95% CI 14.6% to 40.3%) for non-infectious respiratory diseases (eg, aspiration pneumonia, interstitial lung disease, etc) to 82.2% (95% CI 72.7% to 89.5%) for diarrhoeal diseases. Antemortem clinical diagnostic specificity ranged from 75.2% (95% CI 72.1% to 78.2%) for diarrhoeal diseases to 99.0% (95% CI 98.1% to 99.6%) for HIV.Conclusions Antemortem clinical diagnostic errors were common for young children who died in areas with high childhood mortality rates. To further reduce childhood mortality in resource-limited settings, there is an urgent need to improve antemortem diagnostic capability through advances in the availability of diagnostic testing and clinical skills.

Published
2024
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3. Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1–59 months

Author

Elisa Garcia Gomez, Kitiezo Aggrey Igunza, Zachary J. Madewell, Victor Akelo, Dickens Onyango, Shams El Arifeen, Emily S. Gurley, Mohammad Zahid Hossain, Md Atique Iqbal Chowdhury, Kazi Munisul Islam, Nega Assefa, J. Anthony G. Scott, Lola Madrid, Yenenesh Tilahun, Stian Orlien, Karen L. Kotloff, Milagritos D. Tapia, Adama Mamby Keita, Ashka Mehta, Amilcar Magaço, David Torres-Fernandez, Ariel Nhacolo, Quique Bassat, Inácio Mandomando, Ikechukwu Ogbuanu, Carrie Jo Cain, Ronita Luke, Sorie I. B. Kamara, Hailemariam Legesse, Shabir Madhi, Ziyaad Dangor, Sana Mahtab, Amy Wise, Yasmin Adam, Cynthia G. Whitney, Portia C. Mutevedzi, Dianna M. Blau, Robert F. Breiman, Beth A. Tippett Barr, and Chris A. Rees

Subjects
Public aspects of medicine, RA1-1270
Published
2024

4. Provider adherence to clinical care recommendations for infants and children who died in seven low- and middle-income countries in the Child Health and Mortality Prevention Surveillance (CHAMPS) networkResearch in context

