011 - MULTI-CENTRE CHILD HEALTH AND MORTALITY PREVENTION SURVEILLANCE (CHAMPS):DEFINING THE ROLE OF PNEUMONIA IN CASUAL PATHWAY TO DEATH AMONG 1-59-MONTH-OLD CHILDREN IN AFRICA AND SOUTH ASIA. (ID 294)
- Sana Mahtab (South Africa)
- Dianna M. Blau (United States of America)
- Nana B. Thwala (South Africa)
- Vicky L. Baillie (South Africa)
- Ashleigh Fritz (South Africa)
- Dickens Onyango (Kenya)
- Beth Barr (Kenya)
- Inacio Mandomando (Mozambique)
- Quique Bassat (Spain)
- Ikechukwu U. Ogbuanu (Sierra Leone)
- Samba Sow (Mali)
- Karen L. Kotloff (United States of America)
- Nega Assefa (Ethiopia)
- J. Anthony .G. Scott (Kenya)
- Lola Madrid (United Kingdom)
- Shams El Arifeen (Bangladesh)
- Emily S. Gurley (United States of America)
- Cynthia Whitney (United States of America)
- Shabir A. Madhi (South Africa)
Abstract
Background
Traditionally, childhood cause of death (CoD) estimates rely on non-specific verbal autopsy and vital registration data, mainly focussing on the underlying (i.e. predisposing) illness. We describe initial findings from CHAMPS on the broader role of pneumonia role in the casual pathway to death among children 1-59 months age from Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa.
Methods
Post-mortem evaluations include minimal invasive tissue sampling (MITS) from blood, brain, cerebrospinal fluid, liver and lung. Specimens undergo tissue histopathology, molecular organism detection and bacterial culture. Expert panels use MITS findings, ante-mortem clinical data, and verbal autopsy to define the casual pathway to death, including underlying, co-morbid/antecedent and immediate causes.
Results
Of 594 deaths occurring between December 2016 and February 2020 among 1–59-month-olds, pneumonia was determined to be in the causal pathway of 273 (46%, median age 8.4 months), including n=54 (9.1%), n=128 (22%) and n=108 (18%) with pneumonia as the underlying, immediate, and antecedent cause of death; 17 deaths had >1 LRTI episodes attributed as an underlying, immediate or antecedent cause. Underlying conditions in deaths with pneumonia as an immediate or co-morbid cause (N=236) included severe malnutrition (20%), HIV (18%), congenital abnormalities (14%), low birth weight/preterm birth complications (9%), gastroenteritis (6%), sepsis (5%), injury (4%) and malaria (3%).
Conclusions
In low-middle income settings with high under-5 morality, pneumonia contributes to CoD in 1 of every 2 children who die, highlighting the need for better pneumonia prevention and treatment strategies.
