{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:10:32Z","timestamp":1793502632356,"version":"4.5.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi230664-4\"><jats:title>Importance<\/jats:title><jats:p>The 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 &amp;amp;lt;5 years]). More detailed characterization of childhood deaths could inform interventions to improve child survival.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230664-5\"><jats:title>Objective<\/jats:title><jats:p>To describe causes of postneonatal child deaths across 7 mortality surveillance sentinel sites in Africa and Asia.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230664-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>The 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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230664-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The 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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230664-8\"><jats:title>Results<\/jats:title><jats:p>In 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 <jats:italic>Klebsiella pneumoniae<\/jats:italic> (155 of 549 infectious deaths [28.2%]; 127 [81.9%] considered nosocomial), <jats:italic>Plasmodium falciparum<\/jats:italic> (122 of 549 [22.2%]), and <jats:italic>Streptococcus pneumoniae<\/jats:italic> (109 of 549 [19.9%]). Other organisms, such as cytomegalovirus (57 [10.4%]) and <jats:italic>Acinetobacter baumannii<\/jats:italic> (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.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230664-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In 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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.22494","type":"journal-article","created":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T17:49:25Z","timestamp":1690393765000},"page":"e2322494","source":"Crossref","is-referenced-by-count":122,"title":["Causes of Death Among Infants and Children in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network"],"prefix":"10.1001","volume":"6","author":[{"given":"Quique","family":"Bassat","sequence":"first","affiliation":[{"name":"ISGlobal\u2013Hospital Cl\u00ednic, Universitat de Barcelona, Barcelona, Spain"},{"name":"Centro de Investiga\u00e7\u00e3o em Sa\u00fade de Manhi\u00e7a\u2013CISM, Maputo, Mozambique"},{"name":"ICREA, Pg. Llu\u00eds Companys 23, Barcelona, Spain"},{"name":"Pediatrics Department, Hospital Sant Joan de D\u00e9u, Universitat de Barcelona, Esplugues, Barcelona, Spain"},{"name":"Consorcio de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica\u2013CIBERESP, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianna M.","family":"Blau","sequence":"additional","affiliation":[{"name":"Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikechukwu Udo","family":"Ogbuanu","sequence":"additional","affiliation":[{"name":"Crown Agents, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solomon","family":"Samura","sequence":"additional","affiliation":[{"name":"World Hope International, Makeni, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erick","family":"Kaluma","sequence":"additional","affiliation":[{"name":"Crown Agents, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ima-Abasi","family":"Bassey","sequence":"additional","affiliation":[{"name":"Crown Agents, Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samba","family":"Sow","sequence":"additional","affiliation":[{"name":"Centre pour le D\u00e9veloppement des Vaccins, Minist\u00e8re de la Sant\u00e9, Bamako, Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adama Mamby","family":"Keita","sequence":"additional","affiliation":[{"name":"Centre pour le D\u00e9veloppement des Vaccins, Minist\u00e8re de la Sant\u00e9, Bamako, Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milagritos D.","family":"Tapia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashka","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen L.","family":"Kotloff","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afruna","family":"Rahman","sequence":"additional","affiliation":[{"name":"International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazi Munisul","family":"Islam","sequence":"additional","affiliation":[{"name":"International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muntasir","family":"Alam","sequence":"additional","affiliation":[{"name":"International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shams","family":"El Arifeen","sequence":"additional","affiliation":[{"name":"International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily S.","family":"Gurley","sequence":"additional","affiliation":[{"name":"International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh"},{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky","family":"Baillie","sequence":"additional","affiliation":[{"name":"South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; 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