“Today, in the year 2019, our current understanding of what is killing people in low or middle income countries is very poor. If somebody gets really sick in a rural area of sub-Saharan Africa the probabilities that this person will die without accessing the health system or being visited by a clinician are very high. As a result, we have very patchy understanding of what is killing people.”
Quique Bassat, CHAMPS co-site director in Manhiça, Mozambique

 

In the regions of sub-Saharan Africa and South Asia where CHAMPS works, children die at a significantly higher rate than in the West.  Due to poor medical access, many children die without seeing a doctor or without the testing needed to determine what caused the death.  Families are left without knowing the why their loved one has died, and communities and health systems are left without the knowledge needed to prevent future similar deaths.

“Some of these early deaths, we don’t know much at all,” said Bill Gates, in an interview in 2017 with GeekWire. “Was there an infection there? Is there some new tool — an antibiotic, a vaccine — that could have saved that child’s life?”

The information we do have about causes of death for children in these regions is pieced together from interviews with family members and lay-people who can only provide general information about a child’s health prior to their death. In an interview with Dr. Quique Bassat, CHAMPS co-site director in Manhiça, Mozambique, he characterized what is currently available:

“As you can imagine, this is often as unreliable as tossing a coin and saying, what has this person died of? When we did the verbal autopsy [family member interview] and the grandmother of the child responded, the possibilities of that response being close to the actual cause of death are as low as tossing a coin and saying if it’s heads it was malaria, and if it’s tails, it was pneumonia.”

If the current data we have on individual child deaths are incomplete, how do we get better data?  The gold standard for investigating a death is a complete diagnostic autopsy. Such an autopsy allows for full examination of potential causes of death, but it is also very invasive, expensive, and in many settings, culturally inappropriate. Child health advocates need a tool that can provide greater clarity on the cause of a child’s death, without the concerns of inappropriateness, expense, and unsuitability of a traditional autopsy.

Dr. Bassat’s group at the Barcelona Institute of Global Health pioneered such a tool: Minimally Invasive Tissue Sampling, or MITS. His group conducted studies between 2013-2015 demonstrating that MITS is the best substitution for full autopsy for obtaining more precise information on the causes or likely causes of death in low-income countries. The MITS method uses needle biopsies–the same kind of needle biopsies that are used routinely in clinics to diagnose cancer- to obtain small samples for thorough histopathological and microbiological investigation. These needles don’t leave visible marks on the body of a deceased child, and the procedure can be done relatively rapidly, preventing it from interfering with family and cultural burial practices.

The results of CHAMPS testing offer an unprecedented level of precision and accuracy, especially if a child’s death was related to an infectious disease. Instead of only identifying major syndromes, like pneumonia, CHAMPS methods determine the specific pathogen that caused the pneumonia. The medical community can use this information to better diagnose and treat other children, for example, by giving insights into which antibiotics to use. This degree of specificity helps doctors and nurses treat children, and it can enable public health leaders to better target their limited resources to combat the major threats to child health. CHAMPS results also help find or discover causes and contributing causes of child deaths that otherwise would remain unknown.

Dr. Matshidiso Moeti, Regional Director of the WHO Regional Office for Africa, spoke about the potential of CHAMPS data to bring to light opportunities for life-saving public health action in an interview with CHAMPS in October, 2018:

“That is one of the unique values of the CHAMPS process and the data that are generated, even from a single case. I think [CHAMPS data] can show in a stark way what the minister [of health] assumed was happening, what the program director thought was going on, what the district medical officer thought was the system he’d put in place- both in training people, in providing access to medicines through what he might consider to be a functioning procurement and supply system, and find that there are gaps that need to be corrected… [CHAMPS] has the huge potential to highlight areas that need action in a range of aspects of a functioning healthcare system- both for prevention, and for effective management of childhood illness to reduce child mortality in the countries.”

The information CHAMPS is gathering about causes of child death is now being made available to child health organizations and advocates to further understanding of child mortality in Sub-Saharan Africa and South Asia, and to prompt actions that will save the lives of children in these regions. Dr. Bassat concluded:

“We are just at the beginning of understanding what many implications that MITS will play, but it is our wish that the data that is being generated today, and will be generated in the next years, will serve to … change things for the better, because we will be able to design much more appropriate preventive and management strategies for the health care of sick children.”