Why Babies and Young Children Die in Africa and South Asia: 4 in 5 Deaths Preventable

In 2023, an estimated 4.9 million children under 5 died worldwide, along with 1.9 million stillbirths — about 80% of them in sub-Saharan Africa and South Asia, where many countries are unlikely to meet the goal of ending preventable newborn and child deaths by 2030. Conventional cause-of-death data there usually come from verbal autopsy — interviews with family members — and vital registration, which lack lab confirmation, name a single cause and often miss maternal factors and co-existing conditions.

The Child Health and Mortality Prevention Surveillance (CHAMPS) network, begun in 2016 with CDC's scientific and laboratory leadership, investigates deaths with minimally invasive tissue sampling (MITS) — needle biopsies of lung, liver and brain, plus blood, spinal fluid, swabs and, for newborns and stillbirths, placenta and cord — along with lab tests for about 100 pathogens, pathology, verbal autopsy and medical records. Expert panels then assign every cause in the chain leading to death and judge whether it was preventable.

CHAMPS surveillance sites; Nigeria and Pakistan joined in 2023 and weren't included. From CDC's MMWR.

The deaths studied

From December 2016 to December 2024, CHAMPS worked in catchment areas of about 70,000 to 2 million people in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa.

What caused the deaths

Causes of death among 2,071 infants and children, by position in the causal chain. From CDC's MMWR.

• Several causes were common: 44.3% of newborn and 67.9% of infant and child deaths had two or more conditions in the chain.
• Infection contributed to 59.3% of deaths after birth. Where a pathogen was implicated, 44.5% involved more than one, mostly gram-negative bacteria.
• In newborns, the top pathogens were Klebsiella pneumoniae (48.3% of pathogen-linked deaths) and Acinetobacter baumannii (25.9%) — the latter especially in South Africa and Bangladesh — many of them likely acquired in health care settings, according to earlier CHAMPS work.
• In infants and children, top pathogens included K. pneumoniae (31.3%), Plasmodium falciparum malaria (26.9%), Streptococcus pneumoniae (20.1%) and cytomegalovirus (8.5%).
• Undernutrition was widespread in children measured after death: 61.3% underweight, 61.3% wasted and 43.0% stunted.
• A main maternal condition — most often placental complications and high blood pressure in pregnancy — was found in 71.1% of stillbirths and 58.2% of newborn deaths.

Most deaths were preventable

Of 7,558 deaths assessed, 6,103 (80.7%) were judged preventable or possibly preventable with better use of existing maternal, newborn and child health care.

The gaps were rarely a lack of known interventions but uneven quality, late access, staff and supply shortages, weak referral and barriers such as distance, cost, mistrust and reliance on traditional medicine.

Results already used

• Kenya (Siaya County): Kangaroo Mother Care and emergency obstetric and newborn training expanded from 2022; Kangaroo Mother Care admissions nearly doubled from 2022 to 2023 as newborn-unit mortality fell.
• South Africa: antenatal ultrasound expanded — 696 scans from June 2023 to April 2024 — and aspirin to prevent pregnancy hypertension was added to the national formulary.
• Sierra Leone: finding malnutrition in 48% of under-5 deaths prompted the country's first purchase of therapeutic food — 1,700 cartons for $99,000, matched by UNICEF and sent to all 16 districts; HIV findings helped secure $8 million from PEPFAR.
• Ethiopia: neural tube defects emerged as important, supporting folic acid and food fortification.

Limits: sites aren't nationally representative and favored facility deaths; records were sometimes incomplete; pathogen attribution is complex; and preventability reflects expert judgment, not estimates of lives any single intervention would save.

Sources

Based on 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 Surveillance Summaries 75(6), CDC; a work of the United States government in the public domain.