Burden of child mortality from malaria in high endemic areas: results from the CHAMPS Network using minimally invasive tissue sampling

Ogbuanu, Ikechukwu U., Otieno, Kephas, Varo, Rosauro, Sow, Samba O., Ojulong, Julius, Duduyemi, Babatunde, Kowuor, Dickens, Cain, Carrie Jo, Rogena, Emily A., Onyango, Dickens, Akelo, Victor, Tippett Barr, Beth A., terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617, Kotloff, Karen L., Tapia, Milagritos D., Keita, Adama Mamby, Juma, Jane, Assefa, Nega, Assegid, Nardos, Acham, Yenework, Madrid, Lola, Scott, J. Anthony G., Arifeen, Shams El, Gurley, Emily S, Mahtab, Sana, Dangor, Ziyaad, Wadula, Jeannette, Dutoit, Jeanie, Madhi, Shabir A., Mandomando, Inácio, Torres-Fernandez, David, Kincardett, Milton, Mabunda, Rita, Mutevedzi, Portia, Madewell, Zachary J., Blau, Dianna M., Whitney, Cynthia G., Samuels, Aaron M. and Bassat, Quique (2024) 'Burden of child mortality from malaria in high endemic areas: results from the CHAMPS Network using minimally invasive tissue sampling'. Journal of Infection, Vol 88, Issue 3, p. 106107.

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Abstract

Background
Malaria is a leading cause of childhood mortality worldwide. However, accurate estimates of malaria prevalence and causality among patients who die at the country level are lacking due to the limited specificity of diagnostic tools used to attribute etiologies. Accurate estimates are crucial for prioritizing interventions and resources aimed at reducing malaria-related mortality.

Methods
Seven Child Health and Mortality Prevention Surveillance (CHAMPS) Network sites collected comprehensive data on stillbirths and children <5 years, using minimally invasive tissue sampling (MITS). A DeCoDe (Determination of Cause of Death) panel employed standardized protocols for assigning underlying, intermediate, and immediate causes of death, integrating sociodemographic, clinical, laboratory (including extensive microbiology, histopathology, and malaria testing), and verbal autopsy data. Analyses were conducted to ascertain the strength of evidence for cause of death (CoD), describe factors associated with malaria-related deaths, estimate malaria-specific mortality, and assess the proportion of preventable deaths.

Findings
Between December 3, 2016, and December 31, 2022, 2673 deaths underwent MITS and had a CoD attributed from four CHAMPS sites with at least 1 malaria-attributed death. No malaria-attributable deaths were documented among 891 stillbirths or 924 neonatal deaths, therefore this analysis concentrates on the remaining 858 deaths among children aged 1-59 months. Malaria was in the causal chain for 42.9% (126/294) of deaths from Sierra Leone, 31.4% (96/306) in Kenya, 18.2% (36/198) in Mozambique, 6.7% (4/60) in Mali, and 0.3% (1/292) in South Africa. Compared to non-malaria related deaths, malaria-related deaths skewed towards older infants and children (p<0.001), with 71.0% among ages 12-59 months. Malaria was the sole infecting pathogen in 184 (70.2%) of malaria-attributed deaths, whereas bacterial and viral co-infections were identified in the causal pathway in 24·0% and 12.2% of cases, respectively. Malnutrition was found at a similar level in the causal pathway of both malaria (26.7%) and non-malaria (30.7%, p=0.256) deaths. Less than two-thirds (164/262; 62.6%) of malaria deaths had received antimalarials prior to death. Nearly all (98·9%) malaria-related deaths were deemed preventable.

Interpretation
Malaria remains a significant cause of childhood mortality in the CHAMPS malaria-endemic sites. The high bacterial co-infection prevalence among malaria deaths underscores the potential benefits of antibiotics for severe malaria patients. Compared to non-malaria deaths, many of malaria-attributed deaths are preventable through accessible malaria control measures.

Funding
This work was supported by the Bill & Melinda Gates Foundation [OPP1126780].

Item Type:	Article
Subjects:	WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria WS Pediatrics > WS 20 Research (General) WS Pediatrics > Diseases of Children and Adolescents > General Diseases > WS 200 General works
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1016/j.jinf.2024.01.006
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	06 Feb 2024 11:46
Last Modified:	20 Mar 2024 15:16
URI:	https://archive.lstmed.ac.uk/id/eprint/23936

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