{
  "abstract": "Objectives To describe (1) the proportion of deaths that were in recently hospitalised children and (2) causes of mortality among deceased children aged 0–59 months with preceding hospitalisations who enrolled in a mortality surveillance programme.Design Descriptive study using prospectively collected data.Setting Eight Child Health and Mortality Prevention Surveillance (CHAMPS) community and healthcare sites in sub-Saharan Africa and South Asia.Participants Deaths among children aged 0–59 months enrolled in CHAMPS 2016–2023.Interventions None.Primary and secondary outcome measures Deaths with antecedent hospitalisations within 180 days of death. Causes of death determined by expert panels who reviewed clinical data and histopathologic and microbiologic results from postmortem minimally invasive tissue sampling.Results CHAMPS enrolled 8548 deaths; we excluded 3688 neonates who died before discharge or ≤24 hours of birth and 482 with unclear information on antecedent hospitalisations. Out of the 4378 remaining deaths, 16.7% (95% CI 15.7% to 17.9%) were deaths that occurred within 180 days of a hospitalisation (n=733/4378). Of these, 55.7% (95% CI 52.0% to 59.3%) occurred outside healthcare facilities. Among included deaths with minimally invasive tissue sampling completed (n=337), lower respiratory tract infections (41.2%, 95% CI 36.0% to 46.7%), sepsis (39.8%, 95% CI 34.5% to 45.2%) and undernutrition (n=92, 27.3%, 95% CI 22.7% to 32.4%) were most common causes of death among cases with antecedent hospitalisations. The greatest proportion of deaths with antecedent hospital admissions occurred among cases aged 1–11 months (48.0%, 95% CI 44.4% to 51.7%), compared with those aged 0–1 months (21.7%, 95% CI 18.8% to 24.9%) and those aged 1–5 years (30.3%, 95% CI 27.0% to 33.8%). Moreover, the greatest proportion of deaths with antecedent hospital admissions occurred among infants/children with weight-for-age Z-score of <−3 (62.5%, 95% CI 56.5% to 68.0%) compared with those with weight-for-age Z-score of ≥−3 (37.5%, 95% CI 32.0% to 43.5%).Conclusions We observed a high proportion of deaths with antecedent hospitalisations within 180 days among young children across eight sites in sub-Saharan Africa and Asia. Among those deaths, children aged 1–11 months and undernourished infants were over-represented, suggesting early follow-up as a potential point to focus targeted support and future research.",
  "authors": [
    {
      "affiliations": [
        "ISGlobal, Barcelona, Spain",
        "Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique",
        "Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain",
        "Institut de Recerca Sant Joan de Deu, Hospital Sant Joan de Deu, Barcelona, Spain"
      ],
      "name": "Rosauro Varo"
    },
    {
      "affiliations": [
        "Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Kaitlin Cole"
    },
    {
      "affiliations": [
        "Global Health Center, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA"
      ],
      "name": "Zachary J Madewell"
    },
    {
      "affiliations": [
        "ISGlobal, Barcelona, Spain"
      ],
      "name": "Jaime Fanjul Iglesias"
    },
    {
      "affiliations": [
        "Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya"
      ],
      "name": "Kitiezo Aggrey Igunza"
    },
    {
      "affiliations": [
        "Liverpool School of Tropical Medicine, Liverpool, UK"
      ],
      "name": "Victor Akelo"
    },
    {
      "affiliations": [
        "Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya"
      ],
      "name": "Christopher Mugah"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Kisumu County Department of Health, Kisumu, Kenya"
      ],
      "name": "Dickens Onyango"
    },
    {
      "affiliations": [
        "Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya"
      ],
      "name": "Joyce A Were"
    },
    {
      "affiliations": [
        "South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa",
        "Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"
      ],
      "name": "Shabir A Madhi"
    },
    {
      "affiliations": [
        "South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"
      ],
      "name": "Ziyaad Dangor"
    },
    {
      "affiliations": [
        "South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"
      ],
      "name": "Siobhan Johnstone"
    },
    {
      "affiliations": [
        "Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"
      ],
      "name": "Sanjay G Lala"
    },
    {
      "affiliations": [
        "South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa"
      ],
      "name": "Tanya Ruder"
    },
    {
      "affiliations": [
        "Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique"
      ],