Author

Chris A. Rees, Kitiezo Aggrey Igunza, Zachary J. Madewell, Victor Akelo, Dickens Onyango, Shams El Arifeen, Emily S. Gurley, Mohammad Zahid Hossain, Afruna Rahman, Muntasir Alam, J. Anthony G. Scott, Nega Assefa, Lola Madrid, Anteneh Belachew, Haleluya Leulseged, Karen L. Kotloff, Samba O. Sow, Milagritos D. Tapia, Adama Mamby Keita, Diakaridia Sidibe, Antonio Sitoe, Rosauro Varo, Sara Ajanovic, Quique Bassat, Inácio Mandomando, Beth A. Tippett Barr, Ikechukwu Ogbuanu, Carrie Jo Cain, Ima-Abasi Bassey, Ronita Luke, Khadija Gassama, Shabir Madhi, Ziyaad Dangor, Sana Mahtab, Sithembiso Velaphi, Jeanie du Toit, Portia C. Mutevedzi, Dianna M. Blau, Robert F. Breiman, Cynthia G. Whitney, Fatima Solomon, Gillian Sorour, Hennie Lombaard, Jeannette Wadula, Karen Petersen, Martin Hale, Nelesh P. Govender, Peter J. Swart, Sanjay G. Lala, Richard Chawana, Yasmin Adam, Amy Wise, Ashleigh Fritz, Nellie Myburgh, Pedzisai Ndagurwa, Cleopas Hwinya, Sanwarul Bari, Shahana Parveen, Mohammed Kamal, A.S.M. Nawshad Uddin Ahmed, Mahbubul Hoque, Saria Tasnim, Ferdousi Islam, Farida Ariuman, Mohammad Mosiur Rahman, Ferdousi Begum, K. Zaman, Mustafizur Rahman, Dilruba Ahmed, Meerjady Sabrina Flora, Tahmina Shirin, Mahbubur Rahman, Joseph Oundo, Alexander M. Ibrahim, Fikremelekot Temesgen, Tadesse Gure, Addisu Alemu, Melisachew Mulatu Yeshi, Mahlet Abayneh Gizaw, Stian Orlien, Solomon Ali, Peter Otieno, Peter Nyamthimba Onyango, Janet Agaya, Richard Oliech, Joyce Akinyi Were, Dickson Gethi, Sammy Khagayi, George Aol, Thomas Misore, Harun Owuor, Christopher Mugah, Bernard Oluoch, Christine Ochola, Sharon M. Tennant, Carol L. Greene, Ashka Mehta, J. Kristie Johnson, Brigitte Gaume, Rima Koka, Karen D. Fairchild, Diakaridia Kone, Doh Sanogo, Uma U. Onwuchekwa, Nana Kourouma, Seydou Sissoko, Cheick Bougadari Traore, Jane Juma, Kounandji Diarra, Awa Traore, Tiéman Diarra, Kiranpreet Chawla, Tacilta Nhampossa, Zara Manhique, Sibone Mocumbi, Clara Menéndez, Khátia Munguambe, Ariel Nhacolo, Maria Maixenchs, Andrew Moseray, Fatmata Bintu Tarawally, Martin Seppeh, Ronald Mash, Julius Ojulong, Babatunde Duduyemi, James Bunn, Alim Swaray-Deen, Joseph Bangura, Amara Jambai, Margaret Mannah, Okokon Ita, Cornell Chukwuegbo, Sulaiman Sannoh, Princewill Nwajiobi, Dickens Kowuor, Erick Kaluma, Oluseyi Balogun, Solomon Samura, Samuel Pratt, Francis Moses, Tom Sesay, James Squire, Joseph Kamanda Sesay, Osman Kaykay, Binyam Halu, Hailemariam Legesse, Francis Smart, Sartie Kenneh, Soter Ameh, Jana Ritter, Tais Wilson, Jonas Winchell, Jakob Witherbee, Navit T. Salzberg, Jeffrey P. Koplan, Margaret Basket, Ashutosh Wadhwa, Kyu Han Lee, Valentine Wanga, Roosecelis Martines, Shamta Warang, Maureen Diaz, Jessica Waller, Shailesh Nair, Lucy Liu, Courtney Bursuc, Kristin LaHatte, Sarah Raymer, John Blevins, Solveig Argeseanu, Kurt Vyas, and Manu Bhandari

Subjects
Childhood, Mortality, Clinical care, Guideline adherence, Medicine (General), R5-920
Abstract

Summary: Background: Most childhood deaths globally are considered preventable through high-quality clinical care, which includes adherence to clinical care recommendations. Our objective was to describe adherence to World Health Organization recommendations for the management of leading causes of death among children. Methods: We conducted a retrospective, descriptive study examining clinical data for children aged 1–59 months who were hospitalized and died in a Child Health and Mortality Prevention Surveillance (CHAMPS) catchment, December 2016–June 2021. Catchment areas included: Baliakandi and Faridpur, Bangladesh; Kersa, Haramaya, and Harar, Ethiopia; Kisumu and Siaya, Kenya; Bamako, Mali; Manhiça and Quelimane, Mozambique; Makeni, Sierra Leone; Soweto, South Africa. We reviewed medical records of those who died from lower respiratory tract infections, sepsis, malnutrition, malaria, and diarrheal diseases to determine the proportion who received recommended treatments and compared adherence by hospitalization duration. Findings: CHAMPS enrolled 460 hospitalized children who died from the leading causes (median age 12 months, 53.0% male). Median hospital admission was 31 h. There were 51.0% (n = 127/249) of children who died from lower respiratory tract infections received supplemental oxygen. Administration of intravenous fluids for sepsis (15.9%, n = 36/226) and supplemental feeds for malnutrition (14.0%, n = 18/129) were uncommon. There were 51.4% (n = 55/107) of those who died from malaria received antimalarials. Of the 80 children who died from diarrheal diseases, 76.2% received intravenous fluids. Those admitted for ≥24 h more commonly received antibiotics for lower respiratory tract infections and sepsis, supplemental feeds for malnutrition, and intravenous fluids for sepsis than those admitted

