CHAMPS Methodology

Mortality Coding Background

The World Health Organization (WHO) has established coding rules to ensure consistency in recording and classifying child causes of death worldwide. At each CHAMPS site, Determination of Cause of Death (DeCoDe) panels follow WHO guidelines to attribute child mortality using the ICD-11 classification system (11th International Statistical Classification of Diseases and Related Health Problems). This ensures that child mortality data are recorded in a globally comparable format. For each child death, the immediate and underlying causes are identified. For example, a child with a lower respiratory infection may have that condition recorded as the immediate cause of death. If the child also had HIV, the underlying cause would be attributed to that preexisting condition. In cases where comorbid conditions contribute to but don’t directly cause death, CHAMPS captures those as well. 

In some cases, data may be insufficient to determine a cause of death with certainty. These deaths are classified as undetermined. For stillbirths and infant deaths, often resulting from maternal conditions or childbirth complications, CHAMPS follows the WHO’s ICD-PM (Perinatal Mortality) classification, particularly where perinatal and post-birth causes overlap. By using this framework, CHAMPS ensures accurate, standardized documentation of child causes of death, providing critical data for driving pediatric health interventions and saving children’s lives. As we continue to refine our procedures and update data, CHAMPS remains committed to improving child health outcomes.

Data Collection Methods

At CHAMPS surveillance sites, we implement efficient notification systems that report all under-5 child deaths and stillbirths to the local team within 24 hours. Our dedicated site teams promptly review each notification and reach out to families of selected cases to determine eligibility based on CHAMPS criteria.

If eligible, the team seeks informed consent from the parents or guardians to investigate the cause of death through minimally invasive tissue sampling (MITS) and laboratory investigations. These tests include microbiology, HIV, tuberculosis, and malaria, along with advanced diagnostics for various pathogens and tissue histopathology. We also request consent to conduct caregiver interviews, known as verbal autopsies, to gather insights into the child’s symptoms and conditions leading to child death, ensuring we collect all relevant clinical records.

For cases where families grant consent MITS is performed, it typically takes four months to complete testing and compile information. An expert panel then reviews the results, assigning a final cause of death, which is shared with the family. Through this meticulous process, CHAMPS strives to provide critical child health statistics that inform pediatric health interventions, ultimately contributing to our mission of saving children’s lives.

Things to Note

At CHAMPS, our sites are continuously entering and transmitting vital data, which means some recent information may be incomplete or pending quality review.  It’s important to note that only some some of the stillbirths and child deaths occurring in CHAMPS sites are reflected in our reports, with the number enrolled linked to timing of burials and CHAMPS teams’ ability to identify deaths quickly enough. The data
presented is not adjusted for deaths in children who are not enrolled or for overall population size. Consequently, any conclusions about the overall contribution of each child mortality cause to total deaths at a CHAMPS site or any other population should be made with caution. Please contact us with questions or feedback.