Splashing about

To understand the causes of child deaths in order to implement appropriate child survival interventions in the country. We present a systematic review of studies reporting causes of child, infant, and neonatal deaths from India for 1985 to 2008. PubMed, EMBASE, Google Scholar, and WHO regional databases were searched along with a hand search and personal communication with researchers in child health to obtain studies and reports for the database. Study data was summarized and analyzed using appropriate statistical tools. We identified 28 published/unpublished studies and reports (6 multi-centric and 22 single sites). There was one nation wide study and rest were from 15 unique sites in 9 different states of India. There were differences in study design and cause of death assignment methods between the studies, which made comparisons and synthesis difficult. The median percentage of causes of deaths in neonatal period were sepsis/pneumonia: 24.9% (Q1: 19.6% and Q3: 33.4%); asphyxia: 18.5% (Q1: 14.2% and Q3: 21.9%); and pre-maturity/LBW: 16.8% (Q1: 12.5% and Q3: 26.5%). Amongst the infants, sepsis/pneumonia, asphyxia, and prematurity/low birth weight (LBW) remain substantial causes of deaths. The median proportional contribution of neonatal deaths to total infant deaths was 48.5% (Q1: 36.5-Q3: 57.5%). The proportion of deaths due to infectious diseases like diarrhoea, pneumonia, and measles seem to be greater in infancy, in comparison to that in neonatal period. There was no statistically significant difference in the proportional contribution of neonatal deaths to total deaths occurring during infancy (<1 year) between the two equal periods before and after 1996 (p = 0.141). There also was no difference in the proportional contribution by cause of death assignment method (Verbal autopsy vs. other methods; p = 0.715) or by study setting (urban vs. rural; p = 0.175). The median percentage of neonatal deaths by day 1 is 36.7% (Range: 20.0-58.0%). The median cumulative percentage of neonatal deaths by day 3 was 49.7% (Range 35.0-64.6%), and 70.9% (Range: 46.5-92.3%) by day 7. In addition, the timing of deaths during neonatal period seems to be static during the last 2 decades, with majority of deaths occurring during first week of life. This review demonstrates the need for more studies with consistent methodological rigor investigating the causes of child death in India. We conclude that the structure of neonatal causes of death in India may be different from the rest of the world and that interventions to reduce neonatal deaths in first week of life may rapidly improve child survival in the country.

Objective:Accurate and timely information on the causes of child deaths is essential in guiding efforts to improve child survival, by providing data from which health profiles can be constructed and relevant health policies formulated. The purpose of this study was to identify causes of death in children younger than 5 years-old in a tertiary hospital in South Africa.Methods:Death certificates from the Pietersburg/Mankweng hospital complex, for the period of January 1, 2008 through December 31, 2010, were obtained for all patients younger than 5 years and were retrospectively reviewed. Data were collected using a data collection form designed for the study. Information abstracted included: date of death, age, sex, and cause of death.Results:A total of 1266 deaths were recorded, the sex ratio was 1.26 boys per girl. About 611 (48%) of deaths were listed as neonatal deaths (0-28 days), 387 (31%) were listed as infant deaths (29 days-11 months), and 268 (21%) as children’s death (1-4 years). For neonates the leading causes of death were: prematurity/low birth weight, birth asphyxia and pneumonia. For the infant death group, the leading causes of death were pneumonia, diarrhea, and HIV/AIDS; and in the children’s group, the leading causes were injuries, diarrhea and pneumonia. There was no statistical significant difference in the proportions of causes of death based on the sex of children.Conclusion:The top 10 leading causes of death in children under-5 years old treated at Pietersburg/Mankweng Hospital Complex were in descending order: prematurity/low birth weight, pneumonia, diarrheal diseases, birth asphyxia, and severe malnutrition, HIV/AIDS, hydrocephalus, unintentional injuries, meningitis and other infections. These ten conditions represent 73.9% of causes of death at this facility. A mix of multi-faceted interventions is needed to address these causes of death in children.

Over the past 15 years, human immunodeficiency virus (HIV) infection has become a major cause of illness and death in young children. Each year approximately 7000 HIV-infected women give birth in the United States; 1000 to 2000 of their infants are infected with HIV.1 HIV infection is now the seventh leading cause of death in children one to four years of age in the United States.2 The World Health Organization estimates that over 1 million children are infected worldwide.3 These grim statistics emphasize the need for effective interventions to prevent the transmission of HIV from mother to child.The success . . .

