{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T21:28:51Z","timestamp":1792186131114,"version":"4.4.0"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T00:00:00Z","timestamp":1679270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1126780"],"award-info":[{"award-number":["OPP1126780"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Each year, 2.4 million children die within their first month of life. Child Health and Mortality Prevention Surveillance (CHAMPS) established in 7 countries aims to generate accurate data on why such deaths occur and inform prevention strategies. Neonatal deaths that occurred between December 2016 and December 2021 were investigated with MITS within 24\u201372 hours of death. Testing included blood, cerebrospinal fluid and lung cultures, multi-pathogen PCR on blood, CSF, nasopharyngeal swabs and lung tissue, and histopathology examination of lung, liver and brain. Data collection included clinical record review and family interview using standardized verbal autopsy. The full set of data was reviewed by local experts using a standardized process (Determination of Cause of Death) to identify all relevant conditions leading to death (causal chain), per WHO recommendations. For analysis we stratified neonatal death into 24-hours of birth, early (1-&lt;7 days) and late (7-&lt;28 days) neonatal deaths. We analyzed 1458 deaths, 41% occurring within 24-hours, 41% early and 18% late neonatal deaths. Leading underlying causes of death were complications of intrapartum events (31%), complications of prematurity (28%), infections (17%), respiratory disorders (11%), and congenital malformations (8%). In addition to the underlying cause, 62% of deaths had additional conditions and 14% had \u22653 other conditions in the causal chain. The most common causes considering the whole causal chain were infection (40%), prematurity (32%) and respiratory distress syndrome (28%). Common maternal conditions linked to neonatal death were maternal hypertension (10%), labour and delivery complications (8%), multiple gestation (7%), placental complications (6%) obstructed labour and chorioamnionitis (5%, each). CHAMPS\u2019 findings showing the full causal chain of events that lead to death, in addition to maternal factors, highlights the complexities involved in each death along with the multiple opportunities for prevention. Highlighting improvements to prenatal and obstetric care and infection prevention are urgently needed in high-mortality settings.<\/jats:p>","DOI":"10.1371\/journal.pgph.0001612","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T13:27:16Z","timestamp":1679318836000},"page":"e0001612","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":68,"title":["Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS), December 2016 \u2013December 2021"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2606-6951","authenticated-orcid":true,"given":"Sana","family":"Mahtab","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7629-0636","authenticated-orcid":true,"given":"Shabir A.","family":"Madhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky L.","family":"Baillie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toyah","family":"Els","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bukiwe Nana","family":"Thwala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dickens","family":"Onyango","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth A.","family":"Tippet-Barr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Akelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kitiezo Aggrey","family":"Igunza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Omore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shams El","family":"Arifeen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8648-9403","authenticated-orcid":true,"given":"Emily S.","family":"Gurley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muntasir","family":"Alam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atique Iqbal","family":"Chowdhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afruna","family":"Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0875-7596","authenticated-orcid":true,"given":"Quique","family":"Bassat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inacio","family":"Mandomando","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Ajanovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Sitoe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosauro","family":"Varo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samba O.","family":"Sow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen L.","family":"Kotloff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3681-5976","authenticated-orcid":true,"given":"Henry","family":"Badji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milagritos D.","family":"Tapia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheick B.","family":"Traore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0670-6026","authenticated-orcid":true,"given":"Ikechukwu U.","family":"Ogbuanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Bunn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronita","family":"Luke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulaiman","family":"Sannoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9686-1187","authenticated-orcid":true,"given":"Alim","family":"Swarray-Deen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0341-2329","authenticated-orcid":true,"given":"Nega","family":"Assefa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Anthony G.","family":"Scott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lola","family":"Madrid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dadi","family":"Marami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8348-4965","authenticated-orcid":true,"given":"Surafel","family":"Fentaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen