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Leulseged H, A Rees C, Alemu A, A Tippett Barr B, Dheresa M, Madrid L, Scott A, Assefa N. The discrepancy of antemortem clinical diagnosis and postmortem autopsy diagnosis of lung pathologies in under-five deaths and the reasons for discrepancies: a case series analysis. BMC Pediatr 2024; 24:365. [PMID: 38807044 PMCID: PMC11131180 DOI: 10.1186/s12887-024-04854-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/23/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Diagnostic autopsy is the most reliable approach to definitively ascertain the cause of death and evaluate the accuracy of antemortem clinical diagnoses. Identifying diagnostic discrepancies is vital to understanding common gaps in antemortem clinical diagnoses and modifying antemortem diagnostic approaches to increase the accuracy of clinical diagnosis. The objective of this study was to determine the frequency of diagnostic discrepancies between antemortem clinical diagnoses and postmortem autopsies on lung pathologies and to understand the reasons for diagnostic discrepancies among cases included in Child Health and Mortality Prevention Surveillance (CHAMPS) in Ethiopia. METHODS A clinical case series study of deaths among children under-five in the CHAMPS study at three sites in Ethiopia between October 2019 and April 2022 was conducted. The antemortem clinical diagnoses and postmortem pathological diagnoses of the lung were compared for each case. Two senior physicians assessed the findings for both agreement and disagreement. McNemar's test was used to assess for statistically significant differences between antemortem and postmortem diagnoses. RESULTS Seventy-five cases were included (73.3% male). Over half (54.7%) died between the 1st and 7th day of life. Sepsis (66.7%), pneumonia (6.7%), and meconium aspiration syndrome (5.0%) were the most common immediate causes of death. Half (52%) of cases were correctly diagnosed antemortem. The magnitude of diagnostic discrepancy was 35% (95% CI: 20-47%). The most common contributing factors to diagnostic discrepancy were gaps in knowledge (22/75, 35.5%) and problems in consultation and teamwork (22/75, 35.5%). CONCLUSIONS Misdiagnoses were common among young children who died with positive lung pathology findings. In-service education initiatives and multidisciplinary collaboration are needed to mitigate high rates of diagnostic discrepancies among young children to potentially prevent future deaths.
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Affiliation(s)
- Haleluya Leulseged
- Hararghe Health Research Partnership, Haramaya University, Harar Town, Jineala District, PO. BOX: 235, Diredawa, Ethiopia.
- College of Health and Medical Science, Haramaya University, Diredawa, Ethiopia.
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Addisu Alemu
- Hararghe Health Research Partnership, Haramaya University, Harar Town, Jineala District, PO. BOX: 235, Diredawa, Ethiopia
- College of Health and Medical Science, Haramaya University, Diredawa, Ethiopia
| | - Beth A Tippett Barr
- Nyanja Health Research Institute, Salima, Malawi
- London School of Hygiene and Tropical Medicine, London, UK
| | - Merga Dheresa
- Hararghe Health Research Partnership, Haramaya University, Harar Town, Jineala District, PO. BOX: 235, Diredawa, Ethiopia
- College of Health and Medical Science, Haramaya University, Diredawa, Ethiopia
| | - Lola Madrid
- Hararghe Health Research Partnership, Haramaya University, Harar Town, Jineala District, PO. BOX: 235, Diredawa, Ethiopia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Anthony Scott
- Hararghe Health Research Partnership, Haramaya University, Harar Town, Jineala District, PO. BOX: 235, Diredawa, Ethiopia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nega Assefa
- Hararghe Health Research Partnership, Haramaya University, Harar Town, Jineala District, PO. BOX: 235, Diredawa, Ethiopia
- College of Health and Medical Science, Haramaya University, Diredawa, Ethiopia
- London School of Hygiene and Tropical Medicine, London, UK
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Nampota-Nkomba N, Keita AM, Juma J, Sidibe D, Kourouma N, Sissoko S, Haidara FC, Traore CT, Traore CB, Traore A, Gaume B, Sow SO, Kotloff KL, Tapia MD. An Upsurge of Measles Cases in Mali-a Consequence of Pandemic-associated Disruption in Routine Immunization. Open Forum Infect Dis 2024; 11:ofae154. [PMID: 38617075 PMCID: PMC11010308 DOI: 10.1093/ofid/ofae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
Measles deaths highlight immunization program gaps. In the Child Health and Mortality Prevention Surveillance study in Mali, we observed a rise in under-5 measles-related deaths in 2022 that corresponded with increased measles cases at the same time and a decline in measles vaccine coverage in Mali in 2020.
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Affiliation(s)
- Nginache Nampota-Nkomba
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Jane Juma
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | | | - Nana Kourouma
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Seydou Sissoko
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | | | - Cheick Tidiane Traore
- Direction Générale de la Santé et de l’Hygiène Publique, Ministry of Health and Social Development, Bamako, Mali
| | | | - Awa Traore
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Brigitte Gaume
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Mahtab S, Blau DM, Madewell ZJ, Ogbuanu I, Ojulong J, Lako S, Legesse H, Bangura JS, Bassat Q, Mandomando I, Xerinda E, Fernandes F, Varo R, Sow SO, Kotloff KL, Tapia MD, Keita AM, Sidibe D, Onyango D, Akelo V, Gethi D, Verani JR, Revathi G, Scott JAG, Assefa N, Madrid L, Bizuayehu H, Tirfe TT, El Arifeen S, Gurley ES, Islam KM, Alam M, Zahid Hossain M, Dangor Z, Baillie VL, Hale M, Mutevedzi P, Breiman RF, Whitney CG, Madhi SA. Post-mortem investigation of deaths due to pneumonia in children aged 1-59 months in sub-Saharan Africa and South Asia from 2016 to 2022: an observational study. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:201-213. [PMID: 38281495 PMCID: PMC10864189 DOI: 10.1016/s2352-4642(23)00328-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND The Child Health and Mortality Prevention Surveillance (CHAMPS) Network programme undertakes post-mortem minimally invasive tissue sampling (MITS), together with collection of ante-mortem clinical information, to investigate causes of childhood deaths across multiple countries. We aimed to evaluate the overall contribution of pneumonia in the causal pathway to death and the causative pathogens of fatal pneumonia in children aged 1-59 months enrolled in the CHAMPS Network. METHODS In this observational study we analysed deaths occurring between Dec 16, 2016, and Dec 31, 2022, in the CHAMPS Network across six countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in South Asia (Bangladesh). A standardised approach of MITS was undertaken on decedents within 24-72 h of death. Diagnostic tests included blood culture, multi-organism targeted nucleic acid amplifications tests (NAATs) of blood and lung tissue, and histopathology examination of various organ tissue samples. An interdisciplinary expert panel at each site reviewed case data to attribute the cause of death and pathogenesis thereof on the basis of WHO-recommended reporting standards. FINDINGS Pneumonia was attributed in the causal pathway of death in 455 (40·6%) of 1120 decedents, with a median age at death of 9 (IQR 4-19) months. Causative pathogens were identified in 377 (82·9%) of 455 pneumonia deaths, and multiple pathogens were implicated in 218 (57·8%) of 377 deaths. 306 (67·3%) of 455 deaths occurred in the community or within 72 h of hospital admission (presumed to be community-acquired pneumonia), with the leading bacterial pathogens being Streptococcus pneumoniae (108 [35·3%]), Klebsiella pneumoniae (78 [25·5%]), and non-typeable Haemophilus influenzae (37 [12·1%]). 149 (32·7%) deaths occurred 72 h or more after hospital admission (presumed to be hospital-acquired pneumonia), with the most common pathogens being K pneumoniae (64 [43·0%]), Acinetobacter baumannii (19 [12·8%]), S pneumoniae (15 [10·1%]), and Pseudomonas aeruginosa (15 [10·1%]). Overall, viruses were implicated in 145 (31·9%) of 455 pneumonia-related deaths, including 54 (11·9%) of 455 attributed to cytomegalovirus and 29 (6·4%) of 455 attributed to respiratory syncytial virus. INTERPRETATION Pneumonia contributed to 40·6% of all childhood deaths in this analysis. The use of post-mortem MITS enabled biological ascertainment of the cause of death in the majority (82·9%) of childhood deaths attributed to pneumonia, with more than one pathogen being commonly implicated in the same case. The prominent role of K pneumoniae, non-typable H influenzae, and S pneumoniae highlight the need to review empirical management guidelines for management of very severe pneumonia in low-income and middle-income settings, and the need for research into new or improved vaccines against these pathogens. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dianna M Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zachary J Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Sandra Lako
- Aberdeen Women's Centre, Freetown, Sierra Leone
| | | | | | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal - Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain; Institutó Catalana de Recerca I Estudis Avançats, Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal - Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Milagritos D Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Diakaridia Sidibe
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | | | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | - Dickson Gethi
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gunturu Revathi
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hiwot Bizuayehu
- Department of Microbiology, Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | | | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kazi Munisul Islam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Hale
- National Health Laboratory Service, Department of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.
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4
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Garcia Gomez E, Igunza KA, Madewell ZJ, Akelo V, Onyango D, El Arifeen S, Gurley ES, Hossain MZ, Chowdhury MAI, Islam KM, Assefa N, Scott JAG, Madrid L, Tilahun Y, Orlien S, Kotloff KL, Tapia MD, Keita AM, Mehta A, Magaço A, Torres-Fernandez D, Nhacolo A, Bassat Q, Mandomando I, Ogbuanu I, Cain CJ, Luke R, Kamara SIB, Legesse H, Madhi S, Dangor Z, Mahtab S, Wise A, Adam Y, Whitney CG, Mutevedzi PC, Blau DM, Breiman RF, Tippett Barr BA, Rees CA. Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1-59 months. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002494. [PMID: 38329969 PMCID: PMC10852234 DOI: 10.1371/journal.pgph.0002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
Delays in illness recognition, healthcare seeking, and in the provision of appropriate clinical care are common in resource-limited settings. Our objective was to determine the frequency of delays in the "Three Delays-in-Healthcare", and factors associated with delays, among deceased infants and children in seven countries with high childhood mortality. We conducted a retrospective, descriptive study using data from verbal autopsies and medical records for infants and children aged 1-59 months who died between December 2016 and February 2022 in six sites in sub-Saharan Africa and one in South Asia (Bangladesh) and were enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS). Delays in 1) illness recognition in the home/decision to seek care, 2) transportation to healthcare facilities, and 3) the receipt of clinical care in healthcare facilities were categorized according to the "Three Delays-in-Healthcare". Comparisons in factors associated with delays were made using Chi-square testing. Information was available for 1,326 deaths among infants and under 5 children. The majority had at least one identified delay (n = 854, 64%). Waiting >72 hours after illness recognition to seek health care (n = 422, 32%) was the most common delay. Challenges in obtaining transportation occurred infrequently when seeking care (n = 51, 4%). In healthcare facilities, prescribed medications were sometimes unavailable (n = 102, 8%). Deceased children aged 12-59 months experienced more delay than infants aged 1-11 months (68% vs. 61%, P = 0.018). Delays in seeking clinical care were common among deceased infants and children. Additional study to assess the frequency of delays in seeking clinical care and its provision among children who survive is warranted.
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Affiliation(s)
- Elisa Garcia Gomez
- Emory University School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | | | - Zachary J. Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kazi Munisul Islam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nega Assefa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | | | - Lola Madrid
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Yenenesh Tilahun
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Stian Orlien
- College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland
- Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amilcar Magaço
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - David Torres-Fernandez
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | | | | | - Ronita Luke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- Department of Obstetrics and Gynaecology, Rahima Mossa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmin Adam
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia G. Whitney
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Portia C. Mutevedzi
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Dianna M. Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Chris A. Rees
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
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5
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Verani JR, Blau DM, Gurley ES, Akelo V, Assefa N, Baillie V, Bassat Q, Berhane M, Bunn J, Cossa ACA, El Arifeen S, Gunturu R, Hale M, Igunza A, Keita AM, Kenneh S, Kotloff KL, Kowuor D, Mabunda R, Madewell ZJ, Madhi S, Madrid L, Mahtab S, Miguel J, Murila FV, Ogbuanu IU, Ojulong J, Onyango D, Oundo JO, Scott JAG, Sow S, Tapia M, Traore CB, Velaphi S, Whitney CG, Mandomando I, Breiman RF. Child deaths caused by Klebsiella pneumoniae in sub-Saharan Africa and south Asia: a secondary analysis of Child Health and Mortality Prevention Surveillance (CHAMPS) data. THE LANCET. MICROBE 2024; 5:e131-e141. [PMID: 38218193 PMCID: PMC10849973 DOI: 10.1016/s2666-5247(23)00290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/25/2023] [Accepted: 08/30/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Klebsiella pneumoniae is an important cause of nosocomial and community-acquired pneumonia and sepsis in children, and antibiotic-resistant K pneumoniae is a growing public health threat. We aimed to characterise child mortality associated with this pathogen in seven high-mortality settings. METHODS We analysed Child Health and Mortality Prevention Surveillance (CHAMPS) data on the causes of deaths in children younger than 5 years and stillbirths in sites located in seven countries across sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and south Asia (Bangladesh) from Dec 9, 2016, to Dec 31, 2021. CHAMPS sites conduct active surveillance for deaths in catchment populations and following reporting of an eligible death or stillbirth seek consent for minimally invasive tissue sampling followed by extensive aetiological testing (microbiological, molecular, and pathological); cases are reviewed by expert panels to assign immediate, intermediate, and underlying causes of death. We reported on susceptibility to antibiotics for which at least 30 isolates had been tested, and excluded data on antibiotics for which susceptibility testing is not recommended for Klebsiella spp due to lack of clinical activity (eg, penicillin and ampicillin). FINDINGS Among 2352 child deaths with cause of death assigned, 497 (21%, 95% CI 20-23) had K pneumoniae in the causal chain of death; 100 (20%, 17-24) had K pneumoniae as the underlying cause. The frequency of K pneumoniae in the causal chain was highest in children aged 1-11 months (30%, 95% CI 26-34; 144 of 485 deaths) and 12-23 months (28%, 22-34; 63 of 225 deaths); frequency by site ranged from 6% (95% CI 3-11; 11 of 184 deaths) in Bangladesh to 52% (44-61; 71 of 136 deaths) in Ethiopia. K pneumoniae was in the causal chain for 450 (22%, 95% CI 20-24) of 2023 deaths that occurred in health facilities and 47 (14%, 11-19) of 329 deaths in the community. The most common clinical syndromes among deaths with K pneumoniae in the causal chain were sepsis (44%, 95% CI 40-49; 221 of 2352 deaths), sepsis in conjunction with pneumonia (19%, 16-23; 94 of 2352 deaths), and pneumonia (16%, 13-20; 80 of 2352 deaths). Among K pneumoniae isolates tested, 121 (84%) of 144 were resistant to ceftriaxone and 80 (75%) of 106 to gentamicin. INTERPRETATION K pneumoniae substantially contributed to deaths in the first 2 years of life across multiple high-mortality settings, and resistance to antibiotics used for sepsis treatment was common. Improved strategies are needed to rapidly identify and appropriately treat children who might be infected with this pathogen. These data suggest a potential impact of developing and using effective K pneumoniae vaccines in reducing neonatal, infant, and child deaths globally. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Jennifer R Verani
- Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya.
