Setting up child health and mortality prevention surveillance in Ethiopia

Abstract

Background: Mortality rates for children under five years of age, and stillbirth risks, remain high in parts of sub-Saharan Africa and South Asia. The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to ascertain causes of child death in high child mortality settings (>50 deaths/1000 live-births). We aimed to develop a “greenfield” site for CHAMPS, based in Harar and Kersa, in Eastern Ethiopia. This very high mortality setting (>100 deaths/1000 live-births in Kersa) had limited previous surveillance capacity, weak infrastructure and political instability. Here we describe site development, from conception in 2015 to the end of the first year of recruitment. Methods: We formed a collaboration between Haramaya University and the London School of Hygiene & Tropical Medicine and engaged community, national and international partners to support a new CHAMPS programme. We developed laboratory infrastructure and recruited and trained staff. We established project specific procedures to implement CHAMPS network protocols including; death notifications, clinical and demographic data collection, post-mortem minimally invasive tissue sampling, microbiology and pathology testing, and verbal autopsy. We convened an expert local panel to determine cause-of-death. In partnership with the Ethiopian Public Health Institute we developed strategies to improve child and maternal health. Results: Despite considerable challenge, with financial support, personal commitment, and effective partnership, we successfully initiated CHAMPS. One year into recruitment (February 2020), we had received 1173 unique death notifications, investigated 59/99 MITS-eligible cases within the demographic surveillance site, and assigned an underlying and immediate cause of death to 53 children. Conclusions: The most valuable data for global health policy are from high-mortality settings, but initiating CHAMPS has required considerable resource. To further leverage this investment, we need strong, sustained, local research leadership, and to broaden the scientific remit. To support this, we have set up a new collaboration, the “Hararghe Health Research Partnership”.

Causes of stillbirth and death among children younger than 5 years in eastern Hararghe, Ethiopia: a population-based post-mortem study

“…18 The CHAMPS site in eastern Ethiopia was considered a green-field site because it had little previous experience of aetiology research 14 and has been described in detail previously. 16 In February, 2019, CHAMPS activities started in two health and demographic surveillance system (HDSS) areas in eastern Hararghe: Harar (urban) and Kersa (rural). A third area, Haramaya (rural) was added to CHAMPS activities in June, 2020.…”

“…In 2019, the resident population was 58 095, and the under-5 mortality was between five and 20 deaths per 1000 livebirths. 16 Kersa is 44 km from Harar. The Kersa HDSS was established in September, 2007.…”

“… 19 In 2019, the resident population of the Kersa HDSS was 136 505 and there were 86 deaths among under-5s per 1000 livebirths. 16 The Kersa HDSS catchment area includes six health centres that provide primary health care, including deliveries. Haramaya is located between Kersa and Harar.…”

“… 15 Here we present mortality surveillance data from a new CHAMPS site in eastern Ethiopia, a setting where child mortality is high but evidence to understand the causes of death is scarce. 16 …”