There is no question that preventing child mortality should be a priority for all populations. There are moral and philosophical reasons to do so (the ‘fair innings’ argument). The replacement of populations depends on sufficient children surviving to reproductive age. It is also critical for indicators of overall population development: reductions in infant and child mortality exert substantially greater impact on levels of life expectancy than similar proportionate declines in death rates at older ages. The long-term decline in child mortality in the industrialized countries that has accompanied economic and social development has depended in part on the implementation of technologies and programmes that target specific diseases, or groups of diseases that often co-occur in the sick child. A reliable information system to monitor progress with programme implementation, and to highlight areas where greater, or new investment is needed, is a key support for public policy to improve child survival. But how reliably do we know the causes of child death in different countries, particularly in poorer populations? Arguably, the most appropriate mechanism for understanding change in the leading causes of death is a nationally representative vital registration system which routinely captures all deaths and assigns an underlying cause, certified by a medical practitioner. Such systems are well established in all industrialized countries, and increasingly in many developing populations as well, but for over half the countries of the world, particularly in Africa and Asia, vital registration of the fact of death, let alone the cause, is woefully inadequate for public policy. 1 But does the absence of a functioning vital registration system imply that little is usefully known about the leading causes of child death in populations? Certainly not, as the article by Morris and colleagues in this issue demonstrates. 2 Vital registration, even on a sample basis as is done in China, 3 provided it is implemented with diligence and a reasonable understanding of its benefits, is an invaluable source of data on causes of death at all ages. Unfortunately, the achievement of sufficient quality of vital registration appears to be largely dependent on statistical infrastructure investments for the routine monitoring of vital events; investments which are generally of lowest priority for Ministries of Health, or even more removed, for Ministries of the Interior charged with maintaining vital registration. What are the most appropriate strategies to meet the needs of countries for monitoring trends in causes of child mortality, and to guide programme implementation and priority setting? A useful first step is to understand, with reasonable certainty, the overall level of child mortality. Knowing how many children die is of itself useful for policy, but, more importantly, this figure will constrain the individual cause-specific estimates within the bounds of additivity. With the substantial investment in measuring child mortality levels through censuses and survey programmes over the past few decades, levels of child mortality are reasonably reliably known for all but a handful of countries, primarily in Africa. 4 The Demographic and Health Surveys programme alone has provided good quality data on levels of child mortality in over 40 countries over the past 5 years. Information on the age distribution of these child deaths can be used to guide the estimation of causes of death, as for example has been done to separate out the main causes of neonatal deaths. 5 Enough is known about the relationship between broad causes of death and overall levels of child mortality to be reasonably confident about leading causes. This was initially modelled by Preston, 6 with subsequent adaptation of his work to child mortality. 7 But such models are unlikely to capture the important and real variations in causes of child death across populations that occur due to such factors as climate, wars, efficiency and coverage of health services, the differential effects of education, and the emergence of new hazards such as human immunodeficiency virus (HIV)/AIDS. This is best assessed on the basis of a systematic review of community studies and other local epidemiological research according to strict evaluation criteria. There are several examples in the literature, ranging from disease-specific reviews, e.g. for malaria, 8 to systematic assessments of leading causes of child mortality at earlier

Burns are second only to motor vehicle accidents as a cause of accidental deaths in children. Dietrich 12 states that in the United States accidents were the leading cause of death in children from 1 to 14 years of age in 1948. They were responsible for more deaths than pneumonia, congenital anomalies, cancer, tuberculosis, leukemia, and heart disease combined. It has been estimated that there was an average of 8000 deaths per year from burns in the United States from 1940 to 1949. 23 Colebrook 9 reported that 30% of the deaths from burns in 1948 in the United States occurred in children, and in England 43.5% of the deaths from burns occurred in children. The purpose of this report is to review our clinical experience in the management of 85 burned children during the past five years and to outline the procedures which proved to be practical in their