H.","family":"Diaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roosecelis B.","family":"Martines","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7099-2936","authenticated-orcid":true,"given":"Robert F.","family":"Breiman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5667-9660","authenticated-orcid":true,"given":"Zachary J.","family":"Madewell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1253-198X","authenticated-orcid":true,"given":"Dianna M.","family":"Blau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1056-3216","authenticated-orcid":true,"given":"Cynthia G.","family":"Whitney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the CHAMPS Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,20]]},"reference":[{"key":"pgph.0001612.ref001","volume-title":"Newborns: improving survival and well-being","author":"Organization WH","year":"2020"},{"key":"pgph.0001612.ref002","volume-title":"Children: improving survival and well-being","author":"Organization WH","year":"2020"},{"issue":"6","key":"pgph.0001612.ref003","doi-asserted-by":"crossref","first-page":"e710","DOI":"10.1016\/S2214-109X(19)30163-9","article-title":"for Child UI-aG. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis","volume":"7","author":"L Hug","year":"2019","journal-title":"The Lancet Global Health"},{"key":"pgph.0001612.ref004","unstructured":"EvaluatioN IfHMa. Infant and Child Mortality 15th Ave. NE, Seattle: Institute for Health Metrics and Evaluation. Available from: https:\/\/ourworldindata.org\/child-mortality."},{"key":"pgph.0001612.ref005","article-title":"Programme UND","journal-title":"sustainable develpment goals New York: United Nations Development Programme"},{"issue":"3","key":"pgph.0001612.ref006","doi-asserted-by":"crossref","first-page":"e0248143","DOI":"10.1371\/journal.pone.0248143","article-title":"Community surveillance and response to maternal and child deaths in low-and middle-income countries: A scoping review","volume":"16","author":"TJ Basera","year":"2021","journal-title":"PloS one"},{"issue":"10063","key":"pgph.0001612.ref007","doi-asserted-by":"crossref","first-page":"3027","DOI":"10.1016\/S0140-6736(16)31593-8","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201315: an updated systematic analysis with implications for the Sustainable Development Goals","volume":"388","author":"L Liu","year":"2016","journal-title":"The Lancet"},{"issue":"1","key":"pgph.0001612.ref008","article-title":"Factors Influencing Acceptance of Post-Mortem Examination of Children at a Tertiary Care Hospital in Nairobi, Kenya","volume":"85","author":"M Bunei","year":"2019","journal-title":"Ann Glob Health."},{"issue":"4","key":"pgph.0001612.ref009","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.4269\/ajtmh.20-0029","article-title":"An In-Depth Examination of Reasons for Autopsy Acceptance and Refusal in Northern Tanzania","volume":"103","author":"LS Blum","year":"2020","journal-title":"The American Journal of Tropical Medicine and Hygiene"},{"issue":"11","key":"pgph.0001612.ref010","doi-asserted-by":"crossref","first-page":"e1002172","DOI":"10.1371\/journal.pmed.1002172","article-title":"Willingness to know the cause of death and hypothetical acceptability of the minimally invasive autopsy in six diverse African and Asian settings: a mixed methods socio-behavioural study","volume":"13","author":"M Maixenchs","year":"2016","journal-title":"PLoS medicine."},{"key":"pgph.0001612.ref011","article-title":"Evidence synthesis: a systematic review of factors affecting uptake of autopsy examination","author":"C Lewis","year":"2019","journal-title":"Minimally invasive autopsy for fetuses and children based on a combination of post-mortem MRI and endoscopic examination: a feasibility study."},{"issue":"7","key":"pgph.0001612.ref012","doi-asserted-by":"crossref","first-page":"e909","DOI":"10.1016\/S2214-109X(20)30205-9","article-title":"Initial findings from a novel population-based child mortality surveillance approach: a descriptive study","volume":"8","author":"AW Taylor","year":"2020","journal-title":"Lancet Glob Health"},{"issue":"4","key":"pgph.0001612.ref013","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1093\/cid\/ciz574","article-title":"Unraveling specific causes of neonatal mortality using minimally invasive tissue sampling: an observational study","volume":"69","author":"SA Madhi","year":"2019","journal-title":"Clinical Infectious Diseases"},{"issue":"4","key":"pgph.0001612.ref014","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1093\/cid\/ciz565","article-title":"Standardization of Minimally Invasive Tissue Sampling Specimen Collection and Pathology Training for the Child Health and Mortality Prevention Surveillance Network","volume":"69","author":"N Rakislova","year":"2019","journal-title":"Clinical Infectious Diseases"},{"issue":"Suppl 4","key":"pgph.0001612.ref015","doi-asserted-by":"crossref","first-page":"S262","DOI":"10.1093\/cid\/ciz599","article-title":"Mortality Surveillance Methods to Identify and Characterize Deaths in Child Health and Mortality Prevention Surveillance Network Sites","volume":"69","author":"NT Salzberg","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"4","key":"pgph.0001612.ref016","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1093\/cid\/ciz609","article-title":"Health and demographic surveillance systems within the child health and mortality prevention surveillance network","volume":"69","author":"SA Cunningham","year":"2019","journal-title":"Clinical Infectious Diseases"},{"key":"pgph.0001612.ref017","first-page":"S311","article-title":"Development and Implementation of Multiplex TaqMan Array Cards for Specimen Testing at Child Health and Mortality Prevention Surveillance Site Laboratories Clin Infect Dis","volume":"69","author":"MH