| | - Dianna M Blau
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily S Gurley
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Victor Akelo
- Center for Global Health, US Centers for Disease Control and Prevention Kenya, Kisumu, Kenya
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Vicky Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Quique Bassat
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain; Hospital Sant Joan de Déu, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Mussie Berhane
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - James Bunn
- World Health Organization, Sierra Leone, Freetown, Sierra Leone
| | - Anelsio C A Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Shams El Arifeen
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | - Martin Hale
- National Health Laboratory Service, Department of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aggrey Igunza
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Adama M Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Sartie Kenneh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Karen L Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Rita Mabunda
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Zachary J Madewell
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Lola Madrid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Judice Miguel
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | | | | | | | - Joe O Oundo
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Samba Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Milagritos Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cheick B Traore
- Department of Pathological Anatomy and Cytology, University Hospital of Point G, Bamako, Mali
| | - Sithembiso Velaphi
- Department of Pediatrics, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia G Whitney
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa
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6
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Gupta PM, Madewell ZJ, Gannon BM, Grahn M, Akelo V, Onyango D, Mahtab S, Madhi SA, Giri J, Blau DM, Ramakrishnan U, Stein AD, Whitney CG, Young MF, Tanumihardjo SA, Suchdev PS. Hepatic Vitamin A Concentrations and Association with Infectious Causes of Child Death. J Pediatr 2024; 265:113816. [PMID: 37931699 PMCID: PMC10869935 DOI: 10.1016/j.jpeds.2023.113816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To assess postmortem vitamin A (VA) concentrations in children under 5 years of age and evaluate the association between VA deficiency (VAD) and infectious causes of death (CoD). STUDY DESIGN In this cross-sectional study from the Child Health and Mortality Prevention Surveillance (CHAMPS) Network, liver biopsies collected within 72 hours of death were analyzed from 405 stillbirths and children under 5 years in Kenya and South Africa. Total liver VA (TLVA) concentrations were quantified using ultra-performance liquid chromatography, and cutoffs of ≤0.1 μmol/g, >0.1 to <0.7 μmol/g, ≥0.7 to <1.0 μmol/g, and ≥1.0 μmol/g were used to define VAD, adequate VA status, high VA, and hypervitaminosis A, respectively. CoD were determined by expert panel review. RESULTS Among 366 liver samples with viable extraction, pooled prevalences of VAD, adequacy, high VA, and hypervitaminosis were 34.2%, 51.1%, 6.0%, and 8.7%, respectively. VAD was more common among neonates compared with stillbirths, infants, or children, and among those with low birthweight (LBW), underweight, or stunting (P < .05). When adjusting for site, age, and sex, there was no significant association of VAD with increased infectious CoD (OR 1.9, 95% confidence interval [CI] 0.9, 3.8, P = .073). In stratified analyses, VA deficient boys, but not girls, had an increased risk of infectious CoD (OR 3.4, 95% CI 1.3, 10.3, P = .013). CONCLUSIONS Definitive postmortem assessment of VA status identified both VAD and VA excess among children under 5 years of age in Kenya and South Africa. VAD in boys was associated with increased risk of infectious mortality. Our findings may inform a transition from universal VA supplementation (VAS) to targeted strategies in certain countries.
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Affiliation(s)
- Priya M Gupta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Zachary J Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bryan M Gannon
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Michael Grahn
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI
| | - Victor Akelo
- US Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Judith Giri
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Dianna M Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cynthia G Whitney
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Melissa F Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Parminder S Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA; Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA; Department of Pediatrics, Emory University, Atlanta, GA.
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7
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Goldenberg RL, Saleem S, Goudar SS, Moore J, Guruprasad G, Kulkarni V, Dhaded SM, Tikmani SS, Nausheen S, Masheer S, Kallapur MG, Ghanchi NK, Harakuni SU, Ahmed I, Hwang K, Yogeshkumar S, Somannavar MS, Yasmin H, Kim J, Bann CM, Silver RM, McClure EM. The PURPOSe cause of death study in stillbirths and neonatal deaths in India and Pakistan: A review. BJOG 2023; 130 Suppl 3:26-35. [PMID: 37592743 DOI: 10.1111/1471-0528.17635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/11/2023] [Indexed: 08/19/2023]
Abstract
The PURPOSe study was a prospective, observational study conducted in India and Pakistan to determine the cause of death for stillbirths and preterm neonatal deaths, using clinical data together with minimally invasive tissue sampling (MITS) and the histologic and polymerase chain reaction (PCR) evaluation of fetal/neonatal tissues and the placenta. After evaluating all available data, an independent panel chose a maternal, a placental and a fetal/neonatal cause of death. Here, we summarise the major results. Among the most important findings were that most stillbirths were caused by fetal asphyxia, often preceded by placental malperfusion, and clinically associated with pre-eclampsia, placental abruption and a small-for-gestational-age fetus. The preterm neonatal deaths were primarily caused by birth asphyxia, followed by various infections. An important finding was that many of the preterm neonatal deaths were caused by a nosocomial infection acquired after neonatal intensive care (NICU) admission; the most common organisms were Acinetobacter baumannii, followed by Klebsiella pneumoniae, Escherichia coli/Shigella and Haemophilus influenzae. Group B streptococcus was less commonly present in the placentas or internal organs of the neonatal deaths.
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Affiliation(s)
| | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | - Janet Moore
- RTI International, Durham, North Carolina, USA
| | - Gowdar Guruprasad
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | - Vardendra Kulkarni
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | | | | | | | - Mangala G Kallapur
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | | | - Sheetal U Harakuni
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | | | - Kay Hwang
- RTI International, Durham, North Carolina, USA
| | - S Yogeshkumar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
| | | | - Jean Kim
- RTI International, Durham, North Carolina, USA
| | - Carla M Bann
- KLE Academy of Higher Education and Research's JN Medical College, Belagavi, Karnataka, India
- RTI International, Durham, North Carolina, USA
| | - Robert M Silver
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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Gupta PM, Sivalogan K, Oliech R, Alexander E, Klein J, Addo OY, Gethi D, Akelo V, Blau DM, Suchdev PS. Impact of anthropometry training and feasibility of 3D imaging on anthropometry data quality among children under five years in a postmortem setting. PLoS One 2023; 18:e0292046. [PMID: 37768936 PMCID: PMC10538800 DOI: 10.1371/journal.pone.0292046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The Child Health and Mortality Prevention Surveillance Network (CHAMPS) identifies causes of under-5 mortality in high mortality countries. OBJECTIVE To address challenges in postmortem nutritional assessment, we evaluated the impact of anthropometry training and the feasibility of 3D imaging on data quality within the CHAMPS Kenya site. DESIGN Staff were trained using World Health Organization (WHO)-recommended manual anthropometry equipment and novel 3D imaging methods to collect postmortem measurements. Following training, 76 deceased children were measured in duplicate and were compared to measurements of 75 pre-training deceased children. Outcomes included measures of data quality (standard deviations of anthropometric indices and digit preference scores (DPS)), precision (absolute and relative technical errors of measurement, TEMs or rTEMs), and accuracy (Bland-Altman plots). WHO growth standards were used to produce anthropometric indices. Post-training surveys and in-depth interviews collected qualitative feedback on measurer experience with performing manual anthropometry and ease of using 3D imaging software. RESULTS Manual anthropometry data quality improved after training, as indicated by DPS. Standard deviations of anthropometric indices exceeded limits for high data quality when using the WHO growth standards. Reliability of measurements post-training was high as indicated by rTEMs below 1.5%. 3D imaging was highly correlated with manual measurements; however, on average 3D scans overestimated length and head circumference by 1.61 cm and 2.27 cm, respectively. Site staff preferred manual anthropometry to 3D imaging, as the imaging technology required adequate lighting and additional considerations when performing the measurements. CONCLUSIONS Manual anthropometry was feasible and reliable postmortem in the presence of rigor mortis. 3D imaging may be an accurate alternative to manual anthropometry, but technology adjustments are needed to ensure accuracy and usability.
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Affiliation(s)
- Priya M Gupta
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | - Kasthuri Sivalogan
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | | | - Eugene Alexander
- Body Surface Translations, Inc., Athens, Georgia, United States of America
| | - Jamie Klein
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - O Yaw Addo
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dickson Gethi
- US Centers for Disease Control and Prevention-Kenya, Kisumu and Nairobi, Kenya
| | - Victor Akelo
- US Centers for Disease Control and Prevention-Kenya, Kisumu and Nairobi, Kenya
| | - Dianna M Blau
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Parminder S Suchdev
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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9
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Rees CA, Igunza KA, Madewell ZJ, Akelo V, Onyango D, El Arifeen S, Gurley ES, Hossain MZ, Rahman A, Alam M, Scott JAG, Assefa N, Madrid L, Belachew A, Leulseged H, Kotloff KL, Sow SO, Tapia MD, Keita AM, Sidibe D, Sitoe A, Varo R, Ajanovic S, Bassat Q, Mandomando I, Tippett Barr BA, Ogbuanu I, Cain CJ, Bassey IA, Luke R, Gassama K, Madhi S, Dangor Z, Mahtab S, Velaphi S, du Toit J, Mutevedzi PC, Blau DM, Breiman RF, Whitney CG. Provider adherence to clinical care recommendations for infants and children who died in seven low- and middle-income countries in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. EClinicalMedicine 2023; 63:102198. [PMID: 37692079 PMCID: PMC10484959 DOI: 10.1016/j.eclinm.2023.102198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Abstract
Background Most childhood deaths globally are considered preventable through high-quality clinical care, which includes adherence to clinical care recommendations. Our objective was to describe adherence to World Health Organization recommendations for the management of leading causes of death among children. Methods We conducted a retrospective, descriptive study examining clinical data for children aged 1-59 months who were hospitalized and died in a Child Health and Mortality Prevention Surveillance (CHAMPS) catchment, December 2016-June 2021. Catchment areas included: Baliakandi and Faridpur, Bangladesh; Kersa, Haramaya, and Harar, Ethiopia; Kisumu and Siaya, Kenya; Bamako, Mali; Manhiça and Quelimane, Mozambique; Makeni, Sierra Leone; Soweto, South Africa. We reviewed medical records of those who died from lower respiratory tract infections, sepsis, malnutrition, malaria, and diarrheal diseases to determine the proportion who received recommended treatments and compared adherence by hospitalization duration. Findings CHAMPS enrolled 460 hospitalized children who died from the leading causes (median age 12 months, 53.0% male). Median hospital admission was 31 h. There were 51.0% (n = 127/249) of children who died from lower respiratory tract infections received supplemental oxygen. Administration of intravenous fluids for sepsis (15.9%, n = 36/226) and supplemental feeds for malnutrition (14.0%, n = 18/129) were uncommon. There were 51.4% (n = 55/107) of those who died from malaria received antimalarials. Of the 80 children who died from diarrheal diseases, 76.2% received intravenous fluids. Those admitted for ≥24 h more commonly received antibiotics for lower respiratory tract infections and sepsis, supplemental feeds for malnutrition, and intravenous fluids for sepsis than those admitted <24 h. Interpretation Provision of recommended clinical care for leading causes of death among young children was suboptimal. Further studies are needed to understand the reasons for deficits in clinical care recommendation adherence. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Chris A. Rees
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | | | - Zachary J. Madewell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afruna Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Muntasir Alam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Nega Assefa
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Anteneh Belachew
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Ethiopia
| | - Haleluya Leulseged
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Ethiopia
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Samba O. Sow
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | | | | | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sara Ajanovic
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | | | | | | | | | - Ronita Luke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeanie du Toit
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia C. Mutevedzi
- Global Health Institute, Emory University, Atlanta, GA, United States of America
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Cynthia G. Whitney
- Global Health Institute, Emory University, Atlanta, GA, United States of America
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10
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Mahtab S, Madewell ZJ, Madhi SA, Wise A, Swart PJ, Velaphi S, Mandomando I, Bramugy J, Mabunda R, Xerinda E, Scott AG, Assefa N, Madrid L, Bweihun M, Temesgen F, Onyango D, Akelo V, Oliech R, Otieno P, Verani JR, Arifeen SE, Gurley ES, Alam M, Rahman A, Hossain MZ, Sow S, Kotloff K, Tapia M, Keita AM, Sanogo D, Ogbuanu I, Ojulong J, Lako S, Ita O, Kaluma E, Wilson T, Mutevedzi P, Barr BAT, Whitney CG, Blau DM, Bassat Q. Stillbirths and Neonatal Deaths Caused by Group B Streptococcus in Africa and South Asia Identified Through Child Health and Mortality Prevention Surveillance (CHAMPS). Open Forum Infect Dis 2023; 10:ofad356. [PMID: 37674633 PMCID: PMC10478157 DOI: 10.1093/ofid/ofad356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background Invasive Group B Streptococcus (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS). Methods Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multipathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy. Expert panels reviewed all information and assigned causes of death. Results We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to <24 hours, n = 597), early neonatal deaths (END) (1 day to <7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus was determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to <24 hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed <2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths <90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48). Conclusions Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs.