To assess different methods for determining cause of death from verbal autopsy (VA) questionnaire data, the intra-rater reliability of Physician-Certified Verbal Autopsy (PCVA) and the accuracy of PCVA, expert-derived (non-hierarchical) and data-driven (hierarchal) algorithms were assessed for determining common causes of death in Ugandan children. A verbal autopsy validation study was conducted from 2008-2009 in three different sites in Uganda. The dataset included 104 neonatal deaths (0-27 days) and 615 childhood deaths (1-59 months) with the cause(s) of death classified by PCVA and physician review of hospital medical records (the ‘reference standard’). Of the original 719 questionnaires, 141 (20%) were selected for a second review by the same physicians; the repeat cause(s) of death were compared to the original,and agreement assessed using the Kappa statistic.Physician reviewers’ refined non-hierarchical algorithms for common causes of death from existing expert algorithms, from which, hierarchal algorithms were developed. The accuracy of PCVA, non-hierarchical, and hierarchical algorithms for determining cause(s) of death from all 719 VA questionnaires was determined using the reference standard. Overall, intra-rater repeatability was high (83% agreement, Kappa 0.79 [95% CI 0.76-0.82]). PCVA performed well, with high specificity for determining cause of neonatal (>67%), and childhood (>83%) deaths, resulting in fairly accurate cause-specific mortality fraction (CSMF) estimates. For most causes of death in children, non-hierarchical algorithms had higher sensitivity, but correspondingly lower specificity, than PCVA and hierarchical algorithms, resulting in inaccurate CSMF estimates. Hierarchical algorithms were specific for most causes of death, and CSMF estimates were comparable to the reference standard and PCVA. Inter-rater reliability of PCVA was high, and overall PCVA performed well. Hierarchical algorithms performed better than non-hierarchical algorithms due to higher specificity and more accurate CSMF estimates. Use of PCVA to determine cause of death from VA questionnaire data is reasonable while automated data-driven algorithms are improved.

Importance of tuberculosis control to address child survival

The leading causes of death in children vary according to age. Children under five years are vulnerable to infectious diseases such as malaria, pneumonia, diarrhea, HIV, and tuberculosis. Pneumonia is a contagious infectious disease and the most significant cause of death in children under five. Diarrhea is the second leading cause of death in children under five. Diarrhea is the leading cause of malnutrition in children under five. Indonesia is included in the top ten countries with the highest number of deaths in children under five years in 2019. This activity aims to increase knowledge of the community, especially mothers, about pneumonia and diarrhea. The method used was a virtual seminar. The webinar was held on May 7, 2021, using a zoom meeting with 87 participants. The majority of participants had never had pneumonia (98.8%). And the number of participants who had experienced diarrhea was 64 participants (80%). The results showed an increase in knowledge after attending the virtual seminar. The average (mean) knowledge score increased by 1.97. The majority of participants gave excellent marks on activities related to the topic/theme of the event, speakers, audiovisual quality, and question and answer sessions.

BackgroundCurrent estimates for causes of childhood deaths are mainly premised on modeling of vital registration and limited verbal autopsy data and generally only characterize the underlying cause of death (CoD). We investigated the potential of minimally invasive tissue sampling (MITS) for ascertaining the underlying and immediate CoD in children 1 month to 14 years of age.MethodsMITS included postmortem tissue biopsies of brain, liver, and lung for histopathology examination; microbial culture of blood, cerebrospinal fluid (CSF), liver, and lung samples; and molecular microbial testing on blood, CSF, lung, and rectal swabs. Each case was individually adjudicated for underlying, antecedent, and immediate CoD by an international multidisciplinary team of medical experts and coded using the International Classification of Diseases, Tenth Revision (ICD-10).ResultsAn underlying CoD was determined for 99% of 127 cases, leading causes being congenital malformations (18.9%), complications of prematurity (14.2%), human immunodeficiency virus/AIDS (12.6%), diarrheal disease (8.7%), acute respiratory infections (7.9%), injuries (7.9%), and malignancies (7.1%). The main immediate CoD was pneumonia, sepsis, and diarrhea in 33.9%, 19.7%, and 10.2% of cases, respectively. Infection-related deaths were either an underlying or immediate CoD in 78.0% of cases. Community-acquired pneumonia deaths (n = 32) were attributed to respiratory syncytial virus (21.9%), Pneumocystis jirovecii (18.8%), cytomegalovirus (15.6%), Klebsiella pneumoniae (15.6%), and Streptococcus pneumoniae (12.5%). Seventy-one percent of 24 sepsis deaths were hospital-acquired, mainly due to Acinetobacter baumannii (47.1%) and K. pneumoniae (35.3%). Sixty-two percent of cases were malnourished.ConclusionsMITS, coupled with antemortem clinical information, provides detailed insight into causes of childhood deaths that could be informative for prioritization of strategies aimed at reducing under-5 mortality.

