Global study on causes of under-five mortality in India soon

A global study on the hidden causes of deaths of children aged under five will soon be conducted in India, using "minimally-invasive" techniques and advanced laboratory methods, the ICMR chief said today.
Soumya Swaminathan, Director-General of the Indian Council of Medical Research (ICMR) said the study, titled Child Health and Mortality Prevention Surveillance (CHAMPS), funded by the Bill & Melinda Gates Foundation, will start on a pilot-basis in a "month or two" in the country.
"The idea behind this study is to try to understand the causes of death of children under the age of five. In most countries, including India, the maximum burden of premature mortality happens in children under five.

"So, it is important to prevent that, in fact that whole world is now focussed on reducing that through various interventions such as vaccination, improving water, sanitation, access to antibiotics, but unless we understand what are the causes that are killing the children, we can't take preventive measures," she said.
The ICMR chief, who will soon take charge as the Deputy Director General for Programmes, the World Health Organization in Geneva, said the study has already started in "South Africa, Mozambique and Mali".
"It will now be done in Bangladesh and India. We will start the pilot very soon, in Safdarjung Hospital here, in a month or two, because the Ethics Committee approval, and everything, has been done," Swaminathan told PTI.

As part of the study, the Centre-run hospital will act as the 'Expert Guidance Centre', where the paediatrics department's doctors will get trained, will be able to do further training.

"An international team of experts will be coming, from the CDC (Centers for Disease Control and Prevention), Atlanta, in the US. And, the laboratory testing will be done in collaboration with the CDC," she added.
This study will uses a lot of advanced laboratory methods, to uncover the "hidden causes of death", she said.
"The study will be done through taking minimally-invasive tissue biopsies, tissue samples, after the child has died, like taking samples of vein, lung, liver, spleen, blood, and then do a number of microbiological and pathological investigations," the ICMR chief said.

The National Institute of Pathology (NIP) at the Safdarjung Hospital will be the main institute involved i in the study.
"After hospitals, we want to take it to the field areas, where there is a lot of child mortality, so that we can actually capture, ultimately the cause of deaths of children in the community. Also, we want to look at a large number of pathogens and disease conditions," she added.
Swaminathan said the idea originated through discussions on global fora.
"The fact that previous autopsy studies have shown quite surprising things. Most of these autopsy studies have been done in Africa. An autopsies are very difficult to do for many reasons.

"And that is when they came up with this concept of minimally-invasive biopsies, which is more acceptable to the families, and easier to do also for doctors," she said.
The ICMR chief, said though there is still a lot of reluctance socially, but "things are changing".
"If you look at organ donation, more and more people are coming forward. So, it is the way you approach, tell the families the logic and the larger cause, that the child in the neighbourhood could be the next one, so a larger context is important," she added.
According to the CHAMPS official website, "Every year, nearly six million children under the age of five die. Unfortunately, the causes of these deaths often remain a mystery due to gaps in disease surveillance, death registries and data to inform evidence-based policy, especially in low- resource countries, where mortality rates are the highest.