Ten Years of CHAMPS: Understanding the Causes of Child Mortality to Help Prevent It

Understanding the causes of death among babies and young children is essential to help prevent them. This is the aim of the CHAMPS network (Child Health and Mortality Prevention Surveillance), launched by the Bill & Melinda Gates Foundation in 2016 to investigate the causes of death among babies and children under five in some of the world’s poorest countries. A new report published in MMWR, the publication of the US Centers for Disease Control and Prevention (CDC), presents the results of its first ten years of activity and shows that four in five deaths investigated were potentially preventable. The findings highlight opportunities to strengthen maternal, neonatal and child health interventions.

Between 2016 and 2024, CHAMPS identified 18,784 eligible deaths across seven countries: Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa. In 9,415 cases, minimally invasive tissue sampling (MITS), a technique developed and validated by ISGlobal, was used to obtain tissue samples through a minimally invasive procedure. In total, 8,500 cases were reviewed by multidisciplinary teams to determine the causes of death.

A closer look at causes of death

To determine the causes of death, CHAMPS teams use a post-mortem approach that combines different sources of information: minimally invasive tissue sampling, laboratory analyses, interviews with relatives or caregivers (verbal autopsy), and reviews of paediatric and maternal medical records. Multidisciplinary teams then integrate all this evidence to assign one or more causes to each death and assess its potential preventability.

This approach makes it possible to identify not only the underlying cause of death, but also other conditions that contributed to it. The published results show that causes of death are complex and that different factors often coexist. Among stillbirths, the most frequent cause was perinatal asphyxia or hypoxia (lack of oxygen), often associated with hypertensive disorders of pregnancy, placental complications or infections. Among neonatal deaths, the main causes included complications of prematurity, asphyxia or hypoxia, and sepsis. Among babies and children under five, respiratory infections, sepsis, malnutrition, malaria and diarrhoeal diseases were among the main factors identified. 

From data to prevention

Of the 7,558 deaths assessed, 6,103 were considered preventable or potentially preventable, meaning that approximately four in five deaths could have been prevented. These findings highlight opportunities to strengthen maternal, neonatal and child health interventions, particularly antenatal care, obstetric and emergency care during childbirth, infection prevention and control, paediatric care, and nutritional support. 

CHAMPS findings have also contributed to changes in health services. In Kenya, they informed interventions that included expanding kangaroo mother care and training in emergency obstetric and neonatal care. In South Africa, the data contributed to expanding access to antenatal ultrasound and incorporating aspirin for the prevention of hypertensive disorders of pregnancy into the national formulary. In Sierra Leone, findings on malnutrition supported the country’s first national procurement of ready-to-use therapeutic food for children with malnutrition.

A technique developed in Barcelona

One of the cornerstones of CHAMPS is minimally invasive autopsy, a technique developed and validated by ISGlobal research teams through the CaDMIA and CaDMIA-plus projects. The technique makes it possible to obtain small samples from different organs using fine needles for subsequent analysis and provides an alternative to conventional autopsy in settings where the latter may be difficult to perform due to limited infrastructure or cultural considerations.

Ten years after its launch, CHAMPS has provided detailed information on the causes of death among newborns and children under five. These data can help strengthen surveillance systems and better guide interventions aimed at preventing avoidable deaths. 

Reference

Madewell ZJ, Dangor Z, Mutevedzi PC, et al. Causes of Death Among Stillbirths and Children Aged <5 Years in Africa and South Asia — Child Health and Mortality Prevention Surveillance, Seven Countries, 2016–2024. MMWR Surveill Summ 2026;75(No. SS-6):1–24. DOI: http://dx.doi.org/10.15585/mmwr.ss7506a1