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Affiliation(s)
- Sana Mahtab
- South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zachary J Madewell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- National Health for Laboratory Service in South Africa, Johannesburg, South Africa
| | - Peter J Swart
- Department of Obstetrics and Gynecology, Rahima Mossa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Pediatrics, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Rita Mabunda
- ISGlobal—Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | | | - Dickens Onyango
- Kisumu County Department of Health, Ministry of Health, Kisumu, Kenya
| | - Victor Akelo
- US Centers for Disease Control and Prevention–Kenya, Kisumu, Kenya
| | - Richard Oliech
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Peter Otieno
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Disease, Centers for Disease Control, Atlanta, Georgia, USA
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | | | - Samba Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Karen Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Milagritos Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Doh Sanogo
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | | | | | - Sandra Lako
- Aberdeen Women's Centre in Freetown, Sierra Leone
| | | | | | - Tais Wilson
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Beth A Tippett Barr
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal—Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Institutó Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Wunrow HY, Bender RG, Vongpradith A, Sirota SB, Swetschinski LR, Novotney A, Gray AP, Ikuta KS, Sharara F, Wool EE, Aali A, Abd-Elsalam S, Abdollahi A, Abdul Aziz JM, Abidi H, Aboagye RG, Abolhassani H, Abu-Gharbieh E, Adamu LH, Adane TD, Addo IY, Adegboye OA, Adekiya TA, Adnan M, Adnani QES, Afzal S, Aghamiri S, Aghdam ZB, Agodi A, Ahinkorah BO, Ahmad A, Ahmad S, Ahmadzade M, Ahmed A, Ahmed A, Ahmed JQ, Ahmed MS, Akinosoglou K, Aklilu A, Akonde M, Alahdab F, AL-Ahdal TMA, Alanezi FM, Albelbeisi AH, Alemayehu TBB, Alene KA, Al-Eyadhy A, Al-Gheethi AAS, Ali A, Ali BA, Ali L, Ali SS, Alimohamadi Y, Alipour V, Aljunid SM, Almustanyir S, Al-Raddadi RM, Alvis-Guzman N, Al-Worafi YM, Aly H, Ameyaw EK, Ancuceanu R, Ansar A, Ansari G, Anyasodor AE, Arabloo J, Aravkin AY, Areda D, Artamonov AA, Arulappan J, Aruleba RT, Asaduzzaman M, Atalell KA, Athari SS, Atlaw D, Atout MMW, Attia S, Awoke T, Ayalew MK, Ayana TM, Ayele AD, Azadnajafabad S, Azizian K, Badar M, Badiye AD, Baghcheghi N, Bagheri M, Bagherieh S, Bahadory S, Baig AA, Barac A, Barati S, Bardhan M, Basharat Z, Bashiri A, Basnyat B, Bassat Q, Basu S, Bayileyegn NS, Bedi N, Behnoush AH, Bekel AA, Belete MA, Bello OO, Bhagavathula AS, Bhandari D, Bhardwaj P, Bhaskar S, Bhat AN, Bijani A, Bineshfar N, Boloor A, Bouaoud S, Buonsenso D, Burkart K, Cámera LA, Castañeda-Orjuela CA, Cernigliaro A, Charan J, Chattu VK, Ching PR, Chopra H, Choudhari SG, Christopher DJ, Chu DT, Couto RAS, Cruz-Martins N, Dadras O, Dai X, Dandona L, Dandona R, Das S, Dash NR, Dashti M, De la Hoz FP, Debela SA, Dejen D, Dejene H, Demeke D, Demeke FM, Demessa BH, Demetriades AK, Demissie S, Dereje D, Dervišević E, Desai HD, Dessie AM, Desta F, Dhama K, Djalalinia S, Do TC, Dodangeh M, Dodangeh M, Dominguez RMV, Dongarwar D, Dsouza HL, Durojaiye OC, Dziedzic AM, Ekat MH, Ekholuenetale M, Ekundayo TC, El Sayed Zaki M, El-Abid H, Elhadi M, El-Hajj VG, El-Huneidi W, El-Sakka AA, Esayas HL, Fagbamigbe AF, Falahi S, Fares J, Fatehizadeh A, Fatima SAF, Feasey NA, Fekadu G, Fetensa G, Feyissa D, Fischer F, Foroutan B, Gaal PA, Gadanya MA, Gaipov A, Ganesan B, Gebrehiwot M, Gebrekidan KG, Gebremeskel TG, Gedef GM, Gela YY, Gerema U, Gessner BD, Getachew ME, Ghadiri K, Ghaffari K, Ghamari SH, Ghanbari R, Ghazy RMM, Ghozali G, Gizaw ABAB, Glushkova EV, Goldust M, Golechha M, Guadie HA, Guled RA, Gupta M, Gupta S, Gupta VB, Gupta VK, Gupta VK, Hadi NR, Haj-Mirzaian A, Haller S, Hamidi S, Haque S, Harapan H, Hasaballah AI, Hasan I, Hasani H, Hasanian M, Hassankhani H, Hassen MB, Hayat K, Heidari M, Heidari-Foroozan M, Heidari-Soureshjani R, Hezam K, Holla R, Horita N, Hossain MM, Hosseini MS, Hosseinzadeh M, Hostiuc S, Hussain S, Hussein NR, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Iregbu KC, Ismail NE, Iwu CCD, Jaja C, Jakovljevic M, Jamshidi E, Javadi Mamaghani A, Javidnia J, Jokar M, Jomehzadeh N, Joseph N, Joshua CE, Jozwiak JJ, Kabir Z, Kalankesh LR, Kalhor R, Kamal VK, Kandel H, Karaye IM, Karch A, Karimi H, Kaur H, Kaur N, Keykhaei M, Khajuria H, Khalaji A, Khan A, Khan IA, Khan M, Khan T, Khatab K, Khatatbeh MM, Khayat Kashani HR, Khubchandani J, Kim MS, Kisa A, Kisa S, Kompani F, Koohestani HR, Kothari N, Krishan K, Krishnamoorthy Y, Kulimbet M, Kumar M, Kumaran SD, Kuttikkattu A, Kwarteng A, Laksono T, Landires I, Laryea DO, Lawal BK, Le TTT, Ledda C, Lee SW, Lee S, Lema GK, Levi M, Lim SS, Liu X, Lopes G, Lutzky Saute R, Machado Teixeira PH, Mahmoodpoor A, Mahmoud MA, Malakan Rad E, Malhotra K, Malik AA, Martinez-Guerra BA, Martorell M, Mathur V, Mayeli M, Medina JRC, Melese A, Memish ZA, Mentis AFA, Merza MA, Mestrovic T, Michalek IM, Minh LHN, Mirahmadi A, Mirmosayyeb O, Misganaw A, Misra AK, Moghadasi J, Mohamed NS, Mohammad Y, Mohammadi E, Mohammed S, Mojarrad Sani M, Mojiri-forushani H, Mokdad AH, Momtazmanesh S, Monasta L, Moni MA, Mossialos E, Mostafavi E, Motaghinejad M, Mousavi Khaneghah A, Mubarik S, Muccioli L, Muhammad JS, Mulita F, Mulugeta T, Murillo-Zamora E, Mustafa G, Muthupandian S, Nagarajan AJ, Nainu F, Nair TS, Nargus S, Nassereldine H, Natto ZS, Nayak BP, Negoi I, Negoi RI, Nejadghaderi SA, Nguyen HQ, Nguyen PT, Nguyen VT, Niazi RK, Noroozi N, Nouraei H, Nuñez-Samudio V, Nuruzzaman KM, Nwatah VE, Nzoputam CI, Nzoputam OJ, Oancea B, Obaidur RM, Odetokun IA, Ogunsakin RE, Okonji OC, Olagunju AT, Olana LT, Olufadewa II, Oluwafemi YD, Oumer KS, Ouyahia A, P A M, Pakshir K, Palange PN, Pardhan S, Parikh RR, Patel J, Patel UK, Patil S, Paudel U, Pawar S, Pensato U, Perdigão J, Pereira M, Peres MFP, Petcu IR, Pinheiro M, Piracha ZZ, Pokhrel N, Postma MJ, Prates EJS, Qattea I, Raghav PR, Rahbarnia L, Rahimi-Movaghar V, Rahman M, Rahman MA, Rahmanian V, Rahnavard N, Ramadan H, Ramasubramani P, Rani U, Rao IR, Rapaka D, Ratan ZA, Rawaf S, Redwan EMM, Reiner Jr RC, Rezaei N, Riad A, Ribeiro da Silva TM, Roberts T, Robles Aguilar G, Rodriguez JAB, Rosenthal VD, Saddik B, Sadeghian S, Saeed U, Safary A, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahu M, Sajedi SA, Saki M, Salahi S, Salahi S, Saleh MA, Sallam M, Samadzadeh S, Samy AM, Sanjeev RK, Satpathy M, Seylani A, Sha'aban A, Shafie M, Shah PA, Shahrokhi S, Shahzamani K, Shaikh MA, Sham S, Shannawaz M, Sheikh A, Shenoy SM, Shetty PH, Shin JI, Shokri F, Shorofi SA, Shrestha S, Sibhat MM, Siddig EE, Silva LMLR, Singh H, Singh JA, Singh P, Singh S, Sinto R, Skryabina AA, Socea B, Sokhan A, Solanki R, Solomon Y, Sood P, Soshnikov S, Stergachis A, Sufiyan MB, Suliankatchi Abdulkader R, Sultana A, T Y SS, Taheri E, Taki E, Tamuzi JJLL, Tan KK, Tat NY, Temsah MH, Terefa DR, Thangaraju P, Tibebu NS, Ticoalu JHV, Tillawi T, Tincho MB, Tleyjeh II, Toghroli R, Tovani-Palone MR, Tufa DG, Turner P, Ullah I, Umeokonkwo CD, Unnikrishnan B, Vahabi SM, Vaithinathan AG, Valizadeh R, Varthya SB, Vos T, Waheed Y, Walde MT, Wang C, Weerakoon KG, Wickramasinghe ND, Winkler AS, Woldemariam M, Worku NA, Wright C, Yada DY, Yaghoubi S, Yahya GATY, Yenew CYY, Yesiltepe M, Yi S, Yiğit V, You Y, Yusuf H, Zakham F, Zaman M, Zaman SB, Zare I, Zareshahrabadi Z, Zarrintan A, Zastrozhin MS, Zhang H, Zhang J, Zhang ZJ, Zheng P, Zoladl M, Zumla A, Hay SI, Murray CJL, Naghavi M, Kyu HH. Global, regional, and national burden of meningitis and its aetiologies, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2023; 22:685-711. [PMID: 37479374 PMCID: PMC10356620 DOI: 10.1016/s1474-4422(23)00195-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Although meningitis is largely preventable, it still causes hundreds of thousands of deaths globally each year. WHO set ambitious goals to reduce meningitis cases by 2030, and assessing trends in the global meningitis burden can help track progress and identify gaps in achieving these goals. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we aimed to assess incident cases and deaths due to acute infectious meningitis by aetiology and age from 1990 to 2019, for 204 countries and territories. METHODS We modelled meningitis mortality using vital registration, verbal autopsy, sample-based vital registration, and mortality surveillance data. Meningitis morbidity was modelled with a Bayesian compartmental model, using data from the published literature identified by a systematic review, as well as surveillance data, inpatient hospital admissions, health insurance claims, and cause-specific meningitis mortality estimates. For aetiology estimation, data from multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature studies were analysed by use of a network analysis model to estimate the proportion of meningitis deaths and cases attributable to the following aetiologies: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, group B Streptococcus, Escherichia coli, Klebsiella pneumoniae, Listeria monocytogenes, Staphylococcus aureus, viruses, and a residual other pathogen category. FINDINGS In 2019, there were an estimated 236 000 deaths (95% uncertainty interval [UI] 204 000-277 000) and 2·51 million (2·11-2·99) incident cases due to meningitis globally. The burden was greatest in children younger than 5 years, with 112 000 deaths (87 400-145 000) and 1·28 million incident cases (0·947-1·71) in 2019. Age-standardised mortality rates decreased from 7·5 (6·6-8·4) per 100 000 population in 1990 to 3·3 (2·8-3·9) per 100 000 population in 2019. The highest proportion of total all-age meningitis deaths in 2019 was attributable to S pneumoniae (18·1% [17·1-19·2]), followed by N meningitidis (13·6% [12·7-14·4]) and K pneumoniae (12·2% [10·2-14·3]). Between 1990 and 2019, H influenzae showed the largest reduction in the number of deaths among children younger than 5 years (76·5% [69·5-81·8]), followed by N meningitidis (72·3% [64·4-78·5]) and viruses (58·2% [47·1-67·3]). INTERPRETATION Substantial progress has been made in reducing meningitis mortality over the past three decades. However, more meningitis-related deaths might be prevented by quickly scaling up immunisation and expanding access to health services. Further reduction in the global meningitis burden should be possible through low-cost multivalent vaccines, increased access to accurate and rapid diagnostic assays, enhanced surveillance, and early treatment. FUNDING Bill & Melinda Gates Foundation.
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Goldenberg RL, Ordi J, Blau DM, Rakislova N, Kulkarni V, Ghanchi NK, Saleem S, Goudar SS, Goco N, Paganelli C, McClure EM. An approach to determining the most common causes of stillbirth in low and middle-income countries: A commentary. Gates Open Res 2023; 7:102. [PMID: 37795041 PMCID: PMC10547115 DOI: 10.12688/gatesopenres.14112.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 10/06/2023] Open
Abstract
Stillbirth, one of the most common adverse pregnancy outcomes, is especially prevalent in low and middle-income countries (LMICs). Understanding the causes of stillbirth is crucial to developing effective interventions. In this commentary, investigators working across several LMICs discuss the most useful investigations to determine causes of stillbirths in LMICs. Useful data were defined as 1) feasible to obtain accurately and 2) informative to determine or help eliminate a cause of death. Recently, new tools for LMIC settings to determine cause of death in stillbirths, including minimally invasive tissue sampling (MITS) - a method using needle biopsies to obtain internal organ tissue from deceased fetuses for histology and pathogen identification in those tissues have become available. While placental histology has been available for some time, the development of the Amsterdam Criteria in 2016 has provided a useful framework to categorize placental lesions. The authors recommend focusing on the clinical history, the placental evaluation, the external examination of the fetus, and, when available, fetal tissue obtained by MITS, especially of the lung (focused on histology and microbiology) and brain/cerebral spinal fluid (CSF) and fetal blood (focused on microbiological analysis). The authors recognize that this approach may not identify some causes of stillbirth, including some genetic abnormalities and internal organ anomalies, but believe it will identify the most common causes of stillbirth, and most of the preventable causes.
