Causes of Death Among Infants and Children in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network
Authors: Bassat Quique , Blau Dianna M. , Ogbuanu Ikechukwu Udo , Samura Solomon , Kaluma Erick , Bassey Ima-Abasi , Sow Samba , Keita Adama Mamby , Tapia Milagritos D. , Mehta Ashka , Kotloff Karen L. , Rahman Afruna , Islam Kazi Munisul , Alam Muntasir , El Arifeen Shams , Gurley Emily S. , Baillie Vicky , Mutevedzi Portia , Mahtab Sana , Thwala Bukiwe Nana , Tippett Barr Beth A. , Onyango Dickens , Akelo Victor , Rogena Emily , Onyango Peter , Omore Richard , Mandomando Inacio , Ajanovic Sara , Varo Rosauro , Sitoe Antonio , Duran-Frigola Miquel , Assefa Nega , Scott J. Anthony G. , Madrid Lola , Tesfaye Tseyon , Dessie Yadeta , Madewell Zachary J. , Breiman Robert F. , Whitney Cynthia G. , Madhi Shabir A. ,   Child Health and Mortality Prevention Surveillance (CHAMPS) Network, Begum Ferdousi , Rahman Mohammad Mosiur , Kamal Mohammed , Ahmed A.S.M. Nawshad Uddin , Hoque Mahbubul , Chowdhury Md. Atique Iqbal , Tasnim Saria , Rahman Mahbubur , Shirin Tahmina , Flora Meerjady Sabrina , Ahmed Dilruba , Zaman K. , Ahmed Mohammed Sabbir , Hossain Mohammed Zahid , Rahman Mustafizur , Parveen Shahana , Bari Sanwarul , Rahman Qazi Sadek-ur , Islam Ferdousi , Revathi Gutunduru , Igunza Aggrey K. , Kuria Magdalene , Mitei Paul K. , Murila Florence , Verani Jennifer K. , Christopher Mugah A. , Agaya Janet , Owuor Harun O. , Sadat Gregory O. , Kuboka Joy , Otieno Kephas , Oliech Richard , Nyamthimba Peter O. , Anne Aluoch , Otieno Peter O. , Gethi Dickson , Khagayi Sammy , Akinyi Joyce Were , Ogollo Anne , Misore Thomas , Aol George , Obor David , Nyanjom Maryanne , Omwalo Mary , Omondi Frederick , Abaja Were Zacchaeus , Sanogo Doh , Kourouma Nana , Sissoko Seydou , Onwuchekwu Uma U. , Sidibe Diakaridia , Keita Tatiana , Kone Diakaridia , Traore Cheick Bougadari , Juma Jane , Diarra Kounandji , Traore Awa , Diarra Tiéman , Chawla Kiranpreet , Tennant Sharon M. , Greene Carol L. , Johnson J. Kristie , Koka Rima , Fairchild Karen D. , Lako Sandra , Jambai Amara , Kenneh Sartie , Sesay Tom , Bangura Joseph , Duduyemi Babatunde , Nwajiobi Princewill Phillip , Sessay Foday , Senessie Martha , Oham Chuka , Bangura Ibrahim , Bah Abdulai Othman , Swaray-Deen Alim , Luke Ronita , Ita Okokon , Chukwuegbo Cornell , Sannoh Sulaiman , Ojulong Julius , Cain Carrie-Jo , Bunn James , Legesse Hailemariam , Moses Francis , Squire James , Balogun Oluseyi , Kowuor Dickens , Moseray Andrew , Gassama Khadija , Bias Megan , Philipsborn Rebecca P. , Wilson Tais , Salzberg Navit T. , Koplan Jeffrey P. , Seixas Josilene Nascimento , Ritter Jana M. , Basket Margaret , Zaki Sherif R. (deceased) , Wadhwa Ashutosh , Witherbee Jacob , Martines Roosecelis , Diaz Maureen , Waller Jessica , Winchell Jonas M. , Oundo Joseph O. , Temesgen Fikremelekot , Yeshi Melisachew Mulatu , Alemu Addisu , Ibrahim Alexander M. , Gure Tadesse , Orlien Stian , Marami Dadi , Edrids Yunus , Gizaw Mahlet Abayneh , Getnet Fentabil , Fentaw Surafel , Younis Yasir , Belachew Anteneh , Mekonnen Ayantu , Lemma Ephrem , Wale Henok , Acham Yenework , Monjane Celso , Nhachungue Sheila , Menendez Clara , Bramugy Justina , Kincardett Milton , Nhampossa Tacilta , Nhacolo Ariel , Munguambe Khátia , Vitorino Pio , Carrilho Carla , Fernandes Fabiola , Acácio Sozinho , Maixenchs Maria , Hurtado Juan Carlos , Ordi Jaume , Valente Marta , Rakislova Natalia , Chitsungo Dercio , Manhique Zara , Xerinda Elisio , Sacoor Charfudin , Adam Yasmin , Lala Sanjay G. , Petersen Karen L. , Swart Peter J. , Hale Martin , Wadula Jeannette , du Toit Jeanie , Solomon Fatima , Baba Vuyelwa , Lombaard Hennie , Govendar Nelesh , Wise Amy , Ntuli Constance 
