Initial findings from a novel population-based child mortality surveillance approach: a descriptive study
Initial findings from a novel population-based child mortality surveillance approach: a descriptive study
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DOI：
10.1016/s2214-109x(20)30205-9
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发表时间：
2020-07-01
影响因子：
34.3
通讯作者：
Breiman, Robert F.
中科院分区：
文献类型：
--
作者：
Taylor, Allan W.;Blau, Dianna M.;Breiman, Robert F.
2015年，撒哈拉以南非洲和南亚占全球590万5岁以下死亡人数的81%，占260万死产人数的77%。生命登记和死因推断数据是估计主要死因的主要依据，但两者都不具体，只侧重于单一的根本原因。我们的目的是提供死产胎儿、死亡新生儿和5岁以下儿童死亡原因的详细数据，为儿童死亡预防工作提供信息。方法在7个国家的地点建立儿童健康和死亡预防监测网络（CHAMPS）（孟加拉国巴利亚坎迪;埃塞俄比亚哈拉尔和克尔萨;肯尼亚锡亚亚和基苏穆;马里巴马科;莫桑比克马希卡;塞拉利昂邦巴利;在撒哈拉以南非洲和南亚，人口基金（南非索韦托）收集关于5岁以下儿童死亡率和死产的标准化、基于人口的纵向数据，以提高确定死亡原因的准确性。在这里，我们分析了在前5个手术部位实施CHAMPS后的前2年中获得的数据，在此期间使用了监测和尸检诊断，包括微创组织取样（MITS）。从所有现有的死亡儿童临床记录中提取数据，还提取了死产和新生儿死亡的相关孕产妇健康记录，以纳入报告的妊娠或分娩并发症。专家小组遵循标准化程序，确定导致死亡的因果链，包括潜在的，中间的，（共病或前因），以及死胎、新生儿死亡和儿童死亡的直接原因结果2016年12月10日至2018年12月31日，在莫桑比克、南非、肯尼亚、马里、和孟加拉国。我们筛选了2385例死亡通知的入选资格，随后联系了1295个家庭征求同意;在1295例符合条件的病例中，963例（74%）同意接受MITS。在933例病例中，有912例（98%）至少确定了一种死亡原因（180例死胎，449例新生儿死亡和304例儿童死亡）;在933例病例中，有585例（63%）在因果链中确定了两种或两种以上的疾病。死产最常见的根本原因是围产期窒息或缺氧（180例死产中有130例[72%]）和先天性感染或败血症（27例[15%]）。新生儿死亡的最常见潜在原因是早产并发症（449例新生儿死亡中的187例[42%]）、围产期窒息或缺氧（98例[22%]）和新生儿败血症（50例[11%]）。儿童死亡最常见的根本原因是先天性出生缺陷（304例死亡中的39例[13%]）、下呼吸道感染（37例[12%]）和艾滋病毒（35例[12%]）。在933例病例中，503例（54%）至少确定了一种致病病原体。巨细胞病毒、大肠杆菌、B组链球菌和其他感染导致180例死胎中的30例（17%）。在新生儿死亡与潜在的早产，60%是由其他感染性原因沉淀。在275例感染性死亡的儿童中，最常见的致病病原体是肺炎克雷伯菌（86例[31%]）、肺炎链球菌（54例[20%]）、HIV（40例[15%]）和巨细胞病毒（34例[12%]），常见的是多重感染。下呼吸道感染导致304例儿童死亡中的174例（57%）。使用MITS进行死因判定的解释使得能够详细描述导致死亡的条件。全球儿童死亡病因的估计目前基于每例死亡的单一综合征原因，CHAMPS的发现将加强这一估计。这一方法增加了具体性，并更全面地概述了导致死亡的一系列事件，突出了预防5岁以下儿童死亡和死产的多种潜在干预措施。
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; Manhica, 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.