Worldwide, every day, 15,000 infants and young children die, with the majority of the deaths occurring in South Asia and Sub-Saharan Africa. However, as a session at the 2018 International Association of National Public Health Institutes (IANPHI) annual meeting highlighted, very little information is available regarding what actually caused or may have caused the deaths of individual children in these regions.

During the IANPHI meeting session focused on childhood mortality, representatives from the Child Health and Mortality Prevention Surveillance (CHAMPS) Network described how the project is gathering more accurate and precise information involving deaths in children under 5 years old in sites in South Asia and Sub-Saharan Africa. Presenters included Dr. Scott Dowell, Deputy Director for Surveillance and Epidemiology at the Bill & Melinda Gates Foundation, which funds CHAMPS, and Dr. Robert Breiman, the Executive Director of CHAMPS at the Emory University Global Health Institute. Directors or their representatives from National Public Health Institutes in South Africa, Ethiopia, and Mozambique also participated in session and described the value of CHAMPS cause of death information.

Dr. Dowell drew upon a trip he made in 2017 to a CHAMPS site in Mali to illustrate the importance of collecting more and better information on individual child deaths. During his visit to a local hospital, he witnessed an infant die in the hospital’s pediatric ward.

“I wondered what happened to that baby,” Dr. Dowell told those attending the session. “I imagine the baby was wrapped up and given to the mother with some explanation, such as ‘the baby was too small to live,’ ‘it had some sort of infections,’ or ‘it was God’s will.’ I don’t know what explanation would have been given, but there would have been little information about the (actual) cause of death.”

Dr. Dowell said a much different outcome would likely have occurred if the child’s death had occurred in a hospital in the United States.

“In the United States, the survival rate for a low birthweight baby is much higher than in Mali,” he said. “For an infant born at a weight of 1.5 kilos, like the baby in Mali, the survival rate is above 95%. Further, if a baby in the U.S. does die, there is a lot more information gathered – and possibly even an autopsy. But that is not the case in most of the places where CHAMPS is working. Right now, most babies in the developing world die like this baby died – with little information (gathered) about the cause of death.”

Children under the age of five die at a rate 15 times higher in Mali than the in United States, according to the World Bank.

“There is a big difference between knowing with some certainty the cause of death, and not really knowing at all. One leads to all kinds of possible actions, and the other leads to uncertainty about what to do to prevent child death.”           

– Dr. Scott Dowell, Deputy Director for Surveillance and Epidemiology, Bill and Melinda Gates Foundation

In his presentation, Dr. Breiman emphasized that achieving greater success in reducing early childhood mortality in South Asia and Sub-Saharan Africa requires more precise and accurate information on the causes of individual child deaths. In many cases, CHAMPS is uncovering and discovering causes and contributing causes of stillbirths and deaths in children under 5 years old that otherwise would have remained unknown.

“With CHAMPS cause of death information, local hospitals, clinics, and public health programs are better able to take actions to protect other infants and young children, and to do that more quickly,” Dr. Breiman said.

It was noted in the session that IANPHI is a major collaborator in the CHAMPS network. IANPHI’s involvement includes assisting national public health institutes (NPHIs) and ministries of health in developing the skills and using the tools needed to interpret and assess local CHAMPS data as well as how to use CHAMPS cause of death information to design or recommend community, public health, and national strategies and interventions to reduce child mortality.

It was also noted that as the CHAMPS network cause of data encompasses greater numbers of early childhood deaths, and is able to make more data available, IANPHI members, researchers, and global stakeholders will be better equipped to understand the factors causing or contributing to deaths among infants and young children. This, in turn, should help strengthen the design and targeting of interventions and actions to prevent future deaths and help save child lives.