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Causes of Death Among Stillbirths and Children Aged <5 Years in Africa and South Asia — Child Health and Mortality Prevention Surveillance, Seven Countries, 2016–2024

Zachary J. Madewell, PhD

Global Network

CDC Morbidity and Mortality Weekly Report

2026

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Zachary J. Madewell, PhD¹; Ziyaad Dangor, PhD²; Portia C. Mutevedzi, PhD³; Siobhan L. Johnstone, PhD²; Sanjay G. Lala, PhD⁴; Shabir A. Madhi, PhD²^,5; Sithembiso Velaphi, PhD⁴; Nega Assefa, PhD⁶^,7^,8; Meron Kebede, MD⁷; Lola Madrid, PhD⁶^,8; Dadi Marami, MSc⁶^,7; J. Anthony G. Scott, MBBS⁸; George Aol, MCHD⁹; Kitiezo Aggrey Igunza⁹; Hellen Muttai, PhD¹⁰; Peter Nyamthimba Onyango, MA⁹; Peter O. Otieno, MA⁹; Quique Bassat, MD, PhD¹¹^,12^,13^,14^,15^,16^,17; Marcelino Garrine, DVM, PhD¹²^,18; Milton Kincardett, MD¹²; Inácio Mandomando, PhD¹¹^,12^,18^,19; Ariel Nhacolo, MSc¹²; Jane Juma, MCHD²⁰; Adama Mamby Keita, MD²⁰; Karen L. Kotloff, MD²¹; Samba O. Sow, MD²⁰; Milagritos D. Tapia, MD²¹; Afsana Afrin, MPH²²; Shams El Arifeen, DrPH²²; Rajib Biswas, MBBS²²; Emily S. Gurley, PhD²³; Mohammad Zahid Hossain, PhD²²; Soter Ameh, PhD²⁴^,25^,26; Ima-Abasi Bassey, MBBCh²⁴^,27; Erick Kaluma, MPH²⁴; Dickens Kowuor, MSc²⁴; Ikechukwu Udo Ogbuanu, MD, PhD²⁴^,28; Julu Bhatnagar, PhD²⁹; Dianna M. Blau, DVM, PhD¹; Kevin R. Clarke, MD¹; Maureen H. Diaz, PhD³⁰; Michelle Dynes, PhD³¹; Jennifer Kasten, MD²⁹; Roosecelis B. Martines, MD³⁰; Lesley McGee, PhD³⁰; Diane F. Morof, MD³²; Elizabeth O’Mara Sage, PhD¹; Pratima L. Raghunathan, PhD¹; Jana Ritter, DVM²⁹; Wun-Ju Shieh, MD, PhD²⁹; Allan W. Taylor, MD¹; Srinivasan Velusamy, PhD³⁰; Jennifer R. Verani, MD³⁰; Ashutosh Wadhwa, PhD³³; Jessica L. Waller, MS³⁰; Jonas Winchell, PhD³⁰; Jacob S. Witherbee, MPH³⁰; Mary-Claire Worrell, MPH³⁴; Victor Akelo, MD³⁵; Jeffrey P. Koplan, MD³; Robert F. Breiman, MD³^,28; Cynthia G. Whitney, MD³⁶

Problem/Condition: Sub-Saharan Africa and South Asia have the highest rates of stillbirths and rates of death among children aged <5 years, with many countries in those regions unlikely to meet the 2030 goal of ending preventable deaths among newborns and children aged <5 years. Conventional mortality surveillance (determining cause of death…
Post-mortem study of endemic human coronaviruses (HCoV-NL63, OC43, 229E and HKU-1) in deaths of children under five in low- and middle-income countries: Findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) study

Vicky Baillie

Bangladesh, Ethiopia, Kenya, Mozambique, Nigeria, Pakistan, Sierra Leone, and South Africa

Journal of Clinical Virology

2025

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Baillie, V., Dangor, Z., Blau, D. M., Mahtab, S., Du Toit, J., Assefa, N., Oundo, J., Kidanemariam, Z. T., Scott, J. A. G., Ameh, S., Ogbuanu, I. U., Ojulong, J., Bunn, J., Kotloff, K. L., Sow, S. O., Tapia, M. D., Keita, A. M., Garrine, M., Mandomando, I., . . . Madhi, S. A. (2025). Post-mortem study of endemic human coronaviruses (HCoV-NL63, OC43, 229E and HKU-1) in deaths of children under five in low- and middle-income countries: Findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) study. Journal of Clinical Virology, 178, 105804. https://doi.org/10.1016/j.jcv.2025.105804