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Affiliation(s)
| | - Jaume Ordi
- ISGlobal, Universitat de Barcelona, Barcelona, Spain
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Vardendra Kulkarni
- Department of Pathology, Bapuji Educational Association’s J.J.M. Medical College, Davangere, India
| | - Najia Karim Ghanchi
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
- Department of Community Health Sciences, Aga khan University, Karachi, Pakistan
| | | | - Norman Goco
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, 27709, USA
| | - Christina Paganelli
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, 27709, USA
| | - Elizabeth M. McClure
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, 27709, USA
| | - PURPOSe, CHAMPS, ISGlobal, and the MITS Surveillance Alliance investigators
- Obstetrics & Gynecology, Columbia University, New York, NY, USA
- ISGlobal, Universitat de Barcelona, Barcelona, Spain
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Department of Pathology, Bapuji Educational Association’s J.J.M. Medical College, Davangere, India
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
- Department of Community Health Sciences, Aga khan University, Karachi, Pakistan
- Women's and Children's Health Research Unit, KLE University, Belagavi, India
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, 27709, USA
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Madrid L, Vyas KJ, Kancherla V, Leulseged H, Suchdev PS, Bassat Q, Sow SO, El Arifeen S, Madhi SA, Onyango D, Ogbuanu I, Scott JAG, Blau D, Mandomando I, Keita AM, Gurley ES, Mahtab S, Akelo V, Sannoh S, Tilahun Y, Varo R, Onwuchekwa U, Rahman A, Adam Y, Omore R, Lako S, Xerinda E, Islam KM, Wise A, Tippet-Barr BA, Kaluma E, Ajanovic S, Kotloff KL, Hossain MZ, Mutevedzi P, Tapia MD, Rogena E, Moses F, Whitney CG, Assefa N. Neural tube defects as a cause of death among stillbirths, infants, and children younger than 5 years in sub-Saharan Africa and southeast Asia: an analysis of the CHAMPS network. Lancet Glob Health 2023; 11:e1041-e1052. [PMID: 37271162 PMCID: PMC10282076 DOI: 10.1016/s2214-109x(23)00191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Neural tube defects are common birth defects resulting in severe morbidity and mortality; they can largely be prevented with periconceptional maternal intake of folic acid. Understanding the occurrence of neural tube defects and their contribution to mortality in settings where their burden is highest could inform prevention and health-care policy. We aimed to estimate the mortality attributed to neural tube defects in seven countries in sub-Saharan Africa and southeast Asia. METHODS This analysis used data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network and health and demographic surveillance systems from South Africa, Mozambique, Bangladesh, Kenya, Mali, Ethiopia, and Sierra Leone. All stillbirths and infants and children younger than 5 years who died, who were enrolled in CHAMPS, whose families consented to post-mortem minimally invasive tissue sampling (MITS) between Jan 1, 2017, and Dec 31, 2021, and who were assigned a cause of death by a determination of cause of death panel as of May 24, 2022, were included in this analysis, regardless the cause of death. MITS and advanced diagnostic methods were used to describe the frequency and characteristics of neural tube defects among eligible deaths, identify risk factors, and estimate the mortality fraction and mortality rate (per 10 000 births) by CHAMPS site. FINDINGS Causes of death were determined for 3232 stillbirths, infants, and children younger than 5 years, of whom 69 (2%) died with a neural tube defect. Most deaths with a neural tube defect were stillbirths (51 [74%]); 46 (67%) were neural tube defects incompatible with life (ie, anencephaly, craniorachischisis, or iniencephaly) and 22 (32%) were spina bifida. Deaths with a neural tube defect were more common in Ethiopia (adjusted odds ratio 8·09 [95% CI 2·84-23·02]), among female individuals (4·40 [2·44-7·93]), and among those whose mothers had no antenatal care (2·48 [1·12-5·51]). Ethiopia had the highest adjusted mortality fraction of deaths with neural tube defects (7·5% [6·7-8·4]) and the highest adjusted mortality rate attributed to neural tube defects (104·0 per 10 000 births [92·9-116·4]), 4-23 times greater than in any other site. INTERPRETATION CHAMPS identified neural tube defects, a largely preventable condition, as a common cause of death among stillbirths and neonatal deaths, especially in Ethiopia. Implementing interventions such as mandatory folic acid fortification could reduce mortality due to neural tube defects. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Kartavya J Vyas
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Vijaya Kancherla
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Haleluya Leulseged
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Parminder S Suchdev
- Emory Global Health Institute, Emory University, Atlanta, GA, USA; Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Barcelona, Spain; Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Dianna Blau
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Adama M Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Emily S Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Akelo
- US Centers for Disease Control and Prevention Kenya, Kisumu, Kenya
| | | | - Yenenesh Tilahun
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Rosauro Varo
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Uma Onwuchekwa
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Afruna Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Yasmin Adam
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Amy Wise
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Sara Ajanovic
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Karen L Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Milagritos D Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emily Rogena
- Department of Pathology, School of Medicine, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Francis Moses
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Madrid L, Alemu A, Seale AC, Oundo J, Tesfaye T, Marami D, Yigzaw H, Ibrahim A, Degefa K, Dufera T, Teklemariam Z, Gure T, Leulseged H, Wittmann S, Abayneh M, Fentaw S, Temesgen F, Yeshi MM, Dubale M, Girma Z, Ackley C, Damisse B, Breines M, Orlien SMS, Blau DM, Breiman RF, Abate E, Dessie Y, Assefa N, Scott JAG. Causes of stillbirth and death among children younger than 5 years in eastern Hararghe, Ethiopia: a population-based post-mortem study. Lancet Glob Health 2023; 11:e1032-e1040. [PMID: 37271163 PMCID: PMC10282072 DOI: 10.1016/s2214-109x(23)00211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Child mortality is high in Ethiopia, but reliable data on the causes of death are scarce. We aimed to gather data for the contributory causes of stillbirth and child deaths in eastern Ethiopia. METHODS In this population-based post-mortem study, we established a death-notification system in health facilities and in the community in Kersa (rural), Haramaya (rural) and Harar (urban) in eastern Ethiopia, at a new site of the Child Health and Mortality Prevention Surveillance (CHAMPS) network. We collected ante-mortem data, did verbal autopsies, and collected post-mortem samples via minimally invasive tissue sampling from stillbirths (weighing at least 1000 g or with an estimated gestational age of at least 28 weeks) and children who died younger than 5 years. Children-or their mothers, in the case of stillbirths and deaths in children younger than 6 months-had to have lived in the catchment area for the past 6 months to be included. Molecular, microbiological, and histopathological analyses were done in collected samples. Cause of death was established by an expert panel on the basis of these data and classified as underlying, comorbid, or immediate separately for stillbirths, neonatal deaths (deaths aged 0-27 days), and child deaths (aged 28 days to <5 years). FINDINGS Between Feb 4, 2019, and Feb 3, 2021, 312 deaths were eligible for inclusion, and the families gave consent in 195 (63%) cases. Cause of death was established in 193 (99%) cases. Among 114 stillbirths, the underlying cause of death was perinatal asphyxia or hypoxia in 60 (53%) and birth defects in 24 (21%). Among 59 neonatal deaths, the most common underlying cause was perinatal asphyxia or hypoxia (17 [29%]) and the most common immediate cause of death was neonatal sepsis, which occurred in 27 (60%). Among 20 deaths in children aged 28 days to 59 months, malnutrition was the leading underlying cause (15 [75%]) and infections were common immediate and comorbid causes. Pathogens were identified in 19 (95%) child deaths, most commonly Klebsiella pneumoniae and Streptococcus pneumoniae. INTERPRETATION Perinatal asphyxia or hypoxia, infections, and birth defects accounted for most stillbirths and child deaths. Most deaths could have been prevented with feasible interventions, such as improved maternity services, folate supplementation, and improved vaccine uptake. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Addisu Alemu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Anna C Seale
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Warwick Medical School, University of Warwick, Coventry, UK
| | - Joe Oundo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tseyon Tesfaye
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dadi Marami
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hiwot Yigzaw
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alexander Ibrahim
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ketema Degefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Dufera
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Zelalem Teklemariam
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Gure
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Haleluya Leulseged
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Stefanie Wittmann
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mahlet Abayneh
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Surafel Fentaw
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Mehret Dubale
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Zerihun Girma
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Caroline Ackley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Berhanu Damisse
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Markus Breines
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Stian M S Orlien
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ebba Abate
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yadeta Dessie
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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15
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Satav A, Wairagkar N, Khirwadkar S, Dani V, Rasaily R, Agrawal U, Thakar Y, Raje D, Siraj F, Garge P, Palaskar S, Kumbhare S, Simões EAF. Community-Minimal Invasive Tissue Sampling (cMITS) using a modified ambulance for ascertaining the cause of death: A novel approach piloted in a remote inaccessible rural area in India. Arch Public Health 2023; 81:72. [PMID: 37106423 PMCID: PMC10134564 DOI: 10.1186/s13690-023-01062-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Melghat in India is a hilly, forested, difficult to access, impoverished rural area in northeast part of Maharashtra (Central India) with difficult healthcare access. Melghat has very high Mortality rates, because of grossly inadequate medical facilities. (1) Home deaths contribute to 67% of deaths,(2) which are difficult to track and where cause of death is mostly unknown. METHODS A feasibility study was carried out in 93 rural villages and 5 hospitals to assess feasibility of tracking real-time community mortality and to ascertain cause of death in 0-60 months and 16-60 years age group using Minimal Invasive Tissue Sampling (MITS) in purpose-modified ambulance. We used the network of village health workers (VHW)s, to establish real-time community mortality tracking. Upon receipt of reports of home death, we performed MITS within 4 h of death in the vicinity of the village. RESULTS We conducted 16 MITS. Nine, in MITS ambulance in community and seven at MAHAN hospital. The acceptance rate of MITS was 59.26%. Standard operating procedure (SOP) of conducting community MITS in an ambulance, is established. Major challenges were, Covid19 lockdown, reluctance of tribal parents for consent for MITS due to illiteracy, superstitions and fear of organ removal. Ambulance was an easy to reach transport means in remote area, provided a well-designed and discrete facility to perform MITS in community, winning the confidence of bereaved family. This has reduced time interval between time of death and performing MITS. CONCLUSIONS MITS in purpose-modified Ambulance can be used worldwide for community MITS especially in areas which are remote and lack healthcare access. This solution needs to be assessed in different cultural settings to document culture specific issues.
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Affiliation(s)
- Ashish Satav
- Tahsil: Dharni, Mahatma Gandhi Tribal Hospital, MAHAN Trust, District Amaravati, Maharashtra State, Karmgram, Utavali, 444702, India.
- Community Medicine, MAHAN trust, Karmgram, Utavali, Dharni, District Amaravati, India.
| | - Niteen Wairagkar
- Tahsil: Dharni, Mahatma Gandhi Tribal Hospital, MAHAN Trust, District Amaravati, Maharashtra State, Karmgram, Utavali, 444702, India
| | - Shubhada Khirwadkar
- Tahsil: Dharni, Mahatma Gandhi Tribal Hospital, MAHAN Trust, District Amaravati, Maharashtra State, Karmgram, Utavali, 444702, India
| | - Vibhawari Dani
- Tahsil: Dharni, Mahatma Gandhi Tribal Hospital, MAHAN Trust, District Amaravati, Maharashtra State, Karmgram, Utavali, 444702, India
| | - Reeta Rasaily
- Indian Council of Medical Research, New Delhi, India
| | - Usha Agrawal
- National Institute of Pathology, NIOP, New Delhi, India
| | - Yagnesh Thakar
- Tahsil: Dharni, Mahatma Gandhi Tribal Hospital, MAHAN Trust, District Amaravati, Maharashtra State, Karmgram, Utavali, 444702, India
| | - Dhananjay Raje
- Tahsil: Dharni, Mahatma Gandhi Tribal Hospital, MAHAN Trust, District Amaravati, Maharashtra State, Karmgram, Utavali, 444702, India
| | - Fouzia Siraj
- National Institute of Pathology, NIOP, New Delhi, India
| | - Pradyot Garge
- Tahsil: Dharni, Mahatma Gandhi Tribal Hospital, MAHAN Trust, District Amaravati, Maharashtra State, Karmgram, Utavali, 444702, India
| | - Sameer Palaskar
- Tahsil: Dharni, Mahatma Gandhi Tribal Hospital, MAHAN Trust, District Amaravati, Maharashtra State, Karmgram, Utavali, 444702, India
| | - Shraddha Kumbhare
- Tahsil: Dharni, Mahatma Gandhi Tribal Hospital, MAHAN Trust, District Amaravati, Maharashtra State, Karmgram, Utavali, 444702, India
| | - Eric A F Simões
- Center for Global Health, Colorado School of Public Health, University of Colorado School of Medicine, Aurora Colorado, USA.
- Department of Paediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, 12123 E 16Th Ave, Aurora, CO, 80045, USA.
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16
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Mahtab S, Madhi SA, Baillie VL, Els T, Thwala BN, Onyango D, Tippet-Barr BA, Akelo V, Igunza KA, Omore R, Arifeen SE, Gurley ES, Alam M, Chowdhury AI, Rahman A, Bassat Q, Mandomando I, Ajanovic S, Sitoe A, Varo R, Sow SO, Kotloff KL, Badji H, Tapia MD, Traore CB, Ogbuanu IU, Bunn J, Luke R, Sannoh S, Swarray-Deen A, Assefa N, Scott JAG, Madrid L, Marami D, Fentaw S, Diaz MH, Martines RB, Breiman RF, Madewell ZJ, Blau DM, Whitney CG. Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS), December 2016 -December 2021. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001612. [PMID: 36963040 PMCID: PMC10027211 DOI: 10.1371/journal.pgph.0001612] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/27/2023] [Indexed: 03/26/2023]
Abstract
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 24-72 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-<7 days) and late (7-<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 ≥3 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' 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.