Published
2023
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5. Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS), December 2016 –December 2021

Author

Sana Mahtab, Shabir A. Madhi, Vicky L. Baillie, Toyah Els, Bukiwe Nana Thwala, Dickens Onyango, Beth A. Tippet-Barr, Victor Akelo, Kitiezo Aggrey Igunza, Richard Omore, Shams El Arifeen, Emily S. Gurley, Muntasir Alam, Atique Iqbal Chowdhury, Afruna Rahman, Quique Bassat, Inacio Mandomando, Sara Ajanovic, Antonio Sitoe, Rosauro Varo, Samba O. Sow, Karen L. Kotloff, Henry Badji, Milagritos D. Tapia, Cheick B. Traore, Ikechukwu U. Ogbuanu, James Bunn, Ronita Luke, Sulaiman Sannoh, Alim Swarray-Deen, Nega Assefa, J. Anthony G. Scott, Lola Madrid, Dadi Marami, Surafel Fentaw, Maureen H. Diaz, Roosecelis B. Martines, Robert F. Breiman, Zachary J. Madewell, Dianna M. Blau, and Cynthia G. Whitney

Subjects
Public aspects of medicine, RA1-1270
Abstract

Each year, 2.4 million children die within their first month of life. Child Health and Mortality Prevention Surveillance (CHAMPS) established in 7 countries aims to generate accurate data on why such deaths occur and inform prevention strategies. Neonatal deaths that occurred between December 2016 and December 2021 were investigated with MITS within 24–72 hours of death. Testing included blood, cerebrospinal fluid and lung cultures, multi-pathogen PCR on blood, CSF, nasopharyngeal swabs and lung tissue, and histopathology examination of lung, liver and brain. Data collection included clinical record review and family interview using standardized verbal autopsy. The full set of data was reviewed by local experts using a standardized process (Determination of Cause of Death) to identify all relevant conditions leading to death (causal chain), per WHO recommendations. For analysis we stratified neonatal death into 24-hours of birth, early (1-

Published
2023

6. Has Authorship in the Decolonizing Global Health Movement Been Colonized?

Author

Chris A. Rees, Gouri Rajesh, Hussein K. Manji, Catherine Shari, Rodrick Kisenge, Elizabeth M. Keating, Ikechukwu U. Ogbuanu, Kitiezo Aggrey Igunza, Richard Omore, and Karim P. Manji

Subjects
decolonization, authorship, global health partnerships, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract

Background: Decolonization in global health is a recent movement aimed at relinquishing remnants of supremacist mindsets, inequitable structures, and power differentials in global health. Objective: To determine the author demographics of publications on decolonizing global health and global health partnerships between low- and middle-income countries (LMICs) and high-income countries (HICs). Methods: We conducted a cross-sectional analysis of publications related to decolonizing global health and global health partnerships from the inception of the selected journal databases (i.e., Medline, CAB Global Health, EMBASE, CINAHL, and Web of Science) to November 14, 2022. Author country affiliations were assigned as listed in each publication. Author gender was assigned using author first name and the software genderize.io. Descriptive statistics were used for author country income bracket, gender, and distribution. Findings: Among 197 publications on decolonizing global health and global health partnerships, there were 691 total authors (median 2 authors per publication, interquartile range 1, 4). Publications with author bylines comprised exclusively of authors affiliated with HICs were most common (70.0%, n = 138) followed by those with authors affiliated both with HICs and LMICs (22.3%, n = 44). Only 7.6% (n = 15) of publications had author bylines comprised exclusively of authors affiliated with LMICs. Over half (54.0%, n = 373) of the included authors had names that were female and female authors affiliated with HICs most commonly occupied first author positions (51.8%, n = 102). Conclusions: Authors in publications on decolonizing global health and global health partnerships have largely been comprised of individuals affiliated with HICs. There was a marked paucity of publications with authors affiliated with LMICs, whose voices provide context and crucial insight into the needs of the decolonizing global health movement.

Published
2023
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7. Insights on the differentiation of stillbirths and early neonatal deaths: A study from the Child Health and Mortality Prevention Surveillance (CHAMPS) network.

