Breiman RF, Blau DM, Mutevedzi P, et al. - Analyzing CHAMPS (Child Health and Mortality Prevention Surveillance) data, it was found that the proportion of child deaths due to various diagnoses, especially lower respiratory infection (LRI), sepsis, and meningitis, changed markedly when conditions that appear anywhere in the causal chain were included rather than considering underlying condition alone.

• The causes of child deaths were analyzed in 7 sites in Africa and South Asia where child mortality is high.

• A range of 0 to 6 (mean 1.5, IQR 0 to 2) additional conditions in the causal chain resulting in death were identified among 1,232 deaths with an underlying condition determined.

• Among neonates with preterm birth complications (the most common underlying condition), additional conditions in causal chains were found for 91%, which included a different preterm birth complication (65%), neonatal sepsis (45%), LRI (24%), meningitis (21%), and perinatal asphyxia/hypoxia (9%).

• There were 278 infant deaths, of which 212 (79%) were attributed to ≥1 additional cause of death beyond the underlying cause.

• Including all positions in the causal chain for neonatal deaths led to 19-fold and 11-fold increases in attributable roles for meningitis and LRI, respectively.

• The proportion of infant deaths attributable to meningitis and sepsis rose by 16-fold and 11-fold, respectively; for child deaths, sepsis and LRI increased 12-fold and 10-fold, respectively.

• While CHAMPS methods fail to ascertain when 2 conditions lead to death independently or may be synergistic, results indicate that considering the chain of events resulting in death can better guide research and prevention priorities focused at decreasing child deaths.