Breiman RF, Blau DM, Mutevedzi P, et al. - Including conditions that appear anywhere in the causal chain, rather than just the underlying condition, resulted in a significant change in the proportion of deaths attributed to various diagnoses, particularly lower respiratory infection (LRI), sepsis, and meningitis. While CHAMPS methods cannot determine whether two conditions cause death independently or if they are synergistic, the findings suggest that taking into account the chain of events leading to death can help guide research and prevention priorities aimed at reducing child deaths.

• The authors discovered a range of 0 to 6 (mean 1.5, IQR 0 to 2) additional conditions in the causal chain leading to death among 1,232 deaths with an underlying condition determined.

• Preterm birth complications (most commonly respiratory distress syndrome) were the most common underlying condition in neonates (n = 282, 38% ); among those with preterm birth complications, 256 (91%) had additional conditions in causal chains, including 184 (65%) with a different preterm birth complication, 128 (45%) with neonatal sepsis, and 69 (24%) with LRI.

• Of the 278 infant deaths, 212 (79%) had ≥ 1 additional cause of death in addition to the underlying cause.

• Malnutrition and congenital birth defects were the 2 most common underlying conditions in infants.

• Meningitis and sepsis caused 16-fold and 11-fold increases in infant deaths, respectively; sepsis and LRI caused 12-fold and 10-fold increases in child deaths, respectively.