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Affiliation(s)
- Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Toyah Els
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Bukiwe Nana Thwala
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Victor Akelo
- Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Kitiezo Aggrey Igunza
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Quique Bassat
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- Institutó Catalana de Recerca I Estudis Avançats [ICREA], Barcelona, Spain
- Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública [CIBERESP], Madrid, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- Instituto Nacional de Saúde [INS], Maputo, Mozambique
| | - Sara Ajanovic
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Rosauro Varo
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Samba O Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Henry Badji
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Cheick B Traore
- Department of Pathological Anatomy and Cytology, University Hospital of Point G, Bamako, Mali
| | | | - James Bunn
- World Health Organization-Sierra Leone, Freetown, Sierra Leone
| | - Ronita Luke
- Ola During Children's Hospital, Freetown, Sierra Leone
| | - Sulaiman Sannoh
- St. Luke's University Health Network, Easton, Pennsylvania, United States of America
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - J Anthony G Scott
- Department of Infectious Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lola Madrid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Dadi Marami
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Surafel Fentaw
- Bacterial and Mycology Unit, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Maureen H Diaz
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Roosecelis B Martines
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert F Breiman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Zachary J Madewell
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dianna M Blau
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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17
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Madewell ZJ, Whitney CG, Velaphi S, Mutevedzi P, Mahtab S, Madhi SA, Fritz A, Swaray-Deen A, Sesay T, Ogbuanu IU, Mannah MT, Xerinda EG, Sitoe A, Mandomando I, Bassat Q, Ajanovic S, Tapia MD, Sow SO, Mehta A, Kotloff KL, Keita AM, Tippett Barr BA, Onyango D, Oele E, Igunza KA, Agaya J, Akelo V, Scott JAG, Madrid L, Kelil YE, Dufera T, Assefa N, Gurley ES, El Arifeen S, Spotts Whitney EA, Seib K, Rees CA, Blau DM. Prioritizing Health Care Strategies to Reduce Childhood Mortality. JAMA Netw Open 2022; 5:e2237689. [PMID: 36269354 PMCID: PMC9587481 DOI: 10.1001/jamanetworkopen.2022.37689] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although child mortality trends have decreased worldwide, deaths among children younger than 5 years of age remain high and disproportionately circumscribed to sub-Saharan Africa and Southern Asia. Tailored and innovative approaches are needed to increase access, coverage, and quality of child health care services to reduce mortality, but an understanding of health system deficiencies that may have the greatest impact on mortality among children younger than 5 years is lacking. OBJECTIVE To investigate which health care and public health improvements could have prevented the most stillbirths and deaths in children younger than 5 years using data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used longitudinal, population-based, and mortality surveillance data collected by CHAMPS to understand preventable causes of death. Overall, 3390 eligible deaths across all 7 CHAMPS sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) between December 9, 2016, and December 31, 2021 (1190 stillbirths, 1340 neonatal deaths, 860 infant and child deaths), were included. Deaths were investigated using minimally invasive tissue sampling (MITS), a postmortem approach using biopsy needles for sampling key organs and fluids. MAIN OUTCOMES AND MEASURES For each death, an expert multidisciplinary panel reviewed case data to determine the plausible pathway and causes of death. If the death was deemed preventable, the panel identified which of 10 predetermined health system gaps could have prevented the death. The health system improvements that could have prevented the most deaths were evaluated for each age group: stillbirths, neonatal deaths (aged <28 days), and infant and child deaths (aged 1 month to <5 years). RESULTS Of 3390 deaths, 1505 (44.4%) were female and 1880 (55.5%) were male; sex was not recorded for 5 deaths. Of all deaths, 3045 (89.8%) occurred in a healthcare facility and 344 (11.9%) in the community. Overall, 2607 (76.9%) were deemed potentially preventable: 883 of 1190 stillbirths (74.2%), 1010 of 1340 neonatal deaths (75.4%), and 714 of 860 infant and child deaths (83.0%). Recommended measures to prevent deaths were improvements in antenatal and obstetric care (recommended for 588 of 1190 stillbirths [49.4%], 496 of 1340 neonatal deaths [37.0%]), clinical management and quality of care (stillbirths, 280 [23.5%]; neonates, 498 [37.2%]; infants and children, 393 of 860 [45.7%]), health-seeking behavior (infants and children, 237 [27.6%]), and health education (infants and children, 262 [30.5%]). CONCLUSIONS AND RELEVANCE In this cross-sectional study, interventions prioritizing antenatal, intrapartum, and postnatal care could have prevented the most deaths among children younger than 5 years because 75% of deaths among children younger than 5 were stillbirths and neonatal deaths. Measures to reduce mortality in this population should prioritize improving existing systems, such as better access to antenatal care, implementation of standardized clinical protocols, and public education campaigns.
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Affiliation(s)
- Zachary J. Madewell
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Sithembiso Velaphi
- Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashleigh Fritz
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Alim Swaray-Deen
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Tom Sesay
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | | | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde, Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal–Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Institutó Catalana de Recerca I Estudis Avançats, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Sara Ajanovic
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal–Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Milagritos D. Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Samba O. Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Ashka Mehta
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Karen L. Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Adama M. Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | | | | | | | | | - Janet Agaya
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Victor Akelo
- Centers for Disease Control and Prevention–Kenya, Kisumu, Kenya
| | - J. Anthony G. Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yunus-Edris Kelil
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Dufera
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Emily S. Gurley
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Ellen A. Spotts Whitney
- International Association of National Public Health Institutes, Global Health Institute, Emory University, Atlanta, Georgia
| | - Katherine Seib
- International Association of National Public Health Institutes, Global Health Institute, Emory University, Atlanta, Georgia
| | - Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Dianna M. Blau
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
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18
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Quincer E, Philipsborn R, Morof D, Salzberg NT, Vitorino P, Ajanovic S, Onyango D, Ogbuanu I, Assefa N, Sow SO, Mutevedzi P, El Arifeen S, Tippet Barr BA, Scott JAG, Mandomando I, Kotloff KL, Jambai A, Akelo V, Cain CJ, Chowdhury AI, Gure T, Igunza KA, Islam F, Keita AM, Madrid L, Mahtab S, Mehta A, Mitei PK, Ntuli C, Ojulong J, Rahman A, Samura S, Sidibe D, Thwala BN, Varo R, Madhi SA, Bassat Q, Gurley ES, Blau DM, Whitney CG. Insights on the differentiation of stillbirths and early neonatal deaths: A study from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. PLoS One 2022; 17:e0271662. [PMID: 35862419 PMCID: PMC9302850 DOI: 10.1371/journal.pone.0271662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The high burden of stillbirths and neonatal deaths is driving global initiatives to improve birth outcomes. Discerning stillbirths from neonatal deaths can be difficult in some settings, yet this distinction is critical for understanding causes of perinatal deaths and improving resuscitation practices for live born babies. Methods We evaluated data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network to compare the accuracy of determining stillbirths versus neonatal deaths from different data sources and to evaluate evidence of resuscitation at delivery in accordance with World Health Organization (WHO) guidelines. CHAMPS works to identify causes of stillbirth and death in children <5 years of age in Bangladesh and 6 countries in sub-Saharan Africa. Using CHAMPS data, we compared the final classification of a case as a stillbirth or neonatal death as certified by the CHAMPS Determining Cause of Death (DeCoDe) panel to both the initial report of the case by the family member or healthcare worker at CHAMPS enrollment and the birth outcome as stillbirth or livebirth documented in the maternal health record. Results Of 1967 deaths ultimately classified as stillbirth, only 28 (1.4%) were initially reported as livebirths. Of 845 cases classified as very early neonatal death, 33 (4%) were initially reported as stillbirth. Of 367 cases with post-mortem examination showing delivery weight >1000g and no maceration, the maternal clinical record documented that resuscitation was not performed in 161 cases (44%), performed in 14 (3%), and unknown or data missing for 192 (52%). Conclusion This analysis found that CHAMPS cases assigned as stillbirth or neonatal death after DeCoDe expert panel review were generally consistent with the initial report of the case as a stillbirth or neonatal death. Our findings suggest that more frequent use of resuscitation at delivery and improvements in documentation around events at birth could help improve perinatal outcomes.
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Affiliation(s)
- Elizabeth Quincer
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia, United States of America
| | - Rebecca Philipsborn
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Diane Morof
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Durban, South Africa
| | - Navit T. Salzberg
- Public Health Informatics, The Task Force for Global Health, Atlanta, Georgia, United States of America
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | - Sara Ajanovic
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | | | | | - Nega Assefa
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Samba O. Sow
- Centre pour le Développement des Vaccines (CVD-Mali), Bamako, Mali
| | - Portia Mutevedzi
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Beth A. Tippet Barr
- Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - J. Anthony G. Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- Instituto Nacional de Saúde [INS], Maputo, Mozambique
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Victor Akelo
- Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | | | - Tadesse Gure
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Farzana Islam
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | - Lola Madrid
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sana Mahtab
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Constance Ntuli
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | | | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | | | - Bukiwe Nana Thwala
- Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- ISGlobal- Hospital Clinic—Universitat de Barcelona, Barcelona, Spain
| | - Shabir A. Madhi
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- ISGlobal- Hospital Clinic—Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital de Sant Joan de Deu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud, Madrid, Spain
| | - Emily S. Gurley
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cynthia G. Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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19
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Goldenberg RL, Dhaded S, Saleem S, Goudar SS, Tikmani SS, Trotta M, Hwang Jackson K, Guruprasad G, Kulkarni V, Kumar S, Uddin Z, Reza S, Raza J, Yasmin H, Yogeshkumar S, Somannavar MS, Aceituno A, Parlberg L, Silver RM, McClure EM. Birth asphyxia is under-rated as a cause of preterm neonatal mortality in low- and middle-income countries: A prospective, observational study from PURPOSe. BJOG 2022; 129:1993-2000. [PMID: 35593030 DOI: 10.1111/1471-0528.17220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/19/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess respiratory distress syndrome (RDS) compared with birth asphyxia as the cause of death in preterm newborns, assigned by the neonatal intensive care unit (NICU) physician at the time of death and assigned by a panel with complete obstetric history, placental evaluation, tissue histology and microbiology. DESIGN Prospective, observational study. SETTINGS Study NICUs in India and Pakistan. POPULATION Preterm infants delivered in study facility. METHODS A total of 410 preterm infants who died in the NICU with cause of death ascertained by the NICU physicians and independently by expert panels. We compared the percentage of cases assigned RDS versus birth asphyxia as cause of death by the physician and the panel. MAIN OUTCOME MEASURES RDS and birth asphyxia. RESULTS Of 410 preterm neonatal deaths, the discharging NICU physicians found RDS as a cause of death among 83.2% of the cases, compared with the panel finding RDS in only 51.0%. In the same neonatal deaths, the NICU physicians found birth asphyxia as a cause of death in 14.9% of the deaths, whereas the panels found birth asphyxia in 57.6% of the deaths. The difference was greater in Pakistan were the physicians attributed 89.7% of the deaths to RDS and less than 1% to birth asphyxia whereas the panel attributed 35.6% of the deaths to RDS and 62.7% to birth asphyxia. CONCLUSIONS NICU physicians who reported cause of death in deceased preterm infants less often attributed the death to birth asphyxia, and instead more often chose RDS, whereas expert panels with more extensive data attributed a greater proportion of deaths to birth asphyxia than did the physicians.
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Affiliation(s)
| | - Sangappa Dhaded
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, India
| | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, India
| | | | | | | | - Gowder Guruprasad
- Bapuji Educational Association's, J.J.M. Medical College, Davangere, India
| | - Vardendra Kulkarni
- Bapuji Educational Association's, J.J.M. Medical College, Davangere, India
| | - Sunil Kumar
- Bapuji Educational Association's, J.J.M. Medical College, Davangere, India
| | | | | | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | | | - S Yogeshkumar
- KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, India
| | | | | | | | - Robert M Silver
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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20
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Seale AC, Assefa N, Madrid L, Wittmann S, Abdurahman H, Teferi N, Gedefa L, Mohamed A, Debela N, Tesfaye T, Samuel T, Dubale M, Yigzaw H, Taye E, Bekele W, Ackley C, Keno GI, Zegeye Y, Girma Z, Degefa K, Damisse B, Tadesse A, Aliyi M, Feyissa G, Tilahun Y, Wakwaya G, Sintayehu B, Abayneh G, Alemu A, Azore E, Oundo J, Mariam ZT, Marami D, Berihun M, Berhanu M, Mekonnen M, Alemayehu A, Sarkodie-Mensah N, Voller S, Jibendi B, Aseffa A, Balcha T, F. Breiman R, Dowell S, Worku A, Kifle T, Abate E, Dessie Y, Scott JAG. Setting up child health and mortality prevention surveillance in Ethiopia. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13395.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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, sustained, local research leadership, and to broaden the scientific remit. To support this, we have set up a new collaboration, the “Hararghe Health Research Partnership”.
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21
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Onyango DO, Akelo V, van der Sande MAB, Ridzon R, Were JA, Agaya JA, Oele EA, Wandiga S, Igunza AK, Young PW, Blau DM, Joseph RH, Yuen CM, Zielinski-Gutierrez E, Tippett-Barr BA. Causes of death in HIV-infected and HIV-uninfected children aged under-five years in western Kenya. AIDS 2022; 36:59-68. [PMID: 34586084 DOI: 10.1097/qad.0000000000003086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Describe the causes of death among infants and children less than 5 years stratified by HIV status. DESIGN Cross-sectional analysis of causes of death ascertained through minimally invasive tissue sampling (MITS) in the Kenya Child Health and Mortality Prevention Surveillance site. METHODS We included decedents aged 28 days to less than 5 years, whose death was reported within 36 h, underwent MITS, and had HIV test results and causes of death determined. MITS specimens were tested using Taqman Array Cards, culture, cytology, histopathology and immunohistochemistry and HIV PCR. A panel evaluated epidemiologic, clinical, verbal autopsy and laboratory data to assign causes of death using ICD-10 guidelines. Causes of death and etiological agents were stratified by HIV status. RESULTS Of 176 included decedents, 14% (n = 25) were HIV-infected, median viral load was 112 205 copies/ml [interquartile range (IQR) = 9349-2 670 143). HIV-disease (96%; n = 24) and malnutrition (23%; n = 34) were the leading underlying causes of death in HIV-infected and HIV-uninfected decedents, respectively. Malnutrition was more frequent in the causal chain of HIV-infected (56%; n = 14) than HIV-uninfected decedents (31%; n = 49) (P value = 0.03). Viral pneumonia was twice as common in HIV-infected (50%; n = 9) than HIV-uninfected decedents (22%; n = 7) (P value = 0.04). CONCLUSION Nearly all HIV-infected decedents' underlying cause of death was HIV disease, which was associated with malnutrition. Our findings underscore the need for strengthening early identification and management of HIV-infected children. Prevention, early diagnosis and treatment of malnutrition could be instrumental in improving the survival of HIV-infected and HIV-uninfected children.
