Major Causes of Perinatal and Paediatric Mortality in Sub‐Saharan Africa and South Asia: Adjustment for Selection Bias in the CHAMPS Network
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Studies of child mortality that employ minimally invasive tissue sampling (MITS) produce highly accurate cause of death data; however, selection bias may render these as non-representative of their underlying populations. OBJECTIVES: Estimate cause-specific mortality fractions and rates for the five most frequent causes-underlying and others in the chain of events leading to death-among stillbirths, neonatal, infant and child deaths-in Sub-Saharan Africa and South Asia, adjusted for any identified selection biases. METHODS: The Child Health and Mortality Prevention Surveillance (CHAMPS) Network collects standardised, population-based, longitudinal data on causes of death among stillbirths and under-five children in 12 catchments in seven countries in Sub-Saharan Africa and South Asia. Cause-specific mortality fractions and rates were calculated for the five most frequent causes among stillbirths, neonatal, infant and child deaths, and for the five most frequent maternal conditions among perinatal deaths; all estimates were subsequently adjusted for selection bias. Selection probabilities were estimated from membership in subgroups defined by factors hypothesised to affect selection. RESULTS: In 2017-2020, of 10,122 deaths ascertained, 5847 (57.8%) were enrolled in CHAMPS and 2654 (26.2%) additionally consented to MITS. Estimates were calculated for 265 and 65 site/age-specific causes of death and maternal conditions, respectively; five (1.9%) and four (6.2%) required adjustment, respectively, but they did not meaningfully change. Estimates were calculated for 34 site-specific causes of death among all stillbirths and under-five deaths combined; 28 (82.4%) required adjustment (all included age at death), and change-in-estimates demonstrated considerable variability. CONCLUSIONS: Selection bias is not a concern in the CHAMPS Network. Deaths where MITS were performed accurately represent the distribution of causes of death in their respective target populations, specifically when stratified by age or adjusted accordingly. Future studies of child mortality that employ MITS should consider adjusting for age at death for their measures of frequency.
DOI: 10.1111/ppe.70067
Authors: Kartavya J. Vyas, Jonathan A. Muir, Zachary J. Madewell, Priya M. Gupta, Dianna M. Blau, Shams E. Arifeen, Emily S. Gurley, Atique I. Chowdhury, Kazi M. Islam, Afruna Rahman, J. Anthony G. Scott, Nega Assefa, Lola Madrid, Yohanis A. Asefa, Yasir Y. Abdullahi, Dickens Onyango, Victor Akelo, Beth A. Tippett‐Barr, George Aol, Samba O. Sow, Karen L. Kotloff, Milagritos D. Tapia, Adama M. Keita, Kiranpreet Chawla, Quique Bassat, Inacio Mandomando, Ariel Nhacolo, Charfudin Sacoor, Ikechukwu Ogbuanu, Dickens Kowuor, Babatunde Duduyemi, Andrew Moseray, James S. Squire, Shabir Madhi, Sana Mahtab, Yasmin Adam, Amy Wise, Takwanisa Machemedza, Cynthia G. Whitney, the CHAMPS Network
Institutions: Emory University, United States Army, Emory Global Health Institute, Walter Reed Army Institute of Research, Centers for Disease Control and Prevention, Center for Global Health, International Centre for Diarrhoeal Disease Research, Johns Hopkins University, Haramaya University, London School of Hygiene & Tropical Medicine, Centers for Disease Control and Prevention, Kenya Medical Research Institute, KEMRI-Wellcome Trust Research Programme, University of Maryland, Baltimore, Hospital Clínic de Barcelona, Manhiça Health Research Centre, Barcelona Institute for Global Health, Universitat de Barcelona, Instituto Nacional de Saúde, South African Medical Research Council, University of the Witwatersrand
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,770
Funders: Bill and Melinda Gates Foundation, Emory University, Johns Hopkins University, Children's Healthcare of Atlanta, Haramaya University, Universitat de Barcelona, Addis Ababa University, International Centre for Diarrhoeal Disease Research, Bangladesh, Jomo Kenyatta University of Agriculture and Technology, Mekelle University, Sykehuset i Vestfold, Centers for Disease Control and Prevention, Johns Hopkins Bloomberg School of Public Health, National Center for Immunization and Respiratory Diseases
Award: G6416461065
OpenAlex ID: W4413991859