Project Summary

The project aimed to determine the cause of child death and stillbirth, as well as the cause of life threating illness in Harar, Harmaya and Kersa, Eastern Ethiopia. With parental consent, the CHAMPS team collects tissue and fluid samples from the body of a deceased child. These samples undergo sophisticated laboratory analysis. Additionally, clinical records and the family’s health history, obtained through verbal autopsy, are documented. For stillbirths and newborn deaths, maternal clinical information is also collected. Subsequently, the data for each case is presented to an expert panel known as DeCoDe, which reviews the information to determine the exact causes of death for each case presented. After DeCoDe panel determined, Data to Action team communicate causes of death for families and intervene in informing range of policies and public health actions to reduce child mortality. 

CHAMPS is the first and currently the largest project in the HHR portfolio.  It facilitated the establishment of the HHR partnership, and the data gathered has led to development of follow-on research projects within the partnership.

PIs: Prof. Anthony Scott, Prof. Nega Assefa

Lead Institutions: Haramaya University, London School of Hygiene and Tropical Medicine, and Ethiopian Public Health Institute

Sponsor: Bill and Melinda Gates Foundation

Implementation Year: 2017

Status of the project: Ongoing

HOW CHAMPS OPERATES

DSS

CHAMPS conducts its study based on Health and Demographic Surveillance System (HDSS) data to identify and track all pregnancies, births, deaths, and population growth in the catchment area. HDSS data provide context for how CHAMPS interprets its findings related to the mortality of children under five in the catchment area.

Mortality Surveillance

CHAMPS teams in each site work with community and hospital workers to identify stillbirths and child deaths. Families are approached for consent to participate in CHAMPS and, for deaths that are identified within 24 hours, CHAMPS teams request consent for collection of tissues. CHAMPS’s mortality surveillance involves systematically tracking deaths, particularly among children under five, to understand the causes and patterns of mortality.

Data Collection

Data collection at CHAMPS involves obtaining detailed health and demographic information from various sources. With family consent, CHAMPS collects tissue and body fluid samples for testing. Information is gathered from clinical records. Additionally, through verbal autopsy, the family’s account is documented. For stillbirth and new-born deaths, maternal clinical information is also collected.

MITS (Minimally Invasive Tissue Sampling)

Minimally invasive tissue sampling (MITS) is a technique that involves taking small biopsies of key organs, allowing examination of body tissues. MITS involves using biopsy needles to collect small tissue samples from key organs, offering a less invasive alternative to full autopsies. This method is culturally more acceptable, allowing for accurate cause-of-death determination without significant impact on the body. CHAMPS uses this technique to provide a definitive cause of under-five children’s mortality.

Laboratory Work

Tissue and body fluid specimens are submitted by CHAMPS team for laboratory tests at HHR’s ISO 15189 accredited laboratory. The tests include microbiology, molecular diagnostics, and histopathology. The laboratory analyzes tissue and fluid samples to identify pathogens and other health indicators to understand definitive causes of death.

DeCoDe

The Determination of the Cause of Death (DeCoDe) is a multidisciplinary panel of expert panel at CHAMPS who assess information from the verbal autopsy, clinical abstractions (child and maternal), laboratory and pathology results, and any additional information CHAMPS gathers.

The DeCode panel follows the International Classification of Diseases, Tenth Revision (ICD-10) and the World Health Organization (WHO) Medical Certificate of Cause of Death to assign underlying, immediate, and intermediate causes of death for each case.

Data to Action

CHAMPS transforms data into action, working with partners to use the findings to inform evidence-based solutions to save lives. Through Data to Action, CHAMPS informs a range of policies and public health actions to reduce child mortality.