Prioritizing Health Care Strategies to Reduce Childhood Mortality
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Published:2022-10-21
Issue:10
Volume:5
Page:e2237689
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Madewell Zachary J.1, Whitney Cynthia G.2, Velaphi Sithembiso3, Mutevedzi Portia4, Mahtab Sana5, Madhi Shabir A.4, Fritz Ashleigh4, Swaray-Deen Alim5, Sesay Tom6, Ogbuanu Ikechukwu U.7, Mannah Margaret T.6, Xerinda Elisio G.8, Sitoe Antonio8, Mandomando Inacio89, Bassat Quique810111213, Ajanovic Sara810, Tapia Milagritos D.14, Sow Samba O.15, Mehta Ashka14, Kotloff Karen L.14, Keita Adama M.15, Tippett Barr Beth A.16, Onyango Dickens17, Oele Elizabeth17, Igunza Kitiezo Aggrey18, Agaya Janet18, Akelo Victor16, Scott J. Anthony G.19, Madrid Lola1920, Kelil Yunus-Edris20, Dufera Tadesse20, Assefa Nega20, Gurley Emily S.2122, El Arifeen Shams21, Spotts Whitney Ellen A.23, Seib Katherine23, Rees Chris A.24, Blau Dianna M.1, Begum Ferdousi25, Rahman Mohammad Mosiur25, Kamal Mohammed25, Ahmed A.S.M. Nawshad Uddin25, Hoque Mahbubul25, Lee Kyu Han25, Tasnim Saria25, Rahman Mahbubur25, Shirin Tahmina25, Khan Iqbal Ansary25, Flora Meerjady Sabrina25, Ahmed Dilruba25, Zaman K.25, Islam Kazi Munisul25, Ahmed Mohammed Sabbir25, Hossain Mohammed Zahid25, Rahman Mustafizur25, Parveen Shahana25, Bari Sanwarul25, Arjuman Farida25, Islam Farzana25, Islam Ferdousi25, Oundo Joseph O.25, Revathi Gunturu25, Rogena Emily25, Kuria Magdalene25, Mitei Paul K.25, Murila Florence25, Verani Jennifer25, Sanogo Doh25, Kourouma Nana25, Sissoko Seydou25, Onwuchekwu Uma U.25, Sidibe Diakaridia25, Keita Tatiana25, Kone Diakaridia25, Tennant Sharon M.25, Greene Carol L.25, Johnson J. Kristie25, Koka Rima25, Fairchild Karen D.25, Lako Sandra25, Kaluma Erick25, Pratt Samuel25, Kosia Baindu25, Fayorsey Ruby25, Ramirez Rebecca Alkis25, Philipsborn Rebecca P.25, Garel Mischka25, Salzberg Navit T.25, Koplan Jeffrey P.25, Breiman Robert F.25, Ritter Jana M.25, Gary Joy25, Zaki Sherif R. (deceased)25, Verani Jennifer R.25, Witherbee Jacob25, Liu Lucy25, Nair Shailesh25, Winchell Jonas M.25, Temesgen Fikremelekot25, Yeshi Melisachew Mulatu25, Alemu Addisu25, Ibrahim Alexander M.25, Gure Tadesse25, Orlien Stian25, Ali Solomon25, Edrid Yunus25, Gizaw Mahlet Abayneh25, Getnet Fentabil25, Fentaw Surafel25, Monjane Celso25, Nhachungue Sheila25, Menendez Clara25, Bramugy Justina25, Kindcardett Milton25, Nhampossa Tacilta25, Nhacolo Ariel25, Munguambe Khátia25, Vitorino Pio25, Carrilho Carla25, Fernandes Fabiola25, Mocumbi Sibone25, Maixenchs Maria25, Hurtado Juan Carlos25, Ordi Jaume25, Valente Marta25, Rakislova Natalia25, Chitungo Dercio25, Manhique Zara25, Adam Yasmin25, Lala Sanjay G.25, Petersen Karen L.25, Swart Peter J.25, Hale Martin25, Wadula Jeannette25, Dludlu Noluthando25, Solomon Fatima25, Chawana Richard25, Lombaard Hennie25, Sorour Gillian25, Ntuli Constance25,
Affiliation:
1. Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia 2. Emory Global Health Institute, Emory University, Atlanta, Georgia 3. Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 4. South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa 5. Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana 6. Ministry of Health and Sanitation, Freetown, Sierra Leone 7. Crown Agents, Freetown, Sierra Leone 8. Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique 9. Instituto Nacional de Saúde, Maputo, Mozambique 10. ISGlobal–Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain 11. Institutó Catalana de Recerca I Estudis Avançats, Barcelona, Spain 12. Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain 13. Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain 14. Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore 15. Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali 16. Centers for Disease Control and Prevention–Kenya, Kisumu, Kenya 17. Kisumu County Department of Health, Kisumu, Kenya 18. Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya 19. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom 20. College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia 21. International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh 22. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 23. International Association of National Public Health Institutes, Global Health Institute, Emory University, Atlanta, Georgia 24. Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia 25. for the Child Health and Mortality Prevention Surveillance Network
Abstract
ImportanceAlthough 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.ObjectiveTo 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 ParticipantsThis 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 MeasuresFor 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).ResultsOf 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 RelevanceIn 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.
Publisher
American Medical Association (AMA)
Cited by
9 articles.
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