Background:Endemic human coronaviruses (HCoV-229E, HKU1, NL63, and OC43) are common causes of mild or asymptomatic respiratory infections in children but are considered rare causes of death.Methods:We evaluated pediatric deaths from January 2017 through December 2022. A panel of experts determined the cause of death (CoD) by reviewing available data, including…
Adherence to Perinatal Asphyxia or Sepsis Management Guidelines in Low- and Middle-Income Countries

Rahman A

Multiple sites

JAMA Network Open

2025

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Rahman, A., Ray, M., Madewell, Z. J., Igunza, K. A., Akelo, V., Onyango, D., Murila, F., Mwebia, W., Ogbuanu, I. U., Ojulong, J., Kowuor, D., Kaluma, E., Samura, S., El Arifeen, S., Gurley, E. S., Hossain, M. Z., Islam, K. M., Biswas, R., Assefa, N., . . . Rees, C. A. (2025). Adherence to perinatal asphyxia or sepsis management guidelines in low- and middle-income countries. JAMA Network Open, 8(5), e2510790. https://doi.org/10.1001/jamanetworkopen.2025.10790

Key Points Question Do neonates who die of perinatal asphyxia or sepsis in low- and middle-income countries receive guideline-adherent clinical care? Findings In this cross-sectional study of 1194 neonates who died, less than 5% of those who died with perinatal asphyxia received all recommended clinical care, and 61% of those who died…
A comparison of all-cause and HIV cause-specific mortality among children under 5 years of age before and during COVID-19 in Kenya, 2018–2022

Susan Gachau

Kenya

PLOS Global Public Health

2025

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Gachau, S., Akelo, V., Cleveland, A., Were, J., Khagayi, S., Kwaro, D., Taegtmeyer, M., Obor, D., Igunza, A., Munga, S., Omore, R., Misore, T., Aol, G., Onyango, D., Tippett Barr, B. A., & Joseph, R. (2025). A comparison of all-cause and HIV cause-specific mortality among children under 5 years of age before and during COVID-19 in Kenya, 2018–2022. PLOS Global Public Health, 5(5), e0004338. https://doi.org/10.1371/journal.pgph.0004338

The impact of the COVID-19 pandemic on pediatric mortality, including measures to ensure continuity of HIV care, is not well described in Kenya. We evaluated causes of death (COD) among decedents under 5 years of age both before and during the COVID-19 pandemic in Kenya. We analyzed Child Health and…
Importance of postmortem anthropometric evaluation in defining the role of malnutrition as a cause of infant and child deaths in Sub-Saharan Africa and South Asia: a cohort study

Priya Mehta-Gupta Das

Network-wide (all sites)

BMJ Journal

2025

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Das, P. M., Madewell, Z. J., Blau, D. M., Whitney, C.G., Ramakrishnan, U, Stein, A.D., Young, M.F, & Suchdev, P.S. (2025). Importance of postmortem anthropometric evaluation in defining the role of malnutrition as a cause of infant and child deaths in Sub-Saharan Africa and South Asia: a cohort study. BMJ Open, 15(e089874). https://doi.org/10.1136/bmjopen-2024-089874

Objectives: To evaluate how postmortem anthropometric malnutrition (PAM) measures align with expert panel attribution of malnutrition as a causal or significant condition in under-5 mortality (U5M). Design: Cohort study using data from the Child Health and Mortality Prevention Surveillance network, incorporating clinical records, postmortem anthropometrics, minimally invasive tissue sampling, clinical abstraction and…

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Causes of Death Among Stillbirths and Children Aged <5 Years in Africa and South Asia — Child Health and Mortality Prevention Surveillance, Seven Countries, 2016–2024

Post-mortem study of endemic human coronaviruses (HCoV-NL63, OC43, 229E and HKU-1) in deaths of children under five in low- and middle-income countries: Findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) study

Adherence to Perinatal Asphyxia or Sepsis Management Guidelines in Low- and Middle-Income Countries

A comparison of all-cause and HIV cause-specific mortality among children under 5 years of age before and during COVID-19 in Kenya, 2018–2022

Importance of postmortem anthropometric evaluation in defining the role of malnutrition as a cause of infant and child deaths in Sub-Saharan Africa and South Asia: a cohort study