Eight out of ten child deaths in low-income countries could be prevented

2023-07-27 10:16:28

82% of child deaths in low-income countries could be prevented, according to research by the international CHAMPS network, published in JAMA Network Open. The study, which used the technique of minimally invasive autopsy developed by the Barcelona Institute for Global Health (ISGlobal), detected an infectious agent in 87% of cases and points to malnutrition as the most frequent underlying cause.

99% of deaths in children under five years of age occur in low- and middle-income countries. “If we want to prevent these deaths, we need to know the causes, but the problem is that we don’t have reliable data,” he says. Quique Bassat, ICREA researcher at ISGlobal. The clinical data and the testimonies of the family or caregiver (verbal autopsies), methods widely used in low-income areas, are not detailed enough.

If we want to prevent these deaths, we need to know the causes, but we lack reliable data.

Quique Bassat, ISGlobal researcher

Furthermore, it is necessary to distinguish between underlying causes (i.e., those that start the chain of events leading to death) and the immediate cause of death. “This distinction is important because death can be the result of the interaction between different conditions,” explains Bassat.

The scientist is part of a team that has developed and validated a minimally invasive technique to obtain biopsies of different organs and to be able to determine the causes of death through histopathological and microbiological analysis. This technology was adopted by CHAMPS, an international child mortality surveillance network launched in 2016.

636 deaths under the magnifying glass

In this study, a CHAMPS team led by Bassat investigated the causes of infant death in seven countries in sub-Saharan Africa and Southeast Asia (Mozambique, Sierra Leone, Kenya, Mali, Ethiopia, South Africa and Bangladesh), distinguishing between underlying, intermediary and immediate causes.

The main underlying causes of death were: malnutrition (16.5%), HIV infections (11.9%) and malaria (11.2%)

The analysis included 636 deaths in girls and boys between one month and five years of agewhich occurred in the community or in the hospital between 2016 and 2020. In all of them a minimally invasive autopsy had been performed in addition to having clinical data and verbal autopsy.

Malnutrition, the trigger

The main underlying causes of death were: malnutrition (16.5%), HIV infections (11.9%), malaria (11.2%), birth defects (10.1%), respiratory infections (8.4%) ) and diarrhea (7.2%). In 87% of cases, an infectious agent was detected (the most frequent was Klebsiella pneumoniaea bacterium mainly associated with hospital infectionsfollowed by malaria parasite P. falciparum and of Streptococcus pneumoniaebacteria that cause pneumonia).

“Only 25% of deaths were due to a single cause; all the others were due to a complex interplay of factors,” says Bassat. Hence the importance of considering the entire chain of events leading up to deathand not just the immediate cause, to design more effective prevention strategies.

The study concluded that 82% of deaths analyzed could have been prevented, which opens many opportunities to design specific interventions with high impact. Finally, they point out that minimally invasive autopsies allow the analysis of deaths that occur in the community (at home), which provides valuable information on how prevent deaths that escape the health system.

Reference:

Bassat, Q. et al. “Causes of death among infants and children in the Child Health 1 and Mortality Prevention Surveillance (CHAMPS) Network” JAMA Network Open (2023)

Rights: Creative Commons.