Causes of stillbirth and death among children youngerthan 5 years in eastern Hararghe, Ethiopia: a population-based post-mortem study

• Type of Material: Article
• Authors: Lola Madrid, London School of Hygiene & Tropical Medicine; Addisu Alemu, Haramaya University; Anna C Seale, London School of Hygiene & Tropical Medicine; Joe Oundo, London School of Hygiene & Tropical Medicine; Tseyon Tesfaye, Haramaya University; Dadi Marami, Haramaya University; Hiwot Yigzaw, Haramaya University; Alexander Ibrahim, Haramaya University; Ketema Degefa, Haramaya University; Tadesse Dufera, Haramaya University; Zelalem Teklemariam, Haramaya University; Tadesse Gure, Haramaya University; Haleluya Leulseged, Haramaya University; Stefanie Wittmann, London School of Hygiene & Tropical Medicine; Mahlet Abayneh, St Paul's Hospital Millennium Medical College; Surafel Fentaw, Ethiopian Public Health Institute; Fikremelekot Temesgen, Addis Ababa University; Melisachew M Yeshi, Mekele University; Mehret Dubale, London School of Hygiene & Tropical Medicine; Zerihun Girma, Haramaya University; Caroline Ackley, London School of Hygiene & Tropical Medicine; Berhanu Damisse, Haramaya University; Markus Breines, London School of Hygiene & Tropical Medicine; Stian MS Orlien, London School of Hygiene & Tropical Medicine; Dianna M Blau, Centers for Disease Control and Prevention, Atlanta; Robert Breiman, Emory University; Ebba Abate, Ethiopian Public Health Institute; Yadeta Dessie, Haramaya University; Nega Assefa, Haramaya University; Anthony GJ Scott, London School of Hygiene & Tropical Medicine
• Language: English
• Date: 2023-06-20
• Publisher: ELSEVIER SCI LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s). Published by Elsevier Ltd.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/S2214-109X(23)00211-5
• Title of Journal or Parent Work: LANCET GLOBAL HEALTH
• Volume: 11
• Issue: 7
• Start Page: E1032
• End Page: E1040
• Keywords: Public, Environmental & Occupational Health; AUTOPSY; Science & Technology; HEALTH; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Epidemiology

Abstract

Background: Child mortality is high in Ethiopia, but reliable data on the causes of death are scarce. We aimed to gather data for the contributory causes of stillbirth and child deaths in eastern Ethiopia. Methods: In this population-based post-mortem study, we established a death-notification system in health facilities and in the community in Kersa (rural), Haramaya (rural) and Harar (urban) in eastern Ethiopia, at a new site of the Child Health and Mortality Prevention Surveillance (CHAMPS) network. We collected ante-mortem data, did verbal autopsies, and collected post-mortem samples via minimally invasive tissue sampling from stillbirths (weighing at least 1000 g or with an estimated gestational age of at least 28 weeks) and children who died younger than 5 years. Children—or their mothers, in the case of stillbirths and deaths in children younger than 6 months—had to have lived in the catchment area for the past 6 months to be included. Molecular, microbiological, and histopathological analyses were done in collected samples. Cause of death was established by an expert panel on the basis of these data and classified as underlying, comorbid, or immediate separately for stillbirths, neonatal deaths (deaths aged 0–27 days), and child deaths (aged 28 days to <5 years). Findings: Between Feb 4, 2019, and Feb 3, 2021, 312 deaths were eligible for inclusion, and the families gave consent in 195 (63%) cases. Cause of death was established in 193 (99%) cases. Among 114 stillbirths, the underlying cause of death was perinatal asphyxia or hypoxia in 60 (53%) and birth defects in 24 (21%). Among 59 neonatal deaths, the most common underlying cause was perinatal asphyxia or hypoxia (17 [29%]) and the most common immediate cause of death was neonatal sepsis, which occurred in 27 (60%). Among 20 deaths in children aged 28 days to 59 months, malnutrition was the leading underlying cause (15 [75%]) and infections were common immediate and comorbid causes. Pathogens were identified in 19 (95%) child deaths, most commonly Klebsiella pneumoniae and Streptococcus pneumoniae. Interpretation: Perinatal asphyxia or hypoxia, infections, and birth defects accounted for most stillbirths and child deaths. Most deaths could have been prevented with feasible interventions, such as improved maternity services, folate supplementation, and improved vaccine uptake. Funding: Bill & Melinda Gates Foundation.