Millions of young lives have been saved over the last 20 years due to advances in global health, but too many children are still dying of preventable causes. This was the topic of discussion – and call to action – of a recent discussion, led by CHAMPS and its partners, at the annual American Society of Tropical Medicine and Hygiene (ASTMH) Conference in Atlanta, Georgia.
“In some parts of Sub-Saharan Africa, more than 150 out of every 1,000 children don’t make it to their fifth birthday. Compare that to countries like Finland, where the mortality rate is only two in 1, 000,” said Dr. Robert Breiman, Co-Principal Investigator for CHAMPS and Director of the Emory Global Health Institute. “We are impatient to get more parity and get mortality rates closer to what we know they could be.”
To date, efforts to reduce under-five child mortality even more dramatically have been hampered by lack of understanding of why children are getting sick and dying. Existing data regarding causes of child mortality – especially in low-income countries where rates are highest – are typically based on estimates and are often incomplete, of low quality and not timely enough to be used for lifesaving public health policies and actions. These challenges are often complicated by limited clinical and diagnostic information.
During their session at the ASTMH Conference, researchers from multiple countries – including Mozambique, Spain and the United States – highlighted a promising innovation designed to yield high-quality evidence on cause of death. This innovation, called Minimally Invasive Tissue Sampling (MITS), is a way that health practitioners can collect post-mortem specimens through a non-disfiguring clinical procedure.
“Estimating the cause of death in low-resource settings is challenging; in Sub-Saharan Africa, less than five percent of deaths are medically certified. Most deaths are undetected, and most causes are unknown,” said Dr. Quique Bassat, Associate Research Professor at the University of Barcelona. “A complete diagnostic autopsy (CDA) is indisputably the gold standard for cause of death determination but, in some Sub-Saharan African countries, there are literally no pathologists.”
MITS, which involves using needles to extract small samples of tissue from key organs, is being evaluated as an alternative to CDAs. It is a less resource-intensive and more culturally acceptable method that can be performed at local hospitals and health clinics, and even in community settings such as homes.
Effectiveness of MITS was examined during the recent Cause of Death and Minimally Invasive Autopsies (CaDMIA) project, funded by the Bill & Melinda Gates Foundation. CaDMIA revealed that the use of MITS is comparable to CDA in determining cause of death. According to Dr. Jaume Ordi, Research Professor at the University of Barcelona, CDAs were able to determine the cause of death in 54 out of 54 cases in under-five children, while MITS were able to determine cause of death in 52 of 54 cases – 96.3 percent.
While a promising development in data collection to help save young lives, the idea of MITS must still be acceptable to communities where such activities will take place. For the CaDMIA study, Dr. Khátia Munguambe – Social and Behavioral Sciences Lead for CHAMPS – conducted ethnographic research to understand the perspectives of local populations in Mozambique around death, as well as openness to MITS. Through interviews and other interactions with 504 community members, health professionals and others, Dr. Munguambe found a 73 percent acceptability of MITS. She also discovered that an additional 14 percent of participants would agree to MITS for a recently deceased family member, provided that it didn’t violate religious beliefs or go against cultural norms.
Other speakers at the ASTMH session included Dr. Clara Menéndez, Research Professor at the University of Barcelona, and Dr. Pratima Raghunathan, CHAMPS’s Director for Science.
CHAMPS is building on learnings from CaDMIA and other studies to expand on cause of death determination through MITS, as well as rapid flow of accurate data to influence local, national and global health policies and actions. Combining community engagement, health surveillance techniques, advanced laboratory and diagnostic methods, and MITS, CHAMPS will operate across a network of up to 20 sites over a 20-year period, working with partners across the world to help end preventable child mortality.