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Affiliation(s)
- Dickens O Onyango
- Kisumu County Department of Health, Kisumu, Kenya
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Victor Akelo
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Renee Ridzon
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Joyce A Were
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Janet A Agaya
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Steve Wandiga
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Peter W Young
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Dianna M Blau
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachael H Joseph
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | | | | | - Beth A Tippett-Barr
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
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22
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Ritter JM, Seixas JN, Walong E, Dawa J, Onyango C, Pimenta FC, da Gloria Carvalho M, Silva-Flannery L, Jenkinson T, Howard K, Bhatnagar J, Diaz M, Winchell JM, Zaki SR, Chaves SS, Martines RB. Histopathology Is Key to Interpreting Multiplex Molecular Test Results From Postmortem Minimally Invasive Tissue Samples. Clin Infect Dis 2021; 73:S351-S359. [PMID: 34910182 PMCID: PMC8672755 DOI: 10.1093/cid/ciab772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Minimally invasive tissue sampling (MITS) is an alternative to complete autopsy for determining causes of death. Multiplex molecular testing performed on MITS specimens poses challenges of interpretation, due to high sensitivity and indiscriminate detection of pathogenic, commensal, or contaminating microorganisms. METHODS MITS was performed on 20 deceased children with respiratory illness, at 10 timepoints up to 88 hours postmortem. Samples were evaluated by multiplex molecular testing on fresh tissues by TaqMan® Array Card (TAC) and by histopathology, special stains, immunohistochemistry (IHC), and molecular testing (PCR) on formalin-fixed, paraffin-embedded (FFPE) tissues. Results were correlated to determine overall pathologic and etiologic diagnoses and to guide interpretation of TAC results. RESULTS MITS specimens collected up to 3 days postmortem were adequate for histopathologic evaluation and testing. Seven different etiologic agents were detected by TAC in 10 cases. Three cases had etiologic agents detected by FFPE or other methods and not TAC; 2 were agents not present on TAC, and 2 were streptococci that may have been species other than those present on TAC. Result agreement was 43% for TAC and IHC or PCR, and 69% for IHC and PCR. Extraneous TAC results were common, especially when aspiration was present. CONCLUSIONS TAC can be performed on MITS up to 3 days after death with refrigeration and provides a sensitive method for detection of pathogens but requires careful interpretation in the context of clinicoepidemiologic and histopathologic findings. Interpretation of all diagnostic tests in aggregate to establish overall case diagnoses maximizes the utility of TAC in MITS.
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Affiliation(s)
- Jana M Ritter
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Josilene N Seixas
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Edwin Walong
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Jeanette Dawa
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
- Washington State University, Global Health Programs (Kenya office), Nairobi, Kenya
| | - Clayton Onyango
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Fabiana C Pimenta
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria da Gloria Carvalho
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Luciana Silva-Flannery
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tiffany Jenkinson
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katie Howard
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julu Bhatnagar
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maureen Diaz
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sherif R Zaki
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra S Chaves
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya and Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Roosecelis B Martines
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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23
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Hwang KS, Parlberg L, Aceituno A, Moore JL, Goudar SS, Sunder Tikmani S, Saleem S, Guruprasad G, Revankar A, Habib Z, Dhaded SM, Yogesh Kumar S, Raghoji C, Kusugur V, Pujar S, Roujani S, McClure EM, Goldenberg RL. Methodology to Determine Cause of Death for Stillbirths and Neonatal Deaths Using Automated Case Reports and a Cause-of-Death Panel. Clin Infect Dis 2021; 73:S368-S373. [PMID: 34910185 PMCID: PMC8672739 DOI: 10.1093/cid/ciab811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Review of data from multiple sources is often necessary to determine cause of death for stillbirths and neonatal deaths, especially in low- to middle-income countries (LMICs) where available data may vary. The minimally invasive tissue sampling (MITS) procedure provides granular histologic and microbiologic data that clinical reports and verbal autopsies cannot provide. Expert panel evaluation of data from individual deaths can be resource-intensive but remains essential to accurately infer causes of death. Methods The Project to Understand and Research Preterms and Stillbirths in South Asia (PURPOSe) study uses review panels to evaluate causes of death in 2 LMICs. To make the process manageable, a subset of the study variables was selected with professional input and organized into case reports. Case reports include clinical information, laboratory results, fetal or neonatal organ histology and polymerase chain reaction results from tissue obtained by MITS. Panelists evaluated the complete case report forms and then determined the cause of death based on available data. Results Computerized case reports averaged 2 to 3 pages. Approximately 6 to 8 cases were reviewed and discussed per 1-hour panel meeting. All panelists were provided the same information; missing data were noted. This limited bias between panelists and across meetings. Study teams notably took ownership of data quality. Conclusions Standardized case reports for cause-of-death determination panel evaluation improve the efficiency of the review process, clarify available information, and limit bias across panelists, time, and location.
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Affiliation(s)
- Kay S Hwang
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Anna Aceituno
- RTI International, Research Triangle Park, North Carolina, USA
| | - Janet L Moore
- RTI International, Research Triangle Park, North Carolina, USA
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24
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Caballero MT, Grigaites SD, De la Iglesia Niveyro PX, Esperante S, Bianchi AM, Nuño A, Valle S, Afarian G, Ferretti AJP, Baglivo SJ, De Luca J, Zea CM, Caporal P, Labanca MJ, Diamanti A, Alvarez-Paggi D, Bassat Q, Polack FP. Uncovering Causes of Childhood Death Using the Minimally Invasive Autopsy at the Community Level in an Urban Vulnerable Setting of Argentina: A Population-Based Study. Clin Infect Dis 2021; 73:S435-S441. [PMID: 34910178 PMCID: PMC8672764 DOI: 10.1093/cid/ciab838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Precise determination of the causal chain that leads to community deaths in children in low- and middle-income countries is critical to estimating all causes of mortality accurately and to planning preemptive strategies for targeted allocation of resources to reduce this scourge. Methods An active surveillance population-based study that combined minimally invasive tissue sampling (MITS) and verbal autopsies (VA) among children under 5 was conducted in Buenos Aires, Argentina, from September 2018 to December 2020 to define the burden of all causes of community deaths. Results Among 90 cases enrolled (86% of parental acceptance), 81 had complete MITS, 15.6% were neonates, 65.6% were post-neonatal infants, and 18.9% were children aged 1–5 years. Lung infections were the most common cause of death (CoD) in all age groups (57.8%). Among all cases of lung infections, acute bronchiolitis was the most common CoD in infants aged <12 months (23 of 36, 63.9%), and bacterial pneumonia was the most common cause in children aged >12 months (8 of 11, 72.7%). The most common comorbid condition in all age groups was undernutrition in 18 of 90 (20%). It was possible to find an immediate CoD in 78 of 81 subjects where MITS could be done. With this combined approach, we were able to determine that sudden infant death syndrome was overestimated in state reports. Conclusions CoD determination by a combination of MITS and VA provides an accurate estimation of the chain of events that leads to death, emphasizing possible interventions to prevent mortality in children.
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Affiliation(s)
- Mauricio T Caballero
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Sebastian Diaz Grigaites
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Público de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | | | - Sebastian Esperante
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | | | | | | | - Gabriela Afarian
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Público de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | | | | | | | | | - Paula Caporal
- Hospital De Niños Sup. Sor Maria Ludovica, La Plata, Argentina
| | - Maria Jose Labanca
- Hospital Italiano de Buenos Aires, Servicio de Anatomía Patológica, Buenos Aires, Argentina
| | - Adriana Diamanti
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Público de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | - Damian Alvarez-Paggi
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, CP Maputo, Mozambique.,Institución Catalana de Investigación y Estudios Avanzados (ICREA), Pg. Lluís Companys, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
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25
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Feutz E, Voskuijl W, Finch PJ, Liu TC, Bandsma RHJ, Tarr PI, Moxon CA, VanBuskirk K, Lawrence S, Umutesi G, Tickell KD, Berkley JA, Walson JL, Kamiza S, Denno DM. Minimally Invasive Postmortem Intestinal Tissue Sampling in Malnourished and Acutely Ill Children Is Feasible and Informative. Clin Infect Dis 2021; 73:S382-S389. [PMID: 34910181 PMCID: PMC8672761 DOI: 10.1093/cid/ciab790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intestinal disorders such as environmental enteric dysfunction (EED) are prevalent in low- and middle-income countries (LMICs) and important contributors to childhood undernutrition and mortality. Autopsies are rarely performed in LMICs but minimally invasive tissue sampling is increasingly deployed as a more feasible and acceptable procedure, although protocols have been devoid of intestinal sampling to date. We sought to determine (1) the feasibility of postmortem intestinal sampling, (2) whether autolysis precludes enteric biopsies' utility, and (3) histopathologic features among children who died during hospitalization with acute illness or undernutrition. METHODS Transabdominal needle and endoscopic forceps upper and lower intestinal sampling were conducted among children aged 1 week to 59 months who died while hospitalized in Blantyre, Malawi. Autolysis ratings were determined for each hematoxylin and eosin slide, and upper and lower intestinal scoring systems were adapted to assess histopathologic features and their severity. RESULTS Endoscopic and transabdominal sampling procedures were attempted in 28 and 14 cases, respectively, with >90% success obtaining targeted tissue. Varying degrees of autolysis were present in all samples and precluded histopathologic scoring of 6% of 122 biopsies. Greater autolysis in duodenal samples was seen with longer postmortem interval (Beta = 0.06, 95% confidence interval, 0.02-0.11). Histopathologic features identified included duodenal Paneth and goblet cell depletion. Acute inflammation was absent but chronic inflammation was prevalent in both upper and lower enteric samples. Severe chronic rectal inflammation was identified in children as young as 5.5 weeks. CONCLUSIONS Minimally invasive postmortem intestinal sampling is feasible and identifies histopathology that can inform mortality contributors.
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Affiliation(s)
- Erika Feutz
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Wieger Voskuijl
- Amsterdam Centre for Global Child Health, Emma Children’s Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Peter J Finch
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ta-Chiang Liu
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert H J Bandsma
- Hospital for Sick Children, Translational Medicine Program and Centre for Global Child Health, Toronto, Canada
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Phillip I Tarr
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher Alan Moxon
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Malawi-Liverpool Wellcome Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kelley VanBuskirk
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Sarah Lawrence
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Grace Umutesi
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kirkby D Tickell
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - James A Berkley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Steve Kamiza
- Department of Pathology, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Donna M Denno
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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26
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Seale AC, Assefa N, Madrid L, Wittmann S, Abdurahman H, Teferi N, Gedefa L, Mohamed A, Debela N, Tesfaye T, Samuel T, Dubale M, Yigzaw H, Taye E, Bekele W, Ackley C, Keno GI, Zegeye Y, Girma Z, Degefa K, Damisse B, Tadesse A, Aliyi M, Feyissa G, Tilahun Y, Wakwaya G, Sintayehu B, Abayneh G, Alemu A, Azore E, Oundo J, Mariam ZT, Marami D, Berihun M, Berhanu M, Mekonnen M, Alemayehu A, Sarkodie-Mensah N, Voller S, Jibendi B, Aseffa A, Balcha T, F. Breiman R, Dowell S, Worku A, Kifle T, Abate E, Dessie Y, Scott JAG. Setting up child health and mortality prevention surveillance in Ethiopia. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13395.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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”.
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Munguambe K, Maixenchs M, Anselmo R, Blevins J, Ordi J, Mandomando I, Breiman RF, Bassat Q, Menéndez C. Consent to minimally invasive tissue sampling procedures in children in Mozambique: A mixed-methods study. PLoS One 2021; 16:e0259621. [PMID: 34748582 PMCID: PMC8575303 DOI: 10.1371/journal.pone.0259621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Minimally invasive tissue sampling (MITS), also named minimally invasive autopsy is a post-mortem method shown to be an acceptable proxy of the complete diagnostic autopsy. MITS improves the knowledge of causes of death (CoD) in resource-limited settings. Its implementation requires understanding the components of acceptability, including facilitators and barriers in real-case scenarios. METHODS We undertook a mixed-methods analysis comparing anticipated (hypothetical scenario) and experienced (real-case scenario) acceptability of MITS among relatives of deceased children in Mozambique. Anticipated acceptability information was obtained from 15 interviews with relatives of deceased children. The interview focus was on whether and why they would allow the procedure on their dead child in a hypothetical scenario. Experienced acceptability data were obtained from outcomes of consent requested to relatives of 114 deceased children during MITS implementation, recorded through observations, clinical records abstraction and follow-up informal conversations with health care professionals and semi-structured interviews with relatives. RESULTS Ninety-three percent of relatives indicated that they would hypothetically accept MITS on their deceased child. A key reason was knowing the CoD to take preventive actions; whereas the need to conform with the norm of immediate child burial, the secrecy of perinatal deaths, the decision-making complexity, the misalignment between MITS' purpose and traditional values, lack of a credible reason to investigate CoD, and the impotency to resuscitate the deceased were identified as potential points of hesitancy for acceptance. The only refusing respondent linked MITS to a perception that sharing results would constitute a breach of confidentiality and the lack of value attached to CoD determination. Experienced acceptability revealed four different components: actual acceptance, health professionals' hesitancy, relatives' hesitancy and actual refusal, which resulted in 82% of approached relatives to agree with MITS and 79% of cases to undergo MITS. Barriers to acceptability included, among others, health professionals' and facilities' unpreparedness to perform MITS, the threat of not burying the child immediately, financial burden of delays, decision-making complexities and misalignment of MITS' objectives with family values. CONCLUSIONS MITS showed high anticipated and experienced acceptability driven by the opportunity to prevent further deaths. Anticipated acceptability identified secrecy, confidentiality and complex decision-making processes as barriers, while experienced acceptability revealed family- and health facility-level logistics and practical aspects as barriers. Health-system and logistical impediments must also be considered before MITS implementation. Additionally, the multiple components of acceptability must be taken into account to make it more consistent and transferrable.