      "name": "Inacio Mandomando"
    },
    {
      "affiliations": [
        "Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique"
      ],
      "name": "Milton Kincardett"
    },
    {
      "affiliations": [
        "Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique"
      ],
      "name": "Elisio G Xerinda"
    },
    {
      "affiliations": [
        "Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK"
      ],
      "name": "J Anthony G Scott"
    },
    {
      "affiliations": [
        "Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK",
        "College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia"
      ],
      "name": "Nega Assefa"
    },
    {
      "affiliations": [
        "Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK",
        "College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia"
      ],
      "name": "Lola Madrid"
    },
    {
      "affiliations": [
        "College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia"
      ],
      "name": "Faisel A Hassen"
    },
    {
      "affiliations": [
        "College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia"
      ],
      "name": "Yunus Edris"
    },
    {
      "affiliations": [
        "Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA",
        "CHAMPS Sierra Leone, The Africa Research Collaborative, Freetown, Sierra Leone"
      ],
      "name": "Ikechukwu Ogbuanu"
    },
    {
      "affiliations": [
        "CHAMPS Sierra Leone, The Africa Research Collaborative, Freetown, Sierra Leone"
      ],
      "name": "Ima-Abasi Bassey"
    },
    {
      "affiliations": [
        "World Hope International, Freetown, Sierra Leone"
      ],
      "name": "Solomon Samura"
    },
    {
      "affiliations": [
        "World Hope International, Freetown, Sierra Leone"
      ],
      "name": "Abdul Salaam Sillah"
    },
    {
      "affiliations": [
        "Emory University Rollins School of Public Health, Atlanta, Georgia, USA"
      ],
      "name": "Erick Kaluma"
    },
    {
      "affiliations": [
        "International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh"
      ],
      "name": "Shams El Arifeen"
    },
    {
      "affiliations": [
        "International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh"
      ],
      "name": "Rajib Biswas"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"
      ],
      "name": "Emily S Gurley"
    },
    {
      "affiliations": [
        "International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh"
      ],
      "name": "Afruna Rahman"
    },
    {
      "affiliations": [
        "International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh"
      ],
      "name": "Mohammad Zahid Hossain"
    },
    {
      "affiliations": [
        "Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA"
      ],
      "name": "Saad B Omer"
    },
    {
      "affiliations": [
        "Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi City, Pakistan"
      ],
      "name": "Abdul Momin Kazi"
    },
    {
      "affiliations": [
        "Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi City, Pakistan"
      ],
      "name": "Sameer M Belgaumi"
    },
    {
      "affiliations": [
        "Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi City, Pakistan"
      ],
      "name": "Raheel Allana"
    },
    {
      "affiliations": [
        "Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali"
      ],
      "name": "Adama M Keita"
    },
    {
      "affiliations": [
        "ISGlobal, Barcelona, Spain",
        "Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique",
        "Institut de Recerca Sant Joan de Deu, Hospital Sant Joan de Deu, Barcelona, Spain",
        "ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain",
        "Institut Clínic de Medicina I Dermatologia, Hospital Clínic de Barcelona, Barcelona, Spain",
        "Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain"
      ],
      "name": "Quique Bassat"
    },
    {
      "affiliations": [
        "Task Force for Global Health, Atlanta, Georgia, USA"
      ],
      "name": "Portia C Mutevedzi"
    },
    {
      "affiliations": [
        "Task Force for Global Health, Atlanta, Georgia, USA"
      ],
      "name": "Cynthia G Whitney"
    },
    {
      "affiliations": [
        "Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Chris A Rees"
    },
    {
      "affiliations": [],
      "name": "On behalf of the Child Health and Mortality Prevention Surveillance (CHAMPS) Network"
    }
  ],
  "title": "Deaths with preceding hospitalisations within 180 days in eight countries in sub-Saharan Africa and South Asia: A secondary descriptive analysis of the Child Health and Mortality Prevention Surveillance (CHAMPS) network",
  "uid": "1fc53cab-663f-5743-b523-9e388255e3ac"
}