1. Initial findings from a novel population-based child mortality surveillance approach: a descriptive study
- Author
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Rita Mabunda, Richard Chawana, J Patrick Caneer, Rosauro Varo Cobos, Meerjady Sabrina Flora, Dianna M. Blau, Marta Valente, Nelesh P. Govender, Henry Badji, Rebecca Pass Phillipsborn, Ashka Mehta, Tim Morris, Amanda L. Wilkinson, Farzana Islam, Sanjay G. Lala, Allan W. Taylor, Sharon M. Tennant, Sara Ajanovic, Sozinho Acácio, Rima Koka, Cheick B. Traoré, Sherif R. Zaki, Beth A Tippet Barr, Yasmin Adam, Atique Iqbal Chowdhury, Hennie Lombaard, Pio Vitorino, Pratima L Raghunathan, Mustafizur Rahman, Jana M. Ritter, Adriana Gibby, Jeffrey P. Koplan, Anna C. Seale, Karen D. Fairchild, Shabir A. Madhi, Jeannette Wadula, Dickens Onyango, Shahana Parveen, Muntasir Alam, Afruna Rahman, Jaume Ordi, Victor Akelo, Karen Petersen, Sanwarul Bari, Peter J. Swart, Diakaridia Koné, Vicky L. Baillie, Kasthuri Sivalogan, Diakaridia Sidibe, Uma U. Onwuchekwa, Shams El Arifeen, Tacilta Nhampossa, Quique Bassat, Jonas M. Winchell, Mohammed Kamal, Hossain M.S. Sazzad, J. Anthony G. Scott, Reinhard Kaiser, Nega Assefa, Jennifer M. Swanson, Juan Carlos Hurtado, Karen L. Kotloff, Clara Menéndez, Milagritos D. Tapia, Tatiana Keita, J. Kristie Johnson, Samba O. Sow, Natalia Rakislova, Jessica L. Waller, Amara Jambai, Mischka Garel, Emily S. Gurley, Carol L. Greene, Roosecelis B Martines, Scott F. Dowell, Antonio Sitoe, Inacio Mandomando, Maureen H. Diaz, Sibone Mocumbi, Robert F. Breiman, Shailesh Nair, Martin Hale, Adama Mamby Keita, Claudia Moya, Navit T Salzberg, Sithembiso Velaphi, and Rebecca Alkis Ramirez
- Subjects
Pediatrics ,medicine.medical_specialty ,030231 tropical medicine ,Àsia del Sud ,South Asia ,Article ,Sierra leone ,03 medical and health sciences ,South Africa ,0302 clinical medicine ,Lower respiratory tract infection ,Cause of Death ,Medicine ,Humans ,Infants--Mortality ,030212 general & internal medicine ,Longitudinal Studies ,Child ,Africa, Sub-Saharan ,Africa South of the Sahara ,Cause of death ,Pregnancy ,Neonatal sepsis ,business.industry ,Infant, Newborn ,Infant ,General Medicine ,medicine.disease ,Verbal autopsy ,Perinatal asphyxia ,Child mortality ,Child, Preschool ,Population Surveillance ,Child Mortality ,Autopsy ,business ,Mortalitat infantil ,Àfrica subsahariana - Abstract
- Label: BACKGROUND NlmCategory: BACKGROUND content: "Sub-Saharan Africa and south Asia contributed 81% of 5\xC2\xB79 million under-5 deaths and 77% of 2\xC2\xB76 million stillbirths worldwide in 2015. Vital registration and verbal autopsy data are mainstays for the estimation of leading causes of death, but both are non-specific and focus on a single underlying cause. We aimed to provide granular data on the contributory causes of death in stillborn fetuses and in deceased neonates and children younger than 5 years, to inform child mortality prevention efforts." - Label: METHODS NlmCategory: METHODS content: "The Child Health and Mortality Prevention Surveillance (CHAMPS) Network was established at sites in seven countries (Baliakandi, Bangladesh; Harar and Kersa, Ethiopia; Siaya and Kisumu, Kenya; Bamako, Mali; Manhi\xC3\xA7a, Mozambique; Bombali, Sierra Leone; and Soweto, South Africa) to collect standardised, population-based, longitudinal data on under-5 mortality and stillbirths in sub-Saharan Africa and south Asia, to improve the accuracy of determining causes of death. Here, we analysed data obtained in the first 2 years after the implementation of CHAMPS at the first five operational sites, during which surveillance and post-mortem diagnostics, including minimally invasive tissue sampling (MITS), were used. Data were abstracted from all available clinical records of deceased children, and relevant maternal health records were also extracted for stillbirths and neonatal deaths, to incorporate reported pregnancy or delivery complications. Expert panels followed standardised procedures to characterise causal chains leading to death, including underlying, intermediate (comorbid or antecedent causes), and immediate causes of death for stillbirths, neonatal deaths, and child (age 1-59 months) deaths." - Label: FINDINGS NlmCategory: RESULTS content: Between Dec 10, 2016, and Dec 31, 2018, MITS procedures were implemented at five sites in Mozambique, South Africa, Kenya, Mali, and Bangladesh. We screened 2385 death notifications for inclusion eligibility, following which 1295 families were approached for consent; consent was provided for MITS by 963 (74%) of 1295 eligible cases approached. At least one cause of death was identified in 912 (98%) of 933 cases (180 stillbirths, 449 neonatal deaths, and 304 child deaths); two or more conditions were identified in the causal chain for 585 (63%) of 933 cases. The most common underlying causes of stillbirth were perinatal asphyxia or hypoxia (130 [72%] of 180 stillbirths) and congenital infection or sepsis (27 [15%]). The most common underlying causes of neonatal death were preterm birth complications (187 [42%] of 449 neonatal deaths), perinatal asphyxia or hypoxia (98 [22%]), and neonatal sepsis (50 [11%]). The most common underlying causes of child deaths were congenital birth defects (39 [13%] of 304 deaths), lower respiratory infection (37 [12%]), and HIV (35 [12%]). In 503 (54%) of 933 cases, at least one contributory pathogen was identified. Cytomegalovirus, Escherichia coli, group B Streptococcus, and other infections contributed to 30 (17%) of 180 stillbirths. Among neonatal deaths with underlying prematurity, 60% were precipitated by other infectious causes. Of the 275 child deaths with infectious causes, the most common contributory pathogens were Klebsiella pneumoniae (86 [31%]), Streptococcus pneumoniae (54 [20%]), HIV (40 [15%]), and cytomegalovirus (34 [12%]), and multiple infections were common. Lower respiratory tract infection contributed to 174 (57%) of 304 child deaths. - Label: INTERPRETATION NlmCategory: CONCLUSIONS content: Cause of death determination using MITS enabled detailed characterisation of contributing conditions. Global estimates of child mortality aetiologies, which are currently based on a single syndromic cause for each death, will be strengthened by findings from CHAMPS. This approach adds specificity and provides a more complete overview of the chain of events leading to death, highlighting multiple potential interventions to prevent under-5 mortality and stillbirths. - Label: FUNDING NlmCategory: BACKGROUND content: Bill & Melinda Gates Foundation.
- Published
- 2020