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

2019 ◽  
Vol 69 (Supplement_4) ◽  
pp. S262-S273 ◽  
Author(s):  
Navit T Salzberg ◽  
Kasthuri Sivalogan ◽  
Quique Bassat ◽  
Allan W Taylor ◽  
Sunday Adedini ◽  
...  
Keyword(s):  
Child Health ◽  
South Asia ◽  
Cause Of Death ◽  
Demographic Data ◽  
Childhood Mortality ◽  
Sub Saharan Africa ◽  
Quality Data ◽  
Sub Saharan ◽  
Mortality Surveillance ◽  
Health And Mortality

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.

scholarly journals Setting up child health and mortality prevention surveillance in Ethiopia

2021 ◽  
Vol 5 ◽  
pp. 173
Author(s):  
Anna C. Seale ◽  
Nega Assefa ◽  
Lola Madrid ◽  
Stefanie Wittmann ◽  
Hanan Abdurahman ◽  
...  
Keyword(s):  
Child Health ◽  
Cause Of Death ◽  
High Mortality ◽  
Demographic Data ◽  
Child Death ◽  
Sub Saharan Africa ◽  
London School ◽  
Eastern Ethiopia ◽  
Live Births ◽  
Health And Mortality

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 local research capacity and to broaden the scientific remit. To support this, we have set up a new collaboration, the “Hararghe Health Research Partnership”.

scholarly journals Using Participatory Workshops to Assess Alignment or Tension in the Community for Minimally Invasive Tissue Sampling Prior to Start of Child Mortality Surveillance: Lessons From 5 Sites Across the CHAMPS Network

2019 ◽  
Vol 69 (Supplement_4) ◽  
pp. S280-S290 ◽  
Author(s):  
John Blevins ◽  
Elizabeth O’Mara Sage ◽  
Ahoua Kone ◽  
Maria Maixenchs ◽  
Pratima L Raghunathan ◽  
...  
Keyword(s):  
South Africa ◽  
Child Health ◽  
Minimally Invasive ◽  
Childhood Mortality ◽  
Small Samples ◽  
Tissue Sampling ◽  
High Tension ◽  
Gates Foundation ◽  
Mortality Surveillance ◽  
Health And Mortality

Abstract The Child Health and Mortality Prevention Surveillance (CHAMPS) program is a 7-country network (as of December 2018) established by the Bill & Melinda Gates Foundation to identify the causes of death in children in communities with high rates of under-5 mortality. The program carries out both mortality and pregnancy surveillance, and mortality surveillance employs minimally invasive tissue sampling (MITS) to gather small samples of body fluids and tissue from the bodies of children who have died. While this method will lead to greater knowledge of the specific causes of childhood mortality, the procedure is in tension with cultural and religious norms in many of the countries where CHAMPS works—Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. Participatory Inquiry Into Community Knowledge of Child Health and Mortality Prevention (PICK-CHAMP) is a community entry activity designed to introduce CHAMPS to communities and gather initial perspectives on alignments and tensions between CHAMPS activities and community perceptions and priorities. Participants’ responses revealed medium levels of overall alignment in all sites (with the exception of South Africa, where alignment was high) and medium levels of tension (with the exception of Ethiopia, where tension was high). Alignment was high and tension was low for pregnancy surveillance across all sites, whereas Ethiopia reflected low alignment and high tension for MITS. Participants across all sites indicated that support for MITS was possible only if the procedure did not interfere with burial practices and rituals.

scholarly journals Childhood mortality during and after acute illness in sub-Saharan Africa and South Asia - The CHAIN cohort study

2021 ◽  
Author(s):  
Abdoulaye Hama Diallo ◽  
Abu Sadat Mohammad Sayeem Bin Shahid ◽  
Ali Fazal Khan ◽  
Ali Faisal Saleem ◽  
Benson O. Singa ◽  
...  
Keyword(s):  
Cohort Study ◽  
South Asia ◽  
Structural Equation Models ◽  
Acute Illness ◽  
Childhood Mortality ◽  
Sub Saharan Africa ◽  
Medical Illness ◽  
Post Discharge ◽  
Sub Saharan ◽  
Discharge From Hospital

Objectives Mortality during acute illness among children in low- and middle-income settings remain unacceptably high and there is increasing recognition of the importance of post-discharge mortality. A comprehensive understanding of pathways underlying mortality among acutely ill children is needed to develop interventions and improve guidelines. We aimed to determine the incidence, timing and contributions of proximal and underlying exposures for mortality among acutely ill young children from admission to hospital until 6 months after discharge in sub-Saharan Africa and South Asia in the context of guideline-based care. Design A prospective stratified cohort study recruiting acutely ill children at admission to hospital with follow up until 180 days after discharge from hospital (November 2016-July 2019). Setting Nine urban and rural hospitals in sub-Saharan Africa and South Asia across a range of facility levels, and local prevalences of HIV and malaria. Participants Inclusion criteria were age 2-23 months, admission to hospital with acute, non-traumatic medical illness and stratified into three groups by anthropometry. Children were excluded if currently receiving pulmonary resuscitation, had a known condition requiring surgery within 6 months or known terminal illness with death expected within 6 months. Main outcome measures Acute mortality occurring within 30-days from admission; post-discharge mortality within 180-days from discharge; characteristics with direct and indirect associations with mortality within a multi-level a priori framework including demographic, clinical, anthropometric characteristics at admission and discharge from hospital, and pre-existing child-, caregiver- and household-level characteristics. Results Of 3101 participants (median age 11 months), 1218 were severely wasted/kwashiorkor, 763 moderately wasted and 1120 were not wasted. Of 350 deaths, 182 (52%) occurred during index admission, 234 (67%) within 30-days of admission and 168 (48%) within 180-days post-discharge. Ninety (54%) post-discharge deaths occurred at home. The ratio of inpatient to post-discharge mortality was consistent across anthropometric strata and sites. Large high and low risk groups could be disaggregated for both early and post-discharge mortality. Structural equation models identified direct pathways to mortality and multiple socioeconomic, clinical and nutritional domains acting indirectly through anthropometric status. Conclusions Among diverse sites in Africa and South Asia, almost half of mortality occurs post-discharge. Despite being highly predictable, these deaths are not addressed in current guidelines. A fundamental shift to a risk-based approach to inpatient and post-discharge management is needed to further reduce childhood mortality and clinical trials of these approaches with outcomes of mortality, readmission and cost are warranted. Trial Registration ClinicalTrials.gov: NCT03208725