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Affiliation(s)
- Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Maria Maixenchs
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Rui Anselmo
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
| | - John Blevins
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Jaume Ordi
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic- Universitat de Barcelona, Barcelona, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique
| | - Robert F. Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Institución Catalana de Investigación y Estudios Avanzados (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Clara Menéndez
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Caballero MT, Bianchi AM, Grigaites SD, De la Iglesia Niveyro PX, Nuño A, Valle S, Afarian G, Esperante SA, Ferretti AJP, Jares Baglivo S, De Luca J, Alvarez-Paggi D, Diamanti A, Bassat Q, Polack FP. Community Mortality Due to Respiratory Syncytial Virus in Argentina: Population-based Surveillance Study. Clin Infect Dis 2021; 73:S210-S217. [PMID: 34472572 PMCID: PMC8411253 DOI: 10.1093/cid/ciab497] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Many deaths in infants from low-middle income countries (LMICs) occur at home or upon arrival to health facilities. Although acute lower respiratory tract illness plays an important role in community mortality, the accuracy of mortality rates due to respiratory syncytial virus (RSV) remains unknown. Methods An active surveillance study among children aged under 5 years old (U5) was performed in Buenos Aires, Argentina, between January and December 2019, to define the burden and role of RSV in childhood community mortality. Results A total of 63 families of children U5 participated in the study. Based on a combined approach of tissue sampling, verbal autopsies, and expert’s analysis, RSV infection was found in the causal chain of 11 from 12 cases with positive molecular biology results in respiratory samples. The estimated mortality rate due to RSV among infants was 0.27 deaths/1000 live births. The mean age of RSV-related household deaths was 2.8 months of age (standard deviation [SD] 1.7), and 8/12 were male infants (66.7%). Dying at home from RSV was associated with Streptococcus pneumoniae and/or Moraxella catarrhalis lung coinfection (75%), living in slums and settlement (odds ratio [OR], 17.09; 95% confidence interval [CI], 1.3–219.2), and other underlying comorbidities (OR, 14.87; 95% CI, 1.3–164.6). Conclusions Infant community mortality rates due to RSV are higher than those reported in industrialized countries and similar to those reported in hospital-based studies in the same catchment population.
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Affiliation(s)
- Mauricio T Caballero
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | - Sebastian Diaz Grigaites
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Publico de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | | | | | | | - Gabriela Afarian
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Publico de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | - Sebastian A Esperante
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | | | | | - Damian Alvarez-Paggi
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Adriana Diamanti
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Publico de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), CP Maputo, Mozambique.,ICREA, Pg. Lluís Companys, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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29
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Blau DM, Baillie VL, Els T, Mahtab S, Mutevedzi P, Keita AM, Kotloff KL, Mehta A, Sow SO, Tapia MD, Tippett Barr BA, Oluoch BO, Onyango C, Revathi G, Verani JR, Abayneh M, Assefa N, Madrid L, Oundo JO, Scott JAG, Bassat Q, Mandomando I, Sitoe A, Valente M, Varo R, Bassey IA, Cain CJ, Jambai A, Ogbuanu I, Ojulong J, Alam M, El Arifeen S, Gurley ES, Rahman A, Rahman M, Waller JL, Dewey B, Breiman RF, Whitney CG, Madhi SA. Deaths Attributed to Respiratory Syncytial Virus in Young Children in High-Mortality Rate Settings: Report from Child Health and Mortality Prevention Surveillance (CHAMPS). Clin Infect Dis 2021; 73:S218-S228. [PMID: 34472577 PMCID: PMC8411256 DOI: 10.1093/cid/ciab509] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Lower respiratory tract infections are a leading cause of death in young children, but few studies have collected the specimens needed to define the role of specific causes. The Child Health and Mortality Prevention Surveillance (CHAMPS) platform aims to investigate causes of death in children aged <5 years in high–mortality rate settings, using postmortem minimally invasive tissue sampling and other advanced diagnostic techniques. We examined findings for deaths identified in CHAMPS sites in 7 countries in sub-Saharan Africa and south Asia to evaluate the role of respiratory syncytial virus (RSV). Methods We included deaths that occurred between December 2016 and December 2019. Panels determined causes of deaths by reviewing all available data including pathological results from minimally invasive tissue sampling, polymerase chain reaction screening for multiple infectious pathogens in lung tissue, nasopharyngeal swab, blood, and cerebrospinal fluid samples, clinical information from medical records, and verbal autopsies. Results We evaluated 1213 deaths, including 695 in neonates (aged <28 days), 283 in infants (28 days to <12 months), and 235 in children (12–59 months). RSV was detected in postmortem specimens in 67 of 1213 deaths (5.5%); in 24 deaths (2.0% of total), RSV was determined to be a cause of death, and it contributed to 5 other deaths. Younger infants (28 days to <6 months of age) accounted for half of all deaths attributed to RSV; 6.5% of all deaths in younger infants were attributed to RSV. RSV was the underlying and only cause in 4 deaths; the remainder (n = 20) had a median of 2 (range, 1–5) other conditions in the causal chain. Birth defects (n = 8) and infections with other pathogens (n = 17) were common comorbid conditions. Conclusions RSV is an important cause of child deaths, particularly in young infants. These findings add to the substantial body of literature calling for better treatment and prevention options for RSV in high–mortality rate settings.
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Affiliation(s)
- Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Toyah Els
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ashka Mehta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Clayton Onyango
- Centers for Disease Control and Prevention, Kenya, Kisumu, Kenya
| | - Gunturu Revathi
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mahlet Abayneh
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nega Assefa
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lola Madrid
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.,College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Joseph O Oundo
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - J Anthony G Scott
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Quique Bassat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom.,ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Institutó Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Inacio Mandomando
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Antonio Sitoe
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Marta Valente
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Rosauro Varo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom.,ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | - Emily S Gurley
- Crown Agents, Freetown, Sierra Leone.,International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | | | - Jessica L Waller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Betsy Dewey
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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30
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Caballero MT, Satav A, Gill CJ, Omer SB, Pieciak RC, Kazi AM, Simões EA, Polack FP. Challenges of Assessing Community Mortality Due to Respiratory Viruses in Children Aged Less Than 5 Years. Clin Infect Dis 2021; 73:S248-S254. [PMID: 34472573 PMCID: PMC8411250 DOI: 10.1093/cid/ciab487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Estimating the real impact of respiratory syncytial virus (RSV) disease is key for the development of vaccines and treatments. Ascertaining the burden of community mortality due to RSV is challenging due to the lack of primary data. Therefore, conducting observational studies to determine the factors associated with community mortality due to the virus in developing countries is important. Objective Our aim in this study was to describe the obstacles, gaps, and challenges that investigators face in low-income, vulnerable regions in 4 developing countries on 3 continents. Results The main obstacles and challenges of ascertaining community mortality due to RSV were defining strategies to consent families for testing before burial, sampling individuals at the household level, supporting bereaved parents with different cultural and religious backgrounds, establishing tailored strategies for studies in challenging settings, and integrating RSV mortality data from nasopharyngeal samples. Conclusion Detailed logistical planning based on population sociodemographic information, grief counseling, staff training, and a multidisciplinary approach with adequate laboratory infrastructure is critical to successful observational community-based RSV studies.
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Affiliation(s)
- Mauricio T Caballero
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, (CONICET), Buenos Aires, Argentina
| | - Ashish Satav
- Meditation, AIDS, Health, Addiction & Nutrition (MAHAN) (MAHAN) Trust, Mahatma Gandhi Tribal Hospital Karmagram, Utavali, Tahsil, Dharni, Amravati, India
| | - Christopher J Gill
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, USA.,Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.,Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Rachel C Pieciak
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Abdul Momin Kazi
- Department of Pediatrics, The Aga Khan University, Karachi, Pakistan
| | - Eric Af Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Epidemiology, Center for Global Health Colorado School of Public Health, Aurora, Colorado, USA
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31
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Breiman RF, Blau DM, Mutevedzi P, Akelo V, Mandomando I, Ogbuanu IU, Sow SO, Madrid L, El Arifeen S, Garel M, Thwala NB, Onyango D, Sitoe A, Bassey IA, Keita AM, Alemu A, Alam M, Mahtab S, Gethi D, Varo R, Ojulong J, Samura S, Mehta A, Ibrahim AM, Rahman A, Vitorino P, Baillie VL, Agaya J, Tapia MD, Assefa N, Chowdhury AI, Scott JAG, Gurley ES, Kotloff KL, Jambai A, Bassat Q, Tippett-Barr BA, Madhi SA, Whitney CG. Postmortem investigations and identification of multiple causes of child deaths: An analysis of findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. PLoS Med 2021; 18:e1003814. [PMID: 34591862 PMCID: PMC8516282 DOI: 10.1371/journal.pmed.1003814] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 10/14/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The current burden of >5 million deaths yearly is the focus of the Sustainable Development Goal (SDG) to end preventable deaths of newborns and children under 5 years old by 2030. To accelerate progression toward this goal, data are needed that accurately quantify the leading causes of death, so that interventions can target the common causes. By adding postmortem pathology and microbiology studies to other available data, the Child Health and Mortality Prevention Surveillance (CHAMPS) network provides comprehensive evaluations of conditions leading to death, in contrast to standard methods that rely on data from medical records and verbal autopsy and report only a single underlying condition. We analyzed CHAMPS data to characterize the value of considering multiple causes of death. METHODS AND FINDINGS We examined deaths identified from December 2016 through November 2020 from 7 CHAMPS sites (in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa), including 741 neonatal, 278 infant, and 241 child <5 years deaths for which results from Determination of Cause of Death (DeCoDe) panels were complete. DeCoDe panelists included all conditions in the causal chain according to the ICD-10 guidelines and assessed if prevention or effective management of the condition would have prevented the death. We analyzed the distribution of all conditions listed as causal, including underlying, antecedent, and immediate causes of death. Among 1,232 deaths with an underlying condition determined, we found a range of 0 to 6 (mean 1.5, IQR 0 to 2) additional conditions in the causal chain leading to death. While pathology provides very helpful clues, we cannot always be certain that conditions identified led to death or occurred in an agonal stage of death. For neonates, preterm birth complications (most commonly respiratory distress syndrome) were the most common underlying condition (n = 282, 38%); among those with preterm birth complications, 256 (91%) had additional conditions in causal chains, including 184 (65%) with a different preterm birth complication, 128 (45%) with neonatal sepsis, 69 (24%) with lower respiratory infection (LRI), 60 (21%) with meningitis, and 25 (9%) with perinatal asphyxia/hypoxia. Of the 278 infant deaths, 212 (79%) had ≥1 additional cause of death (CoD) beyond the underlying cause. The 2 most common underlying conditions in infants were malnutrition and congenital birth defects; LRI and sepsis were the most common additional conditions in causal chains, each accounting for approximately half of deaths with either underlying condition. Of the 241 child deaths, 178 (75%) had ≥1 additional condition. Among 46 child deaths with malnutrition as the underlying condition, all had ≥1 other condition in the causal chain, most commonly sepsis, followed by LRI, malaria, and diarrheal disease. Including all positions in the causal chain for neonatal deaths resulted in 19-fold and 11-fold increases in attributable roles for meningitis and LRI, respectively. For infant deaths, the proportion caused by meningitis and sepsis increased by 16-fold and 11-fold, respectively; for child deaths, sepsis and LRI are increased 12-fold and 10-fold, respectively. While comprehensive CoD determinations were done for a substantial number of deaths, there is potential for bias regarding which deaths in surveillance areas underwent minimally invasive tissue sampling (MITS), potentially reducing representativeness of findings. CONCLUSIONS Including conditions that appear anywhere in the causal chain, rather than considering underlying condition alone, markedly changed the proportion of deaths attributed to various diagnoses, especially LRI, sepsis, and meningitis. While CHAMPS methods cannot determine when 2 conditions cause death independently or may be synergistic, our findings suggest that considering the chain of events leading to death can better guide research and prevention priorities aimed at reducing child deaths.
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Affiliation(s)
- Robert F. Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Victor Akelo
- US Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- Instituto Nacional de Saúde [INS], Manhiça, Mozambique
| | | | - Samba O. Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Mischka Garel
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Nana Bukiwe Thwala
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | | | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | | | - Adama Mamby Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Addisu Alemu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Dickson Gethi
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- Universitat de Barcelona, Barcelona, Spain
| | | | | | - Ashka Mehta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | - Vicky L. Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Janet Agaya
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - Milagritos D. Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - J. Anthony G. Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily S. Gurley
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Karen L. Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital de Sant Joan de Deu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | | | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Cynthia G. Whitney
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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32
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Assefa N, Hassen JY, Admassu D, Brhane M, Deressa M, Marami D, Teklemariam Z, Dessie Y, Oundo J. COVID-19 Testing Experience in a Resource-Limited Setting: The Use of Existing Facilities in Public Health Emergency Management. Front Public Health 2021; 9:675553. [PMID: 34195170 PMCID: PMC8236620 DOI: 10.3389/fpubh.2021.675553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) is a public health emergency with little testing and treatment experiences at its occurrence. Diagnostic and treatment rapidly changed in the world including Ethiopia. Haramaya University has strived to change its diagnostic capacity using existing facilities in response to the national call to the pandemic. Objective: This summary aims to detail experiences of setting up COVID-19 testing in Haramaya University laboratories, Eastern Ethiopia. Methods: Desktop exercise was conducted to understand the start-up and implementations of COVID-19 testing in two Haramaya University laboratories, Hararghe Health Research Partnership and Campylobacter Genomics and Environmental Enteric Dysfunction laboratories. Communication, formats, guidelines, and standards were reviewed and summarized. Discussion with those involved in the start-up and implementation of the testing were also held. Ideas were summarized to learn the experiences the COVID-19 testing exercises. Lesson Learned: This is a huge experience for Haramaya University to participate in the national call to increase the testing platform in the management of COVID19. Close work relationship with the public health authorities at all levels demonstrated the university's commitment to public service. The university has used the opportunity to advance its molecular testing capability by training its staff and students. The University has also contributed to the capacity development for laboratories in the surrounding areas of Harar, Somali, Oromia, and Dire Dawa. The pandemic has been an opportunity in harnessing existing resource for the benefit of the public during such times of dire needs to provide critical public health laboratory interventions.
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Affiliation(s)
- Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
| | - Jemal Yousuf Hassen
- College of Agriculture and Environmental Sciences, Haramaya University, East Hararghe, Ethiopia
| | - Desalegn Admassu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mussie Brhane
- Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
| | - Mersen Deressa
- Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
| | - Dadi Marami
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
| | - Zelalem Teklemariam
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Joseph Oundo
- Hararghe Health Research Partnerships, Haramaya University, Harar, Ethiopia
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RSV genomic diversity and the development of a globally effective RSV intervention. Vaccine 2021; 39:2811-2820. [PMID: 33895016 DOI: 10.1016/j.vaccine.2021.03.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022]
Abstract
Respiratory syncytial virus (RSV) is the most common cause of serious lower respiratory tract illness in infants and children and causes significant disease in the elderly and immunocompromised. Recently there has been an acceleration in the development of candidate RSV vaccines, monoclonal antibodies and therapeutics. However, the effects of RSV genomic variability on the implementation of vaccines and therapeutics remain poorly understood. To address this knowledge gap, the National Institute of Allergy and Infectious Diseases and the Fogarty International Center held a workshop to summarize what is known about the global burden and transmission of RSV disease, the phylogeographic dynamics and genomics of the virus, and the networks that exist to improve the understanding of RSV disease. Discussion at the workshop focused on the implications of viral evolution and genomic variability for vaccine and therapeutics development in the context of various immunization strategies. This paper summarizes the meeting, highlights research gaps and future priorities, and outlines what has been achieved since the meeting took place. It concludes with an examination of what the RSV community can learn from our understanding of SARS-CoV-2 genomics and what insights over sixty years of RSV research can offer the rapidly evolving field of COVID-19 vaccines.