Published: July 2023

ImportanceThe number of deaths of children younger than 5 years has been steadily decreasing worldwide, from more than 17 million annual deaths in the 1970s to an estimated 5.3 million in 2019 (with 2.8 million deaths occurring in those aged 1-59 months [53% of all deaths in children aged &amp;lt;5 years]). More detailed characterization of childhood deaths could inform interventions to improve child survival.ObjectiveTo describe causes of postneonatal child deaths across 7 mortality surveillance sentinel sites in Africa and Asia.Design, Setting, and ParticipantsThe Child Health and Mortality Prevention Surveillance (CHAMPS) Network conducts childhood mortality surveillance in sub-Saharan Africa and South Asia using innovative postmortem minimally invasive tissue sampling (MITS). In this cross-sectional study, MITS was conducted in deceased children aged 1 to 59 months at 7 sites in sub-Saharan Africa and South Asia from December 3, 2016, to December 3, 2020. Data analysis was conducted between October and November 2021.Main Outcomes and MeasuresThe expert panel attributed underlying, intermediate, and immediate conditions in the chain of events leading to death, based on histopathologic analysis, microbiological diagnostics, clinical data, and verbal autopsies.ResultsIn this study, MITS was performed in 632 deceased children (mean [SD] age at death, 1.3 [0.3] years; 342 [54.1%] male). The 6 most common underlying causes of death were malnutrition (104 [16.5%]), HIV (75 [11.9%]), malaria (71 [11.2%]), congenital birth defects (64 [10.1%]), lower respiratory tract infections (LRTIs; 53 [8.4%]), and diarrheal diseases (46 [7.2%]). When considering immediate causes only, sepsis (191 [36.7%]) and LRTI (129 [24.8%]) were the 2 dominant causes. An infection was present in the causal chain in 549 of 632 deaths (86.9%); pathogens most frequently contributing to infectious deaths included Klebsiella pneumoniae (155 of 549 infectious deaths [28.2%]; 127 [81.9%] considered nosocomial), Plasmodium falciparum (122 of 549 [22.2%]), and Streptococcus pneumoniae (109 of 549 [19.9%]). Other organisms, such as cytomegalovirus (57 [10.4%]) and Acinetobacter baumannii (39 [7.1%]; 35 of 39 [89.7%] considered nosocomial), also played important roles. For the top underlying causes of death, the median number of conditions in the chain of events leading to death was 3 for malnutrition, 3 for HIV, 1 for malaria, 3 for congenital birth defects, and 1 for LRTI. Expert panels considered 494 of 632 deaths (78.2%) preventable and 26 of 632 deaths (4.1%) preventable under certain conditions.Conclusions and RelevanceIn this cross-sectional study investigating causes of child mortality in the CHAMPS Network, results indicate that, in these high-mortality settings, infectious diseases continue to cause most deaths in infants and children, often in conjunction with malnutrition. These results also highlight opportunities for action to prevent deaths and reveal common interaction of various causes in the path toward death.