Author

Elizabeth Quincer, Rebecca Philipsborn, Diane Morof, Navit T Salzberg, Pio Vitorino, Sara Ajanovic, Dickens Onyango, Ikechukwu Ogbuanu, Nega Assefa, Samba O Sow, Portia Mutevedzi, Shams El Arifeen, Beth A Tippet Barr, J Anthony G Scott, Inacio Mandomando, Karen L Kotloff, Amara Jambai, Victor Akelo, Carrie Jo Cain, Atique Iqbal Chowdhury, Tadesse Gure, Kitiezo Aggrey Igunza, Farzana Islam, Adama Mamby Keita, Lola Madrid, Sana Mahtab, Ashka Mehta, Paul K Mitei, Constance Ntuli, Julius Ojulong, Afruna Rahman, Solomon Samura, Diakaridia Sidibe, Bukiwe Nana Thwala, Rosauro Varo, Shabir A Madhi, Quique Bassat, Emily S Gurley, Dianna M Blau, and Cynthia G Whitney

Subjects
Medicine, Science
Abstract

IntroductionThe high burden of stillbirths and neonatal deaths is driving global initiatives to improve birth outcomes. Discerning stillbirths from neonatal deaths can be difficult in some settings, yet this distinction is critical for understanding causes of perinatal deaths and improving resuscitation practices for live born babies.MethodsWe evaluated data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network to compare the accuracy of determining stillbirths versus neonatal deaths from different data sources and to evaluate evidence of resuscitation at delivery in accordance with World Health Organization (WHO) guidelines. CHAMPS works to identify causes of stillbirth and death in children ResultsOf 1967 deaths ultimately classified as stillbirth, only 28 (1.4%) were initially reported as livebirths. Of 845 cases classified as very early neonatal death, 33 (4%) were initially reported as stillbirth. Of 367 cases with post-mortem examination showing delivery weight >1000g and no maceration, the maternal clinical record documented that resuscitation was not performed in 161 cases (44%), performed in 14 (3%), and unknown or data missing for 192 (52%).ConclusionThis analysis found that CHAMPS cases assigned as stillbirth or neonatal death after DeCoDe expert panel review were generally consistent with the initial report of the case as a stillbirth or neonatal death. Our findings suggest that more frequent use of resuscitation at delivery and improvements in documentation around events at birth could help improve perinatal outcomes.

Published
2022
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8. Prioritizing Health Care Strategies to Reduce Childhood Mortality

Author

Zachary J, Madewell, Cynthia G, Whitney, Sithembiso, Velaphi, Portia, Mutevedzi, Sana, Mahtab, Shabir A, Madhi, Ashleigh, Fritz, Alim, Swaray-Deen, Tom, Sesay, Ikechukwu U, Ogbuanu, Margaret T, Mannah, Elisio G, Xerinda, Antonio, Sitoe, Inacio, Mandomando, Quique, Bassat, Sara, Ajanovic, Milagritos D, Tapia, Samba O, Sow, Ashka, Mehta, Karen L, Kotloff, Adama M, Keita, Beth A, Tippett Barr, Dickens, Onyango, Elizabeth, Oele, Kitiezo Aggrey, Igunza, Janet, Agaya, Victor, Akelo, J Anthony G, Scott, Lola, Madrid, Yunus-Edris, Kelil, Tadesse, Dufera, Nega, Assefa, Emily S, Gurley, Shams, El Arifeen, Ellen A, Spotts Whitney, Katherine, Seib, Chris A, Rees, Dianna M, Blau, and Constance, Ntuli

Subjects
Male, Perinatal Death, Infant, Newborn, Infant, General Medicine, Stillbirth, Cross-Sectional Studies, Pregnancy, Child, Preschool, Cause of Death, Child Mortality, Humans, Female, Child, Delivery of Health Care
Abstract

