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

Autor:	Bassat Q; ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.; Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique.; ICREA, Pg. Lluís Companys 23, Barcelona, Spain.; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain.; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública-CIBERESP, Madrid, Spain., Blau DM; Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia., Ogbuanu IU; Crown Agents, Freetown, Sierra Leone., Samura S; World Hope International, Makeni, Sierra Leone., Kaluma E; Crown Agents, Freetown, Sierra Leone., Bassey IA; Crown Agents, Freetown, Sierra Leone., Sow S; Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali., Keita AM; Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali., Tapia MD; Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore., Mehta A; Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore., Kotloff KL; Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore., Rahman A; International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh., Islam KM; International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh., Alam M; International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh., El Arifeen S; International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh., Gurley ES; International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Baillie V; South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Mutevedzi P; South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Mahtab S; South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Thwala BN; South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Tippett Barr BA; Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya., Onyango D; Kisumu County Department of Health, Kisumu, Kenya., Akelo V; Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya., Rogena E; Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya., Onyango P; Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya., Omore R; Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya., Mandomando I; ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.; Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique.; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique., Ajanovic S; ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.; Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique., Varo R; ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.; Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique., Sitoe A; Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique., Duran-Frigola M; Ersilia Open Source Initiative; Cambridge, United Kingdom., Assefa N; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom., Scott JAG; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya., Madrid L; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom., Tesfaye T; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom., Dessie Y; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia., Madewell ZJ; Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia., Breiman RF; Emory Global Health Institute, Emory University, Atlanta, Georgia.; Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.; Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Whitney CG; Emory Global Health Institute, Emory University, Atlanta, Georgia., Madhi SA; South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2023 Jul 03; Vol. 6 (7), pp. e2322494. Date of Electronic Publication: 2023 Jul 03.
DOI:	10.1001/jamanetworkopen.2023.22494
Abstrakt:	Importance: The 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 <5 years]). More detailed characterization of childhood deaths could inform interventions to improve child survival. Objective: To describe causes of postneonatal child deaths across 7 mortality surveillance sentinel sites in Africa and Asia. Design, Setting, and Participants: The 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 Measures: The 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. Results: In 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 Relevance: In 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.
Databáze:	MEDLINE
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