Mutevedzi Portia Chipo, Madewell Zachary J, Kotloff Karen L, Bassat Quique, Chirinda Percina Joao, Cossa Anelsio C A, Xerinda Elisio G, Akelo Victor, Mitei Paul K, Oele Elizabeth, Omore Richard, Onyango Dickens, Bangura Joseph, Luke Ronita, Moseray Andrew, Ogbuanu Ikechukwu Udo, Sesay Tom, Assefa Nega, Libe Temesgen Teferi, Madrid Lola, Yeshi Melisachew M, Scott J Anthony G, Govender Nelesh P, Lala Sanjay G, Madhi Shabir A, Mahtab Sana, Keita Adama Mamby, Sanogo Doh, Sow Samba O, Tapia Milagritos D, El Arifeen Shams, Gurley Emily S, Barr Beth A Tippett, Whitney Cynthia G, Blau Dianna M, Mandomando Inacio
Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America.
Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLOS Glob Public Health. 2025 Jun 25;5(6):e0004772. doi: 10.1371/journal.pgph.0004772. eCollection 2025.
Achieving the Sustainable Development Goal of reducing child mortality to <25 deaths per 1000 live births by 2030 requires strategies to prevent diarrheal disease-related morbidity and mortality. Accurate etiological diagnosis is essential. This study used postmortem diagnostics to investigate the contribution of diarrhea to under-5 mortality and examine co-morbidities and co-infections in Africa and South Asia. Child Health and Mortality Prevention Surveillance (CHAMPS) generates data on child deaths through minimally invasive tissue sampling, clinical record review, and verbal autopsies. Multidisciplinary panels assign cause(s) of death using WHO International Classification of Diseases. This analysis included deaths among children aged 1-59 months enrolled from 18 December 2016-31 December 2023 across six African sites (Ethiopia, Mali, Kenya, Sierra Leone, Mozambique, South Africa) and Bangladesh. Of 1517 deaths assessed, diarrhea was in the causal pathway in 240 (15.8%). The proportion of diarrhea-related deaths was highest in Ethiopia (41.0%, 34/83), followed by Bangladesh, (30.0%, 3/10), Mozambique (21.7%, 56/258), Mali (17.5%, 18/103), Kenya (13.9%, 51/366), Sierra Leone (12.8%, 46/358), and South Africa (9.4%, 32/339). Diarrhea was underlying cause in 44.2% (106/240) of cases and immediate/antecedent cause in 58.3% (140/240), with some deaths involving multiple roles in the causal chain. When diarrhea was underlying cause, sepsis (33.0%) and lower respiratory infections (25.5%) were common downstream conditions; when an antecedent/immediate cause, leading underlying causes were malnutrition (64.3%) and HIV (13.6%). No pathogen was identified in 49.6% (119/240) of diarrhea-related deaths; among these, diarrhea was underlying cause in 42.9%. Among the 121 pathogen-attributed deaths, the most frequent were EAEC (34.7%), typical EPEC (15.7%), Shigella/EIEC (14.0%), ST-ETEC (12.4%), rotavirus (26.4%), and adenovirus (non-40/41: 19.0%; 40/41: 5.0%). These pathogens were frequently identified as co-infections. Diarrheal disease accounted for a substantial share of child deaths across CHAMPS sites. Reducing mortality will require preventing diarrhea and addressing key contributors such as malnutrition and HIV.
要实现到2030年将儿童死亡率降至每1000例活产儿死亡少于25例这一可持续发展目标，需要制定预防腹泻病相关发病和死亡的策略。准确的病因诊断至关重要。本研究采用尸检诊断来调查腹泻对5岁以下儿童死亡率的影响，并检查非洲和南亚的合并症和合并感染情况。儿童健康与死亡率预防监测（CHAMPS）通过微创组织采样、临床记录审查和口头尸检来生成儿童死亡数据。多学科小组使用世界卫生组织国际疾病分类来确定死亡原因。该分析纳入了2016年12月18日至2023年12月31日期间在六个非洲地点（埃塞俄比亚、马里、肯尼亚、塞拉利昂、莫桑比克、南非）和孟加拉国登记的1至59个月大儿童的死亡病例。在评估的1517例死亡病例中，腹泻处于因果路径的有240例（15.8%）。腹泻相关死亡比例在埃塞俄比亚最高（41.0%，34/83），其次是孟加拉国（30.0%，3/10）、莫桑比克（21.7%，56/258）、马里（17.5%，18/103）、肯尼亚（13.9%，51/366）、塞拉利昂（12.8%，46/358）和南非（9.4%，32/339）。腹泻是44.2%（106/240）病例的根本原因，是58.3%（140/240）病例的直接/先前原因，一些死亡在因果链中涉及多种作用。当腹泻是根本原因时，败血症（33.0%）和下呼吸道感染（25.5%）是常见的下游病症；当是先前/直接原因时，主要的根本原因是营养不良（64.3%）和艾滋病毒（13.6%）。在49.6%（119/240）的腹泻相关死亡病例中未鉴定出病原体；其中，腹泻是根本原因占42.9%。在121例病原体归因死亡病例中，最常见的是肠集聚性大肠杆菌（EAEC，34.7%）、典型肠致病性大肠杆菌（EPEC，15.7%）、志贺菌/肠侵袭性大肠杆菌（Shigella/EIEC，14.0%）、耐热肠毒素性大肠杆菌（ST-ETEC，12.4%）、轮状病毒（26.4%）和腺病毒（非40/41型：19.0%；40/41型：5.0%）。这些病原体经常被鉴定为合并感染。腹泻病在CHAMPS各地点的儿童死亡中占很大比例。降低死亡率需要预防腹泻并解决营养不良和艾滋病毒等关键因素。
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