Diaz","year":"2019"},{"key":"pgph.0001612.ref018","doi-asserted-by":"crossref","first-page":"S322","DOI":"10.1093\/cid\/ciz579","article-title":"Pathology and telepathology methods in the Child Health and Mortality Prevention Surveillance Network","volume":"69","author":"RB Martines","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"Suppl 4","key":"pgph.0001612.ref019","doi-asserted-by":"crossref","first-page":"S333","DOI":"10.1093\/cid\/ciz572","article-title":"Overview and Development of the Child Health and Mortality Prevention Surveillance Determination of Cause of Death (DeCoDe) Process and DeCoDe Diagnosis Standards","volume":"69","author":"DM Blau","year":"2019","journal-title":"Clin Infect Dis"},{"key":"pgph.0001612.ref020","volume-title":"ICD-10: international statistical classification of diseases and related health problems","author":"World Health Organization","year":"2004","edition":"2"},{"key":"pgph.0001612.ref021","volume-title":"The WHO application of ICD-10 to deaths during the perinatal period: ICD-PM","author":"World Health Organization","year":"2016"},{"issue":"10","key":"pgph.0001612.ref022","doi-asserted-by":"crossref","first-page":"e2237689","DOI":"10.1001\/jamanetworkopen.2022.37689","article-title":"Prioritizing Health Care Strategies to Reduce Childhood Mortality","volume":"5","author":"ZJ Madewell","year":"2022","journal-title":"JAMA Network Open"},{"key":"pgph.0001612.ref023","article-title":"Evaluation IIfHMa","journal-title":"Neonatal disorders\u2014Level 3 cause"},{"key":"pgph.0001612.ref024","article-title":"Birth asphyxia is under\u2010rated as a cause of preterm neonatal mortality in low\u2010and middle\u2010income countries: A prospective, observational study from PURPOSe","author":"RL Goldenberg","year":"2022","journal-title":"BJOG: An International Journal of Obstetrics & Gynaecology"},{"key":"pgph.0001612.ref025","article-title":"Rate, risk factors, and causes of neonatal deaths in Jordan: analysis of data from Jordan stillbirth and neonatal surveillance system (JSANDS)","volume":"8","author":"NA Al-Sheyab","year":"2020","journal-title":"Frontiers in Public Health."},{"issue":"12","key":"pgph.0001612.ref026","doi-asserted-by":"crossref","first-page":"e1297","DOI":"10.1016\/S2214-109X(18)30385-1","article-title":"Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study","volume":"6","author":"I Ahmed","year":"2018","journal-title":"The Lancet Global Health"},{"key":"pgph.0001612.ref027","author":"Children St","year":"2013","journal-title":"Surviving the First DayLondon: Save the Children International;"},{"issue":"4","key":"pgph.0001612.ref028","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.bpobgyn.2007.02.008","article-title":"Prevention of birth asphyxia: responding appropriately to cardiotocograph (CTG) traces","volume":"21","author":"E Chandraharan","year":"2007","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"11","key":"pgph.0001612.ref029","first-page":"897","article-title":"Intrapartum-related birth asphyxia in South Africa\u2014lessons from the first national perinatal care survey","volume":"92","author":"EJ Buchmann","year":"2002","journal-title":"S Afr Med J"},{"key":"pgph.0001612.ref030","doi-asserted-by":"crossref","first-page":"79","DOI":"10.2147\/RRN.S57990","article-title":"Intrauterine hypoxia: clinical consequences and therapeutic perspectives","volume":"2015","author":"L Thompson","year":"2015","journal-title":"Research and Reports in Neonatology"},{"issue":"2","key":"pgph.0001612.ref031","doi-asserted-by":"crossref","first-page":"426","DOI":"10.3349\/ymj.2016.57.2.426","article-title":"Possible Prevention of Neonatal Death: A Regional Population-Based Study in Japan","volume":"57","author":"S Koshida","year":"2016","journal-title":"Yonsei Med J."},{"issue":"Suppl 1","key":"pgph.0001612.ref032","first-page":"74","article-title":"Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990","volume":"1","author":"AC Lee","year":"2013","journal-title":"Pediatr Res"},{"issue":"5","key":"pgph.0001612.ref033","doi-asserted-by":"crossref","first-page":"360","DOI":"10.7196\/SAMJ.2020.v110i5.14564","article-title":"National Neonatal Sepsis Task Force launch: Supporting infection prevention and surveillance, outbreak investigation and antimicrobial stewardship in neonatal units in South Africa. SAMJ","volume":"110","author":"A Dramowski","year":"2020","journal-title":"South African Medical Journal"},{"issue":"10142","key":"pgph.0001612.ref034","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/S0140-6736(18)31127-9","article-title":"Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study","volume":"392","author":"SK Saha","year":"2018","journal-title":"The Lancet"},{"issue":"3","key":"pgph.0001612.ref035","doi-asserted-by":"crossref","first-page":"9","DOI":"10.7196\/SAMJ.2017.v108i3b.12804","article-title":"Reducing neonatal deaths in South Africa: Progress and challenges","volume":"108","author":"N Rhoda","year":"2018","journal-title":"South African Medical Journal"},{"key":"pgph.0001612.ref036","author":"WH Organization","journal-title":"WHO recommendations on health promotion interventions for maternal and newborn health Geneva: WHO"},{"key":"pgph.0001612.ref037","volume-title":"Children\u2019s and Adolescents\u2019 Health","author":"Organization WH","year":"2021"},{"key":"pgph.0001612.ref038","volume-title":"Ending Preventable Newborn Deaths and Stillbirths by 2030","author":"Organization WH, UNICEF","year":"2020"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0001612","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T13:27:50Z","timestamp":1679318870000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0001612"}},"subtitle":[],"editor":[{"given":"Hannah","family":"Tappis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,3,20]]},"references-count":38,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0001612","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,20]]}}}