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. 2025 Sep 4.
doi: 10.1111/ppe.70067. Online ahead of print.

Major Causes of Perinatal and Paediatric Mortality in Sub-Saharan Africa and South Asia: Adjustment for Selection Bias in the CHAMPS Network

Kartavya J Vyas  1   2   3 , Jonathan A Muir  1   2 , Zachary J Madewell  2   4 , Priya M Gupta  1   2 , Dianna M Blau  2   4 , Shams E Arifeen  5 , Emily S Gurley  6 , Atique I Chowdhury  5 , Kazi M Islam  5 , Afruna Rahman  5 , J Anthony G Scott  7   8 , Nega Assefa  8 , Lola Madrid  7   8 , Yohanis A Asefa  8 , Yasir Y Abdullahi  8 , Dickens Onyango  9 , Victor Akelo  10   11 , Beth A Tippett-Barr  10   11 , George Aol  12 , Samba O Sow  13 , Karen L Kotloff  14 , Milagritos D Tapia  14 , Adama M Keita  13 , Kiranpreet Chawla  13 , Quique Bassat  15   16 , Inacio Mandomando  16   17 , Ariel Nhacolo  16 , Charfudin Sacoor  16 , Ikechukwu Ogbuanu  18 , Dickens Kowuor  18 , Babatunde Duduyemi  18 , Andrew Moseray  18 , James S Squire  18 , Shabir Madhi  19 , Sana Mahtab  19 , Yasmin Adam  19 , Amy Wise  19 , Takwanisa Machemedza  19 , Cynthia G Whitney  1   2 ; CHAMPS Network
Collaborators, Affiliations

Major Causes of Perinatal and Paediatric Mortality in Sub-Saharan Africa and South Asia: Adjustment for Selection Bias in the CHAMPS Network

Kartavya J Vyas et al. Paediatr Perinat Epidemiol. .

Abstract

Background: Studies of child mortality that employ minimally invasive tissue sampling (MITS) produce highly accurate cause of death data; however, selection bias may render these as non-representative of their underlying populations.

Objectives: Estimate cause-specific mortality fractions and rates for the five most frequent causes-underlying and others in the chain of events leading to death-among stillbirths, neonatal, infant and child deaths-in Sub-Saharan Africa and South Asia, adjusted for any identified selection biases.

Methods: The Child Health and Mortality Prevention Surveillance (CHAMPS) Network collects standardised, population-based, longitudinal data on causes of death among stillbirths and under-five children in 12 catchments in seven countries in Sub-Saharan Africa and South Asia. Cause-specific mortality fractions and rates were calculated for the five most frequent causes among stillbirths, neonatal, infant and child deaths, and for the five most frequent maternal conditions among perinatal deaths; all estimates were subsequently adjusted for selection bias. Selection probabilities were estimated from membership in subgroups defined by factors hypothesised to affect selection.

Results: In 2017-2020, of 10,122 deaths ascertained, 5847 (57.8%) were enrolled in CHAMPS and 2654 (26.2%) additionally consented to MITS. Estimates were calculated for 265 and 65 site/age-specific causes of death and maternal conditions, respectively; five (1.9%) and four (6.2%) required adjustment, respectively, but they did not meaningfully change. Estimates were calculated for 34 site-specific causes of death among all stillbirths and under-five deaths combined; 28 (82.4%) required adjustment (all included age at death), and change-in-estimates demonstrated considerable variability.

Conclusions: Selection bias is not a concern in the CHAMPS Network. Deaths where MITS were performed accurately represent the distribution of causes of death in their respective target populations, specifically when stratified by age or adjusted accordingly. Future studies of child mortality that employ MITS should consider adjusting for age at death for their measures of frequency.

Keywords: South Asia; Sub‐Saharan Africa; cause of death; child mortality; selection bias; stillbirths.

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