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Paganelli CR, Goco NJ, McClure EM, Banke KK, Blau DM, Breiman RF, Menéndez C, Rakislova N, Bassat Q. The evolution of minimally invasive tissue sampling in postmortem examination: a narrative review. Glob Health Action 2021; 13:1792682. [PMID: 32713325 PMCID: PMC7480574 DOI: 10.1080/16549716.2020.1792682] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Because of low acceptance rates and limited capacity, complete diagnostic autopsies (CDAs) are seldom conducted in low- and middle-income countries (LMICs). There have been growing investments in less-invasive postmortem examination methodologies, including needle-based autopsy, known as minimally invasive autopsy or minimally invasive tissue sampling (MITS). MITS has been shown to be a feasible and informative alternative to CDA for cause of death investigation and mortality surveillance purposes. OBJECTIVE The aim of this narrative review is to describe historical use and evolution of needle-based postmortem procedures as a tool to ascertain the cause of death, especially in LMICs. METHODS Key word searches were conducted in PubMed and EBSCO in 2018 and 2019. Abstracts were reviewed against inclusion and exclusion criteria. Full publications were reviewed for those abstracts meeting inclusion criteria and a start set was established. A snowball search methodology was used and references for all publications meeting inclusion criteria were manually reviewed until saturation was reached. RESULTS A total of 1,177 publications were initially screened. Following an iterative review of references, 79 publications were included in this review. Twenty-nine studies, published between 1955 and 2019, included MITS as part of postmortem examination. Of the publications included, 76% (60/79) have publication dates after 2010. More than 60% of all publications included addressed MITS in LMICs, and a total of nine publications compared MITS with CDA. CONCLUSIONS Although there is evidence of less-invasive postmortem sampling starting in the 1800s, more structured needle-based postmortem examination publications started to appear in the mid-twentieth century. Early studies were mostly conducted in high-income countries but starting in 2010 the number of publications began to increase, and a growing number of studies were conducted in LMICs. Initial studies in LMICs were disease-specific but since 2015 have evolved to include more expansive postmortem examination.
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Affiliation(s)
| | | | | | - Kathryn K Banke
- Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Dianna M Blau
- Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, GA, USA
| | - Clara Menéndez
- ISGlobal Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal Department of Pathology Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| | - Quique Bassat
- ISGlobal Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
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35
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Krishnan A, Gupta V, Nongkynrih B, Kumar R, Kaur R, Malhotra S, Salve HR, Narayan V, Gupta A. Mortality in India established through verbal autopsies (MINErVA): Strengthening national mortality surveillance system in India. J Glob Health 2020; 10:020431. [PMID: 33282224 PMCID: PMC7688192 DOI: 10.7189/jogh.10.020431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Following data access and storage concerns, Government of India transferred the management of its Sample Registration System (SRS) based mortality surveillance (formerly known as the Million Death Study) to an Indian agency. This paper introduces the new system, challenges it faced and its vision for future. Methods The All India Institute of Medical Sciences (AIIMS), New Delhi, the new nodal agency, established the “Mortality in India Established through Verbal Autopsy” (MINErVA) platform with state level partners across India in November 2017. The network in its first three years has undertaken capacity building of supervisors conducting verbal autopsy under the SRS, established a panel of trained physician reviewers and developed three IT-based platforms for training, quality control and coding. Coding of VA forms started from January 2015 onwards, and the cause specific mortality fractions (CSMF) of the first 14 185 adult verbal autopsy (VA) records for 2015 were compared with earlier published data for 2010-2013 to check for continuity of system performance. Results The network consists of 25 institutions and a panel of 676 trained physician reviewers. 916 supervisors have been trained in conducting verbal autopsies. More than 75 000 VA forms have been coded to date. The median time taken for finalizing cause of death on the coding platform is 37 days. The level of physician agreement (67%) and proportion of VA forms requiring adjudication (12%) are consistent with published literature. Preliminary CSMF estimates for 2015 were comparable with those for 2010-2013 and identified same top ten causes of death. In addition to the delay, two major challenges identified for coding were language proficiency of physician reviewers vis-à-vis language of narratives and quality of verbal autopsies. While an initial strategic decision was made to consolidate the system to ensure continuity, future vision of the network is to move towards technology-based solutions including electronic data capture of VAs and its analysis and improving the use of mortality data in decision making. Conclusion MINErVA network is now fully functional and is moving towards achieving global standards. It provides valuable lessons for other developing countries to establish their own mortality surveillance systems.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Gupta
- Dr Rajendra Prasad Centre of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Baridalyne Nongkynrih
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravneet Kaur
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Harshal R Salve
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Venkatesh Narayan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ayon Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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36
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Cunningham SA, Shaikh NI, Nhacolo A, Raghunathan PL, Kotloff K, Naser AM, Mengesha MM, Adedini SA, Misore T, Onuwchekwa UU, Worrell MC, El Arifeen S, Assefa N, Chowdhury AI, Kaiser R, Madhi SA, Mehta A, Obor D, Sacoor C, Sow SO, Tapia MD, Wilkinson AL, Breiman RF. Health and Demographic Surveillance Systems Within the Child Health and Mortality Prevention Surveillance Network. Clin Infect Dis 2020; 69:S274-S279. [PMID: 31598663 PMCID: PMC6785673 DOI: 10.1093/cid/ciz609] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Health and demographic surveillance systems (HDSSs) provide a foundation for characterizing and defining priorities and strategies for improving population health. The Child Health and Mortality Prevention Surveillance (CHAMPS) project aims to inform policy to prevent child deaths through generating causes of death from surveillance data combined with innovative diagnostic and laboratory methods. Six of the 7 sites that constitute the CHAMPS network have active HDSSs: Mozambique, Mali, Ethiopia, Kenya, Bangladesh, and South Africa; the seventh, in Sierra Leone, is in the early planning stages. This article describes the network of CHAMPS HDSSs and their role in the CHAMPS project. To generate actionable health and demographic data to prevent child deaths, the network depends on reliable demographic surveillance, and the HDSSs play this crucial role.
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Affiliation(s)
| | - Nida I Shaikh
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pratima L Raghunathan
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Abu Mohd Naser
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Melkamu M Mengesha
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sunday A Adedini
- Medical Research Council, Respiratory and Meningeal Pathogen Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Demography and Population Studies Program, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Uma U Onuwchekwa
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Mary Claire Worrell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Reinhard Kaiser
- US Centers for Disease Control and Prevention-Sierra Leone, Freetown, Sierra Leone
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogen Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David Obor
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Samba O Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Amanda L Wilkinson
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
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37
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Salzberg NT, Sivalogan K, Bassat Q, Taylor AW, Adedini S, El Arifeen S, Assefa N, Blau DM, Chawana R, Cain CJ, Cain KP, Caneer JP, Garel M, Gurley ES, Kaiser R, Kotloff KL, Mandomando I, Morris T, Nyamthimba Onyango P, Sazzad HMS, Scott JAG, Seale AC, Sitoe A, Sow SO, Tapia MD, Whitney EA, Worrell MC, Zielinski-Gutierrez E, Madhi SA, Raghunathan PL, Koplan JP, Breiman RF. Mortality Surveillance Methods to Identify and Characterize Deaths in Child Health and Mortality Prevention Surveillance Network Sites. Clin Infect Dis 2020; 69:S262-S273. [PMID: 31598664 PMCID: PMC6785672 DOI: 10.1093/cid/ciz599] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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.
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Affiliation(s)
- Navit T Salzberg
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | | | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.,Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud, Spain
| | - Allan W Taylor
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sunday Adedini
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard Chawana
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | | | - Kevin P Cain
- US Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | - J Patrick Caneer
- Public Health Informatics Institute, The Task Force for Global Health, Atlanta, Georgia, USA
| | - Mischka Garel
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Emily S Gurley
- icddr,b, Dhaka, Bangladesh.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Reinhard Kaiser
- US Centers for Disease Control and Prevention-Sierra Leone, Freetown, Sierra Leone
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique
| | - Timothy Morris
- Public Health Informatics Institute, The Task Force for Global Health, Atlanta, Georgia, USA
| | | | - Hossain M S Sazzad
- University of New South Wales, Sydney, Australia.,PEI, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anna C Seale
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.,KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Samba O Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ellen A Whitney
- International Association of National Public Health Institutes, US Office at Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Mary Claire Worrell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Pratima L Raghunathan
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey P Koplan
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
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38
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Taylor AW, Blau DM, Bassat Q, Onyango D, Kotloff KL, Arifeen SE, Mandomando I, Chawana R, Baillie VL, Akelo V, Tapia MD, Salzberg NT, Keita AM, Morris T, Nair S, Assefa N, Seale AC, Scott JAG, Kaiser R, Jambai A, Barr BAT, Gurley ES, Ordi J, Zaki SR, Sow SO, Islam F, Rahman A, Dowell SF, Koplan JP, Raghunathan PL, Madhi SA, Breiman RF. Initial findings from a novel population-based child mortality surveillance approach: a descriptive study. Lancet Glob Health 2020; 8:e909-e919. [PMID: 32562647 PMCID: PMC7303945 DOI: 10.1016/s2214-109x(20)30205-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sub-Saharan Africa and south Asia contributed 81% of 5·9 million under-5 deaths and 77% of 2·6 million stillbirths worldwide in 2015. Vital registration and verbal autopsy data are mainstays for the estimation of leading causes of death, but both are non-specific and focus on a single underlying cause. We aimed to provide granular data on the contributory causes of death in stillborn fetuses and in deceased neonates and children younger than 5 years, to inform child mortality prevention efforts. METHODS The Child Health and Mortality Prevention Surveillance (CHAMPS) Network was established at sites in seven countries (Baliakandi, Bangladesh; Harar and Kersa, Ethiopia; Siaya and Kisumu, Kenya; Bamako, Mali; Manhiça, Mozambique; Bombali, Sierra Leone; and Soweto, South Africa) to collect standardised, population-based, longitudinal data on under-5 mortality and stillbirths in sub-Saharan Africa and south Asia, to improve the accuracy of determining causes of death. Here, we analysed data obtained in the first 2 years after the implementation of CHAMPS at the first five operational sites, during which surveillance and post-mortem diagnostics, including minimally invasive tissue sampling (MITS), were used. Data were abstracted from all available clinical records of deceased children, and relevant maternal health records were also extracted for stillbirths and neonatal deaths, to incorporate reported pregnancy or delivery complications. Expert panels followed standardised procedures to characterise causal chains leading to death, including underlying, intermediate (comorbid or antecedent causes), and immediate causes of death for stillbirths, neonatal deaths, and child (age 1-59 months) deaths. FINDINGS Between Dec 10, 2016, and Dec 31, 2018, MITS procedures were implemented at five sites in Mozambique, South Africa, Kenya, Mali, and Bangladesh. We screened 2385 death notifications for inclusion eligibility, following which 1295 families were approached for consent; consent was provided for MITS by 963 (74%) of 1295 eligible cases approached. At least one cause of death was identified in 912 (98%) of 933 cases (180 stillbirths, 449 neonatal deaths, and 304 child deaths); two or more conditions were identified in the causal chain for 585 (63%) of 933 cases. The most common underlying causes of stillbirth were perinatal asphyxia or hypoxia (130 [72%] of 180 stillbirths) and congenital infection or sepsis (27 [15%]). The most common underlying causes of neonatal death were preterm birth complications (187 [42%] of 449 neonatal deaths), perinatal asphyxia or hypoxia (98 [22%]), and neonatal sepsis (50 [11%]). The most common underlying causes of child deaths were congenital birth defects (39 [13%] of 304 deaths), lower respiratory infection (37 [12%]), and HIV (35 [12%]). In 503 (54%) of 933 cases, at least one contributory pathogen was identified. Cytomegalovirus, Escherichia coli, group B Streptococcus, and other infections contributed to 30 (17%) of 180 stillbirths. Among neonatal deaths with underlying prematurity, 60% were precipitated by other infectious causes. Of the 275 child deaths with infectious causes, the most common contributory pathogens were Klebsiella pneumoniae (86 [31%]), Streptococcus pneumoniae (54 [20%]), HIV (40 [15%]), and cytomegalovirus (34 [12%]), and multiple infections were common. Lower respiratory tract infection contributed to 174 (57%) of 304 child deaths. INTERPRETATION Cause of death determination using MITS enabled detailed characterisation of contributing conditions. Global estimates of child mortality aetiologies, which are currently based on a single syndromic cause for each death, will be strengthened by findings from CHAMPS. This approach adds specificity and provides a more complete overview of the chain of events leading to death, highlighting multiple potential interventions to prevent under-5 mortality and stillbirths. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Allan W Taylor
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Quique Bassat
- ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain; Pediatrics Department, Pediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health and Division of Infectious Disease and Tropical Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Richard Chawana
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, School of Pathology and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, School of Pathology and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health and Division of Infectious Disease and Tropical Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Navit T Salzberg
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | | | - Timothy Morris
- Emory Global Health Institute, Emory University, Atlanta, GA, USA; Public Health Informatics Institute, Task Force for Global Health, Atlanta, GA, USA
| | - Shailesh Nair
- Emory Global Health Institute, Emory University, Atlanta, GA, USA; Public Health Informatics Institute, Task Force for Global Health, Atlanta, GA, USA
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Anna C Seale
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Beth A Tippet Barr
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily S Gurley
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jaume Ordi
- ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sherif R Zaki
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samba O Sow
- Centre for Vaccine Development, Bamako, Mali
| | - Farzana Islam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Afruna Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Jeffrey P Koplan
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Pratima L Raghunathan
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, School of Pathology and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, GA, USA.
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39
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Goldenberg RL, McClure EM. Thoughts on assigning cause of death for stillbirth and neonatal death: a commentary. BJOG 2019; 127:532-535. [PMID: 31705706 DOI: 10.1111/1471-0528.16007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Affiliation(s)
- R L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, USA
| | - E M McClure
- Statistical, Environmental, and Health Sciences, Research Triangle Institute, Durham, North Carolina, USA
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