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

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-<7 days) and late (7-<28 days) neonatal deaths. We analyzed 1458 deaths, 41% occurring within 24-hours, 41% early and 18% late neonatal deaths. Leading underlying causes of death were complications of intrapartum events (31%), complications of prematurity (28%), infections (17%), respiratory disorders (11%), and congenital malformations (8%). In addition to the underlying cause, 62% of deaths had additional conditions and 14% had ≥3 other conditions in the causal chain. The most common causes considering the whole causal chain were infection (40%), prematurity (32%) and respiratory distress syndrome (28%). Common maternal conditions linked to neonatal death were maternal hypertension (10%), labour and delivery complications (8%), multiple gestation (7%), placental complications (6%) obstructed labour and chorioamnionitis (5%, each). CHAMPS’ findings showing the full causal chain of events that lead to death, in addition to maternal factors, highlights the complexities involved in each death along with the multiple opportunities for prevention. Highlighting improvements to prenatal and obstetric care and infection prevention are urgently needed in high-mortality settings.

Causes of Death Among Infants and Children in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network

“…Malaria (present in 19.5% of deaths, despite being absent from sites such as South Africa, Ethiopia, or Bangladesh) and diarrheal diseases (14.2% of the cases) were other common causes of death along with congenital birth defects (mostly as an underlying COD). Importantly, conditions affecting women during pregnancy (maternal factors) also played a major role in 7.9% of the postneonatal deaths, although less commonly than for deaths occurring in the neonatal period, even though our estimates may be biased by the inconsistent availability of maternal data for deaths, particularly for older children. Taken together, our findings confirm the major CODs among infants and childhood previously described in the literature but provide new estimates of their interrelations, relative importance at each site, and role using data we believe are more accurate.…”

Stillbirths and Neonatal Deaths Caused by Group B Streptococcus in Africa and South Asia Identified Through Child Health and Mortality Prevention Surveillance (CHAMPS)

“…In cases in which a single condition was identified as the primary cause of death, that condition was considered the underlying cause. For deaths involving multiple contributing conditions, a causal chain including underlying, antecedent, and immediate causes was assigned [ 16 ]. The underlying cause was the condition considered to have underpinned the chain of events leading to death.…”

Post-mortem investigation of deaths due to pneumonia in children aged 1–59 months in sub-Saharan Africa and South Asia from 2016 to 2022: an observational study

“… 6 Post-mortem MITS enables comprehensive examination of microbiology and pathology and has been used to investigate causes of childhood deaths, including characterisation of pathogen-specific causes of infection-related cases. 7 , 8 , 9…”