Mahtab Sana, Madhi Shabir A, Baillie Vicky L, Els Toyah, Thwala Bukiwe Nana, Onyango Dickens, Tippet-Barr Beth A, Akelo Victor, Igunza Kitiezo Aggrey, Omore Richard, Arifeen Shams El, Gurley Emily S, Alam Muntasir, Chowdhury Atique Iqbal, Rahman Afruna, Bassat Quique, Mandomando Inacio, Ajanovic Sara, Sitoe Antonio, Varo Rosauro, Sow Samba O, Kotloff Karen L, Badji Henry, Tapia Milagritos D, Traore Cheick B, Ogbuanu Ikechukwu U, Bunn James, Luke Ronita, Sannoh Sulaiman, Swarray-Deen Alim, Assefa Nega, Scott J Anthony G, Madrid Lola, Marami Dadi, Fentaw Surafel, Diaz Maureen H, Martines Roosecelis B, Breiman Robert F, Madewell Zachary J, Blau Dianna M, Whitney Cynthia G
South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Kenya County Department of Health, Kisumu, Kenya.
PLOS Glob Public Health. 2023 Mar 20;3(3):e0001612. doi: 10.1371/journal.pgph.0001612. eCollection 2023.
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.
每年有240万儿童在出生后的第一个月内死亡。2016年在7个国家设立的儿童健康与死亡率预防监测（CHAMPS）旨在获取关于此类死亡原因的准确数据，并为预防策略提供依据。对2016年12月至2021年12月期间发生的新生儿死亡病例，在死亡后24至72小时内采用MITS进行调查。检测包括血液、脑脊液和肺部培养，对血液、脑脊液、鼻咽拭子和肺组织进行多病原体PCR检测，以及对肺、肝和脑进行组织病理学检查。数据收集包括临床记录回顾和使用标准化口头尸检进行的家庭访谈。全套数据由当地专家按照标准化流程（死因判定）进行审查，以确定导致死亡的所有相关状况（因果链），这是根据世界卫生组织的建议进行的。为了进行分析，我们将新生儿死亡分为出生后24小时内、早期（1至<7天）和晚期（7至<28天）新生儿死亡。我们分析了1458例死亡病例，其中41%发生在出生后24小时内，41%为早期死亡，18%为晚期新生儿死亡。主要潜在死因包括产时事件并发症（31%）、早产并发症（28%）、感染（17%）、呼吸系统疾病（11%）和先天性畸形（8%）。除了潜在死因外，62%的死亡病例还有其他状况，14%的病例在因果链中有≥3种其他状况。考虑整个因果链，最常见的死因是感染（40%）、早产（32%）和呼吸窘迫综合征（28%）。与新生儿死亡相关的常见母亲状况包括母亲高血压（10%）、分娩并发症（8%）、多胎妊娠（7%）、胎盘并发症（6%）、产程梗阻和绒毛膜羊膜炎（各5%）。CHAMPS的研究结果显示了导致死亡的完整事件因果链，除了母亲因素外，还凸显了每例死亡所涉及的复杂性以及多个预防机会。在高死亡率地区，迫切需要强调改善产前和产科护理以及预防感染。
