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Neurological Symptoms and Cause of Death Among Young Children in Low- and Middle-Income Countries

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Child Health and Mortality Prevention Surveillance (CHAMPS) Consortium

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IMPORTANCE The emergence of acute neurological symptoms in children necessitates immediate
intervention. Although low- and middle-income countries (LMICs) bear the highest burden of
neurological diseases, there is a scarcity of diagnostic and therapeutic resources. Therefore, current
understanding of the etiology of neurological emergencies in LMICs relies mainly on clinical
diagnoses and verbal autopsies.
OBJECTIVE To characterize the association of premortem neurological symptoms and their
management with postmortem-confirmed cause of death among children aged younger than 5 years
in LMICs and to identify current gaps and improve strategies to enhance child survival.
DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted between
December 3, 2016, and July 22, 2022, at the 7 participating sites in the Child Health and Mortality
Prevention Surveillance (CHAMPS) network (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra
Leone, and South Africa). Minimally invasive tissue sampling was performed at the CHAMPS sites
with specimens from deceased children aged younger than 5 years. This study included deceased
children who underwent a premortem neurological evaluation and had a postmortem-confirmed
cause of death. Data analysis was performed between July 22, 2022, and January 15, 2023.
MAIN OUTCOMES AND MEASURES Descriptive analysis was performed using neurological
evaluations from premortem clinical records and from postmortem determination of cause of death
(based on histopathology, microbiological testing, clinical records, and verbal autopsies).
RESULTS Of the 2127 deaths of children codified during the study period, 1330 (62.5%) had
neurological evaluations recorded and were included in this analysis. The 1330 children had a median
age of 11 (IQR, 2-324) days; 745 (56.0%) were male and 727 (54.7%) presented with neurological
symptoms during illness before death. The most common postmortem-confirmed neurological
diagnoses related to death were hypoxic events (308 [23.2%]), meningoencephalitis (135 [10.2%]),
and cerebral malaria (68 [5.1%]). There were 12 neonates with overlapping hypoxic events and
meningoencephalitis, but there were no patients with overlapping meningoencephalitis and cerebral
malaria. Neurological symptoms were similar among diagnoses, and no combination of symptoms
was accurate in differentiating them without complementary tools. However, only 25 children
(18.5%) with meningitis had a lumbar puncture performed before death. Nearly 90% of deaths (442
of 511 [86.5%]) with neurological diagnoses in the chain of events leading to deathwere considered
preventable.

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Articles publicats en revistes (Medicina)

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Manifestacions neurològiques de les malalties

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Neurologic manifestations of general diseases

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Neurological Symptoms and Cause of Death Among Young Children in Low- and Middle-Income Countries