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This study examines the stability of ICD-10 diagnoses of patients admitted to Al Ain (United Arab Emirates) inpatients psychiatric unit during the period from November 1993 to August 1995. Diagnostic stability is a measure of the degree to which diagnoses remained unchanged at a later hospital admission. One hundred and seven patients were admitted more than once during this period, accounting for 168 readmissions. High levels of diagnostic stability were found for ICD-10 Fl-psychiatric disorders (100%), F2-schizophrenia (87%), F3-bipolar disorders (87%) and F3-depressive disorders (73%). A poor level of stability was found for patients with neurotic, stress related and adjustment disorders (F4), ranging from zero for somatoform disorders to 50% for generalized anxiety and panic disorders. Poor levels of stability were also found for other psychoses (excluding schizophrenia and affective psychoses) and personality disorders. We conclude that the introduction of ICD-10 as a formal diagnostic system has greatly improved the temporal stability of the most commonly encountered psychiatric disorders (ICD-10 Fl to F3 disorders), confirming the construct validity of those psychiatric disorders. Further investigations are required to evaluate the diagnostic stability of neurotic and other psychotic disorders.

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 <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.