Data on enrolled populations
Enrolled Populations data provide the number of cases that were enrolled in the surveillance program and of which the minimally invasive tissue sampling (MITS) procedure and laboratory investigations was performed to determine the cause of death for children under five years of age. The data is broken down by site, age and sex, and the date the protocol was performed. The data can also be filtered by CHAMPS site, sex of the child, age range, location of death, source of death notification, and time period.
Understanding the Data
Mortality Coding Background
Members of Determination of Cause of Death, or DeCoDe, panels at each CHAMPS site review all data available for each death and follow WHO guidance to attribute causes of death. These procedures include using ICD-10 (10th International Statistical Classification of Diseases and Related Health Problems) to classify conditions and recording causes of death in a format matching WHO’s death certificate. In some situations, a death will have an immediate cause (lower respiratory infection, for example) that occurred in an otherwise healthy child. In these situations, the immediate and underlying cause of death will be the same. In other situations, a death may have an immediate cause (lower respiratory infection, for example) that occurred as a consequence of a child having other diseases (HIV infection, for example). In this case, the condition that originally existed that gave rise to one or more complications that led to death is known as the underlying cause of death. Comorbid conditions are those that may have contributed to the cause of death, but not directly. CHAMPS records immediate and underlying causes of death and comorbid conditions. In rare cases, the data available to DeCoDe panels are not adequate to determine a cause of death with any certainty. In these situations, the cause of death is recorded as undetermined.
For stillbirths and newborns, causes of death are often related to conditions affecting the mother or complications of childbirth or preterm birth. For these situations, CHAMPS uses a WHO application of ICD-10 for the perinatal period, ICD-PM. Because deaths in young infants may be attributed to both perinatal causes and conditions that arise after birth, CHAMPS is working to standardize procedures for deaths occurring in this age group. In situations where ICD-10 and ICD-PM codes are inconsistent, ICD-PM principles will be applied. Note that results may change as data are updated and coding procedures become more refined.
Data Collection Methods
If a case meets CHAMPS eligibility criteria, the team seeks informed consent from the parents or guardians to further investigate the cause of death through the postmortem minimally invasive tissue sampling (MITS) procedure and laboratory investigations. The laboratory investigations include microbiology, HIV, tuberculosis and malaria testing. Additional advanced diagnostics include multiplex molecular testing for many specific viral, bacterial, fungal and parasitic pathogens as well as tissue histopathology. The site teams also request consent to perform caregiver interviews, known as verbal autopsies, to explore the symptoms and conditions that may have led to the child’s death, and to collect any clinical records. Families are free to decide whether to take part in the procedures.
For those cases in which families grant consent and the MITS procedure has been performed, completing the tests and assembling the information requires 4 months. Then, an expert panel reviews all laboratory, clinical and verbal autopsy information on each case and assigns a final cause of death. This final cause of death is then provided to the family members.
Things to Note
Only a fraction of child deaths occurring in CHAMPS sites are reflected; the numbers are not adjusted for deaths in children not enrolled or for population size. No conclusions should be made about the overall contribution of each cause to total deaths for a CHAMPS site or other population.
Data that contribute to CHAMPS cause of death determinations are complex, and we're learning how expert panels should interpret it to assign causes of death. How we report the chain of causation will likely change over time.
Results presented here will change as the CHAMPS team refines methods and cleans data. If you find information that appears incorrect or confusing, contact us.