Background/Objective: Accurate determination and documentation of causes of death in children are essential for generating reliable mortality statistics and guiding public health strategies. Previous studies have reported frequent inaccuracies in pediatric death certificates (DCs), including the use of vague terms, omissions of relevant conditions, and variability across physician specialties. This study evaluated the accuracy of pediatric DCs in Shiga Prefecture, Japan; identified common errors in these DCs; and examined changes in the underlying causes of pediatric death before and after the COVID-19 pandemic. Methods: We performed a population-based retrospective review of 391 DCs for individuals under 18 years issued between 2015 and 2023. Two pediatricians and two forensic pathologists independently reviewed each DC, assessed accuracy, and classified errors using predefined criteria. Error rates were compared by physician specialty. Underlying causes of death were reassessed into ten categories, and their distributions were compared between 2015–2019 and 2020–2023. Results: Overall, 30.9% of DCs contained errors. The error rates differed by physician specialty: obstetricians had the highest error rate (92.9%), whereas forensic physicians had the lowest (8.4%). The most common error type was the use of non-specific mechanisms such as “cardiac arrest” or “respiratory failure”, rather than the actual causes of death. Congenital anomalies were often listed under other significant conditions contributing to death and not as an underlying cause of death. After the onset of the COVID-19 pandemic, deaths from acute diseases declined from 16.8% to 4.0%, while deaths from congenital disorders increased from 12.6% to 24.3%. Conclusions: Pediatric DCs often contain errors, particularly those completed by obstetricians. Misclassifying mechanisms as causes of death and underreporting congenital anomalies remain the main challenges. Strengthening physician education and introducing systematic review processes are essential to improve accuracy, clarify regional mortality trends, and guide effective public health interventions.

This paper presents an overview of the IRC Child Injury Series, a working paper series on child injury that has its first focus on injury in developing countries. The series summarizes the findings of six national and subnational surveys in Asia: Bangladesh, China (two regions), Philippines, Thailand and Viet Nam. The surveys, undertaken using a new methodology resembling a census, found that injury is the leading cause of death after infancy in children through 17 years of age in all countries surveyed. The methodology involved creating a very large, representative sample of households in each national/subnational survey and directly counting all mortality events in the previous three years and all morbidity events that required missing work, school, or being hospitalized from injury in the previous one year. The results show that prior estimates of child mortality have omitted most injury deaths in early childhood as they did not include children aged five years and over. As a result, injury, which is a leading cause of death in children under five, and the leading cause of death in children aged five years and over, has been largely invisible to policymakers and is not included in child health programmes. The surveys show a consistent pattern of types of injury in the different stages of childhood in the countries surveyed. Drowning, greatly underestimated by traditional methods of surveillance, is the leading injury cause, responsible for over half of all injury deaths in children. Evidence from the surveys shows that the social, health and economic burden of non-fatal injury is significantly high. While falls, road traffic, cuts and burns were found to be leading causes of morbidity, injury caused by animals also emerged as a leading cause of mortality and morbidity. Addressing injury is necessary to continue current progress in child mortality and morbidity reductions in the region.

Type 1 and type 2 diabetes in children and young people: updated <scp>NICE</scp> guidance

In the USA, intentional and accidental injuries are the most frequent causes of death in children. Many of these deaths could be avoided through preventive measures, and aetiological studies are needed to reduce fatalities. The leading causes of accidental death vary by age. We analysed all paediatric accidental deaths recorded by a busy urban Medical Examiner"s Office in Chicago, Illinois (USA). We searched the electronic database for accidental deaths in children aged under 10 between 1 August 2014 and 31 July 2019. 131 deaths were identified with a preponderance of males and African Americans. This is consistent with ratios of other deaths recorded for this age group (during the same period and area). The leading causes of death were asphyxia due to an unsafe sleeping environment (in subjects <1-year-old), and road traffic accidents/drowning (in subjects >1-year-old). Behaviours, risk factors and environments most likely to contribute to fatal injuries are discussed. Our study highlights the role of forensic pathologists and medico-legal death investigators who identify the causes and circumstances surrounding these deaths. The research results may help from an epidemiological perspective to implement age-specific preventive strategies.

Association of Gun Violence With Vascular Injury And Worse Mortality Outcomes In The Pediatric Population

A birth defect is “any anomaly, functional or structural, that presents in infancy or later in life and is caused by events preceding birth, whether inherited or acquired.” Medically significant birth defects are essentially conditions that are present at birth and require at least some degree of medical intervention (Table 60–1). Approximately 3%–5% of all children are born with a medically significant birth defect. Approximately 150,000 children are born in the United States every year with one or more birth defects. These defects are the single leading cause of infant mortality in the United States, resulting in 20% of all infant deaths. Birth defects are the second leading cause of death in children 1 to 4 years of age and the fourth leading cause of death in children 5 to 15 years. Birth defects are also a leading cause of hospital admissions. Over 11% of all pediatric hospital admissions are due to genetic disorders, and 18.5% are for children with other congenital anomalies.