Causes of Death Among Stillbirths and Children Aged <5 Years in Africa and South Asia - Child Health and Mortality Prevention Surveillance, Seven Countries, 2016-2024.

Summary

This large, multicountry Child Health and Mortality Prevention Surveillance study integrated minimally invasive tissue sampling, molecular and conventional microbiology, histopathology, verbal autopsy, and clinical record review to determine causes and preventability of deaths. Among 8,500 deaths with multidisciplinary cause-of-death determinations, sepsis contributed to 36.5% of neonatal deaths and 36.9% of infant and child deaths; 80.7% of deaths with a preventability assessment were preventable or potentially preventable.

Key Findings

• Among 8,500 deaths with completed multidisciplinary cause-of-death determinations, 36.5% of neonatal deaths and 36.9% of infant and child deaths involved sepsis.
• Gram-negative bacteria predominated, and 44.5% of deaths with identified pathogens had polymicrobial involvement.
• Of 7,558 deaths assessed for preventability, 6,103 (80.7%) were considered preventable or possibly preventable through improvements in existing maternal, newborn, and child health interventions.

Clinical Implications

Clinical and public health programs should prioritize antenatal and intrapartum care, neonatal infection prevention, laboratory-supported surveillance, antimicrobial and infection-control capacity, and targeted prevention of gram-negative and polymicrobial infections. The findings also support incorporating minimally invasive postmortem investigation into mortality review systems where feasible.

Limitations

• The surveillance catchment areas were not nationally representative of all countries or regions.
• Enrollment and minimally invasive tissue sampling required family consent, and only 8,500 deaths had completed multidisciplinary cause-of-death determinations.

Future Directions

Future work should evaluate how CHAMPS-derived findings can be integrated into routine vital registration, maternal and neonatal mortality reviews, infection-control programs, and vaccine development. Implementation studies are needed to determine which surveillance components are feasible and cost-effective in different resource settings.