How au­top­sies can save chil­dren’s lives

Financial Mirror (Cyprus) - - FRONT PAGE -

In an age in which data are more plen­ti­ful and ac­ces­si­ble than ever be­fore, we are ac­cus­tomed to bas­ing our de­ci­sions on as much ev­i­dence as we can gather. The more im­por­tant the de­ci­sion, the keener we are to en­sure that our re­search is thor­ough and our in­for­ma­tion is ac­cu­rate.

And yet, when it comes to what is ar­guably one of the most im­por­tant de­ci­sions we face to­day, we have very lit­tle data. As part of the Sus­tain­able De­vel­op­ment Goals, adopted by the United Na­tions last Septem­ber, the in­ter­na­tional com­mu­nity has pledged to end pre­ventable deaths of chil­dren un­der the age of five by 2030. And yet, in the re­gions with the high­est mor­tal­ity rates, we lack the most ba­sic in­for­ma­tion about why chil­dren die. We know that in­fec­tious dis­eases cause the most deaths, but we do not know which ones. When it comes to de­cid­ing how best to al­lo­cate our re­sources, we are ef­fec­tively fly­ing blind.

Since 1990, we have halved child mor­tal­ity world­wide; but nearly six mil­lion chil­dren un­der the age of five still die from pre­ventable causes. Four out of five child deaths oc­cur in Sub-Sa­ha­ran Africa or South Asia, re­gions where there are few doc­tors and even fewer pathol­o­gists. Stan­dard med­i­cal in­ves­ti­ga­tions of the causes of death are rare. In many cases, there is no of­fi­cial death record at all.

When the cause of death is in­ves­ti­gated, it is al­most ex­clu­sively through a “ver­bal au­topsy.” Par­ents are asked, typ­i­cally three months af­ter their loss, about the cir­cum­stances sur­round­ing their child’s death. But while they may be able to re­port that their baby suf­fered from rapid breath­ing or di­ar­rhea, they have no way of iden­ti­fy­ing the cause of th­ese symp­toms.

The prob­lem is ag­gra­vated when it comes to the nearly 45% of deaths that oc­cur dur­ing the first month of life. In th­ese cases, the cause of death is of­ten recorded sim­ply as a “neona­tal death,” a la­bel that pro­vides no hint as to what caused the ill­ness. This in­for­ma­tion is use­less and can­not help pre­vent other fam­i­lies from suf­fer­ing the same tragedy.

Ex­pe­ri­ence from suc­cess­ful health cam­paigns, such as erad­i­cat­ing po­lio or con­trol­ling Ebola, shows that while early progress can be achieved rel­a­tively eas­ily, last­ing re­sults re­quire enor­mous ef­forts and very ac­cu­rate sur­veil­lance data. It is to col­lect this cru­cial in­for­ma­tion that the Child Health and Mor­tal­ity Preven­tion Sur­veil­lance – or CHAMPS – pro­gramme has been launched.

The CHAMPS pro­gramme – a long-term ini­tia­tive led by the Emory Global Health In­sti­tute, with part­ners in­clud­ing the In­ter­na­tional As­so­ci­a­tion of Na­tional Pub­lic Health In­sti­tutes, US Cen­tres for Dis­ease Con­trol and Preven­tion, and the Task Force for Global Health – even­tu­ally will in­volve some 20 sites in ar­eas with the high­est child mor­tal­ity rates. This will al­low us to record causes of death more ac­cu­rately and track progress as vac­ci­na­tion cam­paigns and other mea­sures are in­tro­duced.

Th­ese sites will rely on a new tech­nique that al­lows tiny sam­ples of key or­gans, such as the liver or lungs, to be ex­tracted with a nee­dle, caus­ing min­i­mal dam­age to the body of a de­ceased child. The sam­ples will then be sent for anal­y­sis to strength­ened lo­cal labs and ref­er­ence cen­tres to pro­vide a more ac­cu­rate and com­plete pic­ture of all causes of death.

There are many pos­si­ble in­ter­ven­tions – such as pro­vid­ing folic acid to pre­vent birth de­fects, in­tro­duc­ing new vac­cines, or treat­ing in­fec­tions ear­lier – that we know could have an im­pact on child mor­tal­ity. CHAMPS will pro­vide the in­for­ma­tion needed to pri­ori­tise th­ese mea­sures.

Fur­ther­more, each site will help build the

ca­pac­ity

of part­ner coun­tries’ pub­lic health sys­tems, pro­vid­ing valu­able data and tech­ni­cal sup­port that will have an im­pact far be­yond help­ing to re­duce child mor­tal­ity. For ex­am­ple, the sur­veil­lance cen­tres will gen­er­ate the data needed to tackle in­fec­tious dis­eases, pro­vide early warn­ing of epi­demics, and gen­er­ally im­prove global health.

The CHAMPS ini­tia­tive is still in its early days. The sites – six of which are be­ing funded by the Bill & Melinda Gates Foun­da­tion through an ini­tial $73 mil­lion grant for the first three years – are just be­ing es­tab­lished. More part­ners and more fund­ing will be needed to ex­pand the net­work and main­tain it over the long term. And it will take time for the ben­e­fits to be­come clear.

But early re­sults are en­cour­ag­ing. Wor­ries that par­ents would be re­luc­tant to al­low post-mortem tests on their chil­dren have proved un­founded. On the con­trary, our ex­pe­ri­ence so far shows that par­ents are very in­ter­ested in find­ing out what killed their chil­dren. At a well-es­tab­lished pi­lot site in Soweto, South Africa, both moth­ers and fa­thers are re­turn­ing to learn the re­sults of the test­ing – an un­prece­dented level of in­ter­est.

I be­lieve that CHAMPS’ work may have the great­est im­pact of any­thing in which I have been in­volved in my 20 years in pub­lic health. By ac­cu­rately track­ing the causes of child mor­tal­ity, we can tar­get treat­ments more pre­cisely and usher in a new era – one in which pre­ventable child deaths re­ally will be a thing of the past.

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