scholarly journals Overview and Development of the Child Health and Mortality Prevention Surveillance Determination of Cause of Death (DeCoDe) Process and DeCoDe Diagnosis Standards

2019 ◽  
Vol 69 (Supplement_4) ◽  
pp. S333-S341 ◽  
Author(s):  
Dianna M Blau ◽  
J Patrick Caneer ◽  
Rebecca P Philipsborn ◽  
Shabir A Madhi ◽  
Quique Bassat ◽  
...  
Keyword(s):  
Child Health ◽  
Cause Of Death ◽  
Sub Saharan Africa ◽  
World Health ◽  
Mortality Data ◽  
Sequence Of Events ◽  
Decode Process ◽  
Clinical Records ◽  
Health And Mortality

Abstract Mortality surveillance and cause of death data are instrumental in improving health, identifying diseases and conditions that cause a high burden of preventable deaths, and allocating resources to prevent these deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) network uses a standardized process to define, assign, and code causes of stillbirth and child death (<5 years of age) across the CHAMPS network. A Determination of Cause of Death (DeCoDe) panel composed of experts from a local CHAMPS site analyzes all available individual information, including laboratory, histopathology, abstracted clinical records, and verbal autopsy findings for each case and, if applicable, also for the mother. Using this information, the site panel ascertains the underlying cause (event that precipitated the fatal sequence of events) and other antecedent, immediate, and maternal causes of death in accordance with the International Classification of Diseases, Tenth Revision and the World Health Organization death certificate. Development and use of the CHAMPS diagnosis standards—a framework of required evidence to support cause of death determination—assures a homogenized procedure leading to a more consistent interpretation of complex data across the CHAMPS network. This and other standardizations ensures future comparability with other sources of mortality data produced externally to this project. Early lessons learned from implementation of DeCoDe in 5 CHAMPS sites in sub-Saharan Africa and Bangladesh have been incorporated into the DeCoDe process, and the implementation of DeCoDe has the potential to spur health systems improvements and local public health action.

scholarly journals Development and Implementation of Multiplex TaqMan Array Cards for Specimen Testing at Child Health and Mortality Prevention Surveillance Site Laboratories

2019 ◽  
Vol 69 (Supplement_4) ◽  
pp. S311-S321 ◽  
Author(s):  
Maureen H Diaz ◽  
Jessica L Waller ◽  
M Jordan Theodore ◽  
Nishi Patel ◽  
Bernard J Wolff ◽  
...  
Keyword(s):  
Child Health ◽  
Data Management ◽  
Real Time ◽  
Sub Saharan Africa ◽  
Quality Data ◽  
Molecular Testing ◽  
Acid Extraction ◽  
Infectious Disease Diagnostics ◽  
Taqman Array ◽  
Health And Mortality

Abstract Child Health and Mortality Prevention Surveillance (CHAMPS) laboratories are employing a variety of laboratory methods to identify infectious agents contributing to deaths of children <5 years old and stillbirths in sub-Saharan Africa and South Asia. In support of this long-term objective, our team developed TaqMan Array Cards (TACs) for testing postmortem specimens (blood, cerebrospinal fluid, lung tissue, respiratory tract swabs, and rectal swabs) for >100 real-time polymerase chain reaction (PCR) targets in total (30–45 per card depending on configuration). Multipathogen panels were configured by syndrome and customized to include pathogens of significance in young children within the regions where CHAMPS is conducted, including bacteria (57 targets covering 30 genera), viruses (48 targets covering 40 viruses), parasites (8 targets covering 8 organisms), and fungi (3 targets covering 3 organisms). The development and application of multiplex real-time PCR reactions to the TAC microfluidic platform increased the number of targets in each panel while maintaining assay efficiency and replicates for heightened sensitivity. These advances represent a substantial improvement in the utility of this technology for infectious disease diagnostics and surveillance. We optimized all aspects of the CHAMPS molecular laboratory testing workflow including nucleic acid extraction, quality assurance, and data management to ensure comprehensive molecular testing of specimens and high-quality data. Here we describe the development and implementation of multiplex TACs and associated laboratory protocols for specimen processing, testing, and data management at CHAMPS site laboratories.

Human Development Paradigm for South Asia

2018 ◽  
Keyword(s):  
South Asia ◽  
Human Development ◽  
Sub Saharan Africa ◽  
Health And Nutrition ◽  
The People ◽  
Sub Saharan ◽  
Development Paradigm

In the chapter, Haq gives a snapshot of the human progress of South Asia, comparing it with other regions. He was worried about the region beginning to lag behind all other regions, including Sub-Saharan Africa. He highlights the role of the two largest economies in the region, India and Pakistan, in financing the major investment in education, health and nutrition for the people. Haq advocates some fiscal and monetary reforms are suggested to invest in human development.

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