Overview and Development of the Child Health and Mortality Prevention Surveillance Determination of Cause of Death (DeCoDe) Process and DeCoDe Diagnosis Standards.

Dianna M Blau ,Inácio Mandomando,Shams El Arifeen,Nega Assefa,Quique Bassat,J Patrick Caneer,Dickens Onyango,Rosauro Varo,Reinhard Kaiser,Richard Chawana,Kitiezo Aggrey Igunza,Timothy Morris,Karen L Kotloff ,Shabir А Madhi ,Rebecca Philipsborn ,Milagritos D Tapia ,Anna C Seale ,Siobhan L Johnstone ,Ahmed Shafiqur Rahman ,Pratima L Raghunathan ,Robert F Breiman

doi:10.1093/cid/ciz572

Abstract

Mortality surveillance and cause of death data are instrumental in improving health, identifying diseases and conditions that cause a high burden of preventable deaths, and allocating resources to prevent these deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) network uses a standardized process to define, assign, and code causes of stillbirth and child death (<5 years of age) across the CHAMPS network. A Determination of Cause of Death (DeCoDe) panel composed of experts from a local CHAMPS site analyzes all available individual information, including laboratory, histopathology, abstracted clinical records, and verbal autopsy findings for each case and, if applicable, also for the mother. Using this information, the site panel ascertains the underlying cause (event that precipitated the fatal sequence of events) and other antecedent, immediate, and maternal causes of death in accordance with the International Classification of Diseases, Tenth Revision and the World Health Organization death certificate. Development and use of the CHAMPS diagnosis standards—a framework of required evidence to support cause of death determination—assures a homogenized procedure leading to a more consistent interpretation of complex data across the CHAMPS network. This and other standardizations ensures future comparability with other sources of mortality data produced externally to this project. Early lessons learned from implementation of DeCoDe in 5 CHAMPS sites in sub-Saharan Africa and Bangladesh have been incorporated into the DeCoDe process, and the implementation of DeCoDe has the potential to spur health systems improvements and local public health action.

Highlights

Even when the conditions causing death are known, these are often inaccurately or inconsistently recorded on a death certificate
The Child Health and Mortality Prevention Surveillance (CHAMPS) Determination of Cause of Death (DeCoDe) panel process was developed as a methodology to review data collected through systematic CHAMPS surveillance activities, elucidate the causal chain of events leading to death, and systematically assign cause of death using
Throughout the design and implementation of the DeCoDe process, advisors involved with these reviews were consulted to design an efficient and robust procedure, which could be utilized across all CHAMPS sites

Summary

Introduction

Even when the conditions causing death are known, these are often inaccurately or inconsistently recorded on a death certificate. A panel of experts, known as the DeCoDe panel, comprised by a variety of clinical and laboratorial expertise, thoroughly analyzes and reviews the compiled data in the local context to propose, in light of all available evidence, the most plausible explanation for the underlying cause of death and the fatal sequence of events. This in-depth review is conducted at each CHAMPS surveillance site. Throughout the design and implementation of the DeCoDe process, advisors involved with these reviews were consulted to design an efficient and robust procedure, which could be utilized across all CHAMPS sites

Discussion

Conclusion