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They did not participate in analysis or conclusions of this work and did not play a role in decision to publish and preparation of this manuscript.Д¬ompeting interests: I have read the journalвЂ™s policy and the authors of this manuscript have the following competing interests: QB, a co-author of this paper is also a Guest Editor on this special issue on Global Child Health: From Birth to Adolescence and Beyond. The funder participated in discussions of study design and data collection. ДЇunding: This work was funded by the Bill and Melinda Gates Foundation (Grant number: OPP1126780) to RFB and CGW. Datasets are publicly available at (Child Health and Mortality Prevention Surveillance, 2021, 'CHAMPS De-identified Dataset. The work is made available under the Creative Commons CC0 public domain dedication.Дata Availability: Data can be accessed at and requests can be made at that site to access additional datasets.

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This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. Received: FebruAccepted: SeptemPublished: September 30, 2021 PLoS Med 18(9):ДЄcademic Editor: Marie-Louise Newell, University of Southampton, UNITED KINGDOM (2021) Postmortem investigations and identification of multiple causes of child deaths: An analysis of findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. While comprehensive CoD determinations were done for a substantial number of deaths, there is potential for bias regarding which deaths in surveillance areas underwent minimally invasive tissue sampling (MITS), potentially reducing representativeness of findings.Д¬itation: Breiman RF, Blau DM, Mutevedzi P, Akelo V, Mandomando I, Ogbuanu IU, et al. For infant deaths, the proportion caused by meningitis and sepsis increased by 16-fold and 11-fold, respectively for child deaths, sepsis and LRI are increased 12-fold and 10-fold, respectively. Including all positions in the causal chain for neonatal deaths resulted in 19-fold and 11-fold increases in attributable roles for meningitis and LRI, respectively. Among 46 child deaths with malnutrition as the underlying condition, all had в‰Ґ1 other condition in the causal chain, most commonly sepsis, followed by LRI, malaria, and diarrheal disease. Of the 241 child deaths, 178 (75%) had в‰Ґ1 additional condition. The 2 most common underlying conditions in infants were malnutrition and congenital birth defects LRI and sepsis were the most common additional conditions in causal chains, each accounting for approximately half of deaths with either underlying condition. Of the 278 infant deaths, 212 (79%) had в‰Ґ1 additional cause of death (CoD) beyond the underlying cause. For neonates, preterm birth complications (most commonly respiratory distress syndrome) were the most common underlying condition ( 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, 69 (24%) with lower respiratory infection (LRI), 60 (21%) with meningitis, and 25 (9%) with perinatal asphyxia/hypoxia. While pathology provides very helpful clues, we cannot always be certain that conditions identified led to death or occurred in an agonal stage of death. Among 1,232 deaths with an underlying condition determined, we found a range of 0 to 6 (mean 1.5, IQR 0 to 2) additional conditions in the causal chain leading to death. We analyzed the distribution of all conditions listed as causal, including underlying, antecedent, and immediate causes of death. DeCoDe panelists included all conditions in the causal chain according to the ICD-10 guidelines and assessed if prevention or effective management of the condition would have prevented the death. We examined deaths identified from December 2016 through November 2020 from 7 CHAMPS sites (in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa), including 741 neonatal, 278 infant, and 241 child <5 years deaths for which results from Determination of Cause of Death (DeCoDe) panels were complete.