ImportanceAlthough child mortality trends have decreased worldwide, deaths among children younger than 5 years of age remain high and disproportionately circumscribed to sub-Saharan Africa and Southern Asia. Tailored and innovative approaches are needed to increase access, coverage, and quality of child health care services to reduce mortality, but an understanding of health system deficiencies that may have the greatest impact on mortality among children younger than 5 years is lacking.ObjectiveTo investigate which health care and public health improvements could have prevented the most stillbirths and deaths in children younger than 5 years using data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network.Design, Setting, and ParticipantsThis cross-sectional study used longitudinal, population-based, and mortality surveillance data collected by CHAMPS to understand preventable causes of death. Overall, 3390 eligible deaths across all 7 CHAMPS sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) between December 9, 2016, and December 31, 2021 (1190 stillbirths, 1340 neonatal deaths, 860 infant and child deaths), were included. Deaths were investigated using minimally invasive tissue sampling (MITS), a postmortem approach using biopsy needles for sampling key organs and fluids.Main Outcomes and MeasuresFor each death, an expert multidisciplinary panel reviewed case data to determine the plausible pathway and causes of death. If the death was deemed preventable, the panel identified which of 10 predetermined health system gaps could have prevented the death. The health system improvements that could have prevented the most deaths were evaluated for each age group: stillbirths, neonatal deaths (aged ResultsOf 3390 deaths, 1505 (44.4%) were female and 1880 (55.5%) were male; sex was not recorded for 5 deaths. Of all deaths, 3045 (89.8%) occurred in a healthcare facility and 344 (11.9%) in the community. Overall, 2607 (76.9%) were deemed potentially preventable: 883 of 1190 stillbirths (74.2%), 1010 of 1340 neonatal deaths (75.4%), and 714 of 860 infant and child deaths (83.0%). Recommended measures to prevent deaths were improvements in antenatal and obstetric care (recommended for 588 of 1190 stillbirths [49.4%], 496 of 1340 neonatal deaths [37.0%]), clinical management and quality of care (stillbirths, 280 [23.5%]; neonates, 498 [37.2%]; infants and children, 393 of 860 [45.7%]), health-seeking behavior (infants and children, 237 [27.6%]), and health education (infants and children, 262 [30.5%]).Conclusions and RelevanceIn this cross-sectional study, interventions prioritizing antenatal, intrapartum, and postnatal care could have prevented the most deaths among children younger than 5 years because 75% of deaths among children younger than 5 were stillbirths and neonatal deaths. Measures to reduce mortality in this population should prioritize improving existing systems, such as better access to antenatal care, implementation of standardized clinical protocols, and public education campaigns.

Published
2022

9. Overview and Development of the Child Health and Mortality Prevention Surveillance Determination of Cause of Death (DeCoDe) Process and DeCoDe Diagnosis Standards

Author

Inacio Mandomando, Anna C. Seale, Shabir A. Madhi, Rebecca Pass Philipsborn, Nega Assefa, Karen L. Kotloff, Rosauro Varo, Dickens Onyango, Robert F. Breiman, Kitiezo Aggrey Igunza, Siobhan Johnstone, Pratima L Raghunathan, Dianna M. Blau, Shams El Arifeen, Milagritos D. Tapia, Tim Morris, Afruna Rahman, Richard Chawana, J Patrick Caneer, Quique Bassat, and Reinhard Kaiser

Subjects
Microbiology (medical), medicine.medical_specialty, Process (engineering), vital records, Supplement Articles, mortality review, Infant mortality, Global Health, Child health, cause of death, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, 030212 general & internal medicine, CHAMPS, Child, Children, Africa South of the Sahara, Cause of death, Bangladesh, 030219 obstetrics & reproductive medicine, business.industry, Public health, Child Health, Diagnosis standards, Reference Standards, Stillbirth, medicine.disease, Verbal autopsy, 3. Good health, Child mortality, Infectious Diseases, Population Surveillance, Child Mortality, data management, Death certificate, Medical emergency, business, Infants, Mortalitat infantil
Abstract

Mortality surveillance and cause of death data are instrumental in improving health, identifying diseases and conditions that cause a high burden of preventable deaths, and allocating resources to prevent these deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) network uses a standardized process to define, assign, and code causes of stillbirth and child death (, This manuscript details the method for the determination of cause of death in stillbirths and deaths in children under 5 at CHAMPS surveillance sites as well as standardization processes across the network.

Published
2019
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