Mortality Surveillance Methods to Identify and Characterize Deaths in Child Health and Mortality Prevention Surveillance Network Sites

Abstract

Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-income countries in sub-Saharan Africa and South Asia. In these settings, children often die at home, without contact with the health system, and are neither accounted for, nor attributed with a cause of death. In addition, when cause of death determinations occur, they often use nonspecific methods. Consequently, findings from models currently utilized to build national and global estimates of causes of death are associated with substantial uncertainty. Higher-quality data would enable stakeholders to effectively target interventions for the leading causes of childhood mortality, a critical component to achieving the Sustainable Development Goals by eliminating preventable perinatal and childhood deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network tracks the causes of under-5 mortality and stillbirths at sites in sub-Saharan Africa and South Asia through comprehensive mortality surveillance, utilizing minimally invasive tissue sampling (MITS), postmortem laboratory and pathology testing, verbal autopsy, and clinical and demographic data. CHAMPS sites have established facility- and community-based mortality notification systems, which aim to report potentially eligible deaths, defined as under-5 deaths and stillbirths within a defined catchment area, within 24–36 hours so that MITS can be conducted quickly after death. Where MITS has been conducted, a final cause of death is determined by an expert review panel. Data on cause of death will be provided to local, national, and global stakeholders to inform strategies to reduce perinatal and childhood mortality in sub-Saharan Africa and South Asia.

Health and Demographic Surveillance Systems Within the Child Health and Mortality Prevention Surveillance Network

“…CHAMPS uses age- and sex-specific population counts and person-years lived at each site to calculate rates, including infant mortality rates, under-5 mortality rates, and stillbirth rates. This information is also used to assess the proportion of child deaths that undergo minimally invasive tissue sampling (MITS) procedures and the proportion of deaths for which the cause was identified through verbal autopsies or clinical records [1, 10]. The information collected by the HDSSs on households’ demographic and socioeconomic characteristics, access to healthcare, and health facilities in the DSA provides contextual information for child mortality, helping the CHAMPS project to identify factors contributing to mortality and opportunities for interventions.…”

“…A key objective of the Child Health and Mortality Prevention Surveillance project is to define population-based rates for definitive causes of death through diagnostic and laboratory methods nested within population surveillance [1]. The CHAMPS HDSSs provide this platform, including through demographic data for estimating population-based mortality rates and contextual information for understanding factors associated with the deaths of children <5 years of age.…”

Global burden of acute lower respiratory infection associated with human metapneumovirus in children under 5 years in 2018: a systematic review and modelling study

“…1 The proportion of human metapneumovirus-attributable ALRI deaths was estimated using data for December, 2016, to October, 2019, obtained from Child Health and Mortality Prevention Surveillance ( appendix p 18 ). 34 Details of included studies are in the appendix (pp 34–53, 60–67 ). All analyses were done in R (version 3.5.2).…”

Maternal and neonatal data collection systems in low- and middle-income countries for maternal vaccines active safety surveillance systems: A scoping review

“…Although all of the included systems recorded data electronically [ 28 , 49 , 62 , 85 , 100 , 108 , 141 , 145 , 150 , 152 , 161 , 169 ] and SmartCare [ 178 , 179 ], used a mixed modality and initially captured data only on paper. Trained health providers, including nurses and doctors, collected the data in all systems.…”