Until 2017, the causes of child deaths have been evaluated by verbal autopsy. A new approach was started with MITS (Minimally Invasive Tissue Sampling) under a surveillance named Child Health and Mortality Prevention Surveillance (CHAMPS). The primary objective of CHAMPS is to identify the precise causes of stillbirths and deaths among children under five years of age. IEDCR, in collaboration with the icddr,b has been conducting the CHAMPS activities from 2017. The CHAMPS network is a multi-country initiative, implementing its activities in nine countries, including Bangladesh. The primary objective of CHAMPS is to identify the precise causes of stillbirths and deaths among children under five years of age.

In Bangladesh, CHAMPS is implementing its activities in one upazila of Rajbari named Baliakandi, and six upazilas of Faridpur. Facility-based mortality surveillance was established in September 2017 at BSMMCH (Bangabandhu Sheikh Mujib Medical College Hospital), Faridpur and later on expanded to ZMCH (Dr. Zahed Memorial Child Hospital) and BUHC (Baliakandi Upazila Health Complex) to identify most of the hospitalizations and deaths of children under five years living in the CHAMPS catchment area. To capture community deaths, community mortality surveillance was established in 2019 in Baliakandi, Rajbari.

Procedure: After a death of a child under 5 years or stillbirth delivery, a medical team (consisting of physicians, consent takers and medical technologists) conduct MITS (Minimally Invasive Tissue Sampling) from the deceased child's body both in the facility and community after taking informed written consent from the families. Subsequently the clinical documents, verbal autopsy provided by the mother/ caregiver and laboratory findings of the collected samples are gathered. An expert panel of specialists named as DeCoDe (Determination of Cause of Death) panel consisting of obstetrician, gynecologist, pathologist and epidemiologist is assigned to determine the cause of death.

The number of death notifications and approaches for MITS by the CHAMPS team increased gradually over the years. This is due to improvement of the infrastructure of 3 surveillance facilities as well as boosted capacity to provide more services which eventually gain people’s trust to visit these places more. The MITS numbers also increased as a result of strong community engagement activities and good coordination with Government and private stakeholders (Fig 9).

Out of 720 DeCoDe cases, 626 cases were mentioned with preventive recommendations. The majority of the preventive recommendations were associated with improved quality of antenatal care (ANC) (59%) and improved clinical management (29%) (Fig 10). For the remaining cases, recommendations were not suggested due to insufficient maternal data.

Highlights:

• More than half of the MITS cases were stillbirths (STB). Intrauterine hypoxia causes 86% of stillbirths and 42% of early neonatal deaths. However, 7% of stillbirths were due to intrauterine infection.

• 38% of the early neonates and 59% of the late neonates died due to prematurity.

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-- Data Source: https://champs.iedcr.gov.bd/data