Uncovering Causes of Childhood Death Using the Minimally Invasive Autopsy at the Community Level in an Urban Vulnerable Setting of Argentina: A Population-Based Study

Background: Precise determination of the causal chain that leads to community deaths in children in low-and middle-income countries is critical to estimating all causes of mortality accurately and to planning preemptive strategies for targeted allocation of resources to reduce this scourge. Methods: An active surveillance population-based study that combined minimally invasive tissue sampling (MITS) and verbal autopsies (VA) among children under 5 was conducted in Buenos Aires, Argentina, from September 2018 to December 2020 to define the burden of all causes of community deaths. Results: Among 90 cases enrolled (86% of parental acceptance), 81 had complete MITS, 15.6% were neonates, 65.6% were post-neonatal infants, and 18.9% were children aged 1-5 years. Lung infections were the most common cause of death (CoD) in all age groups (57.8%). Among all cases of lung infections, acute bronchiolitis was the most common CoD in infants aged 12 months (8 of 11, 72.7%). The most common comorbid condition in all age groups was undernutrition in 18 of 90 (20%). It was possible to find an immediate CoD in 78 of 81 subjects where MITS could be done. With this combined approach, we were able to determine that sudden infant death syndrome was overestimated in state reports. Conclusions: CoD determination by a combination of MITS and VA provides an accurate estimation of the chain of events that leads to death, emphasizing possible interventions to prevent mortality in children.Fil: Caballero, Mauricio Tomás. Fundación Infant; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Diaz Grigaites, Sebastian. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: de la Iglesia Niveyro, Paola Ximena. Instituto Universitario del Hospital Italiano de Buenos Aires; ArgentinaFil: Esperante, Sebastian. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Infant; ArgentinaFil: Bianchi, Alejandra M.. Fundación Infant; ArgentinaFil: Nuño, Alejandra. Fundación Infant; ArgentinaFil: Valle, Sandra. Fundación Infant; ArgentinaFil: Afarian, Gabriela. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Ferretti, Adrian Julio Pantaleon. Fundación Infant; ArgentinaFil: Baglivo, Sofia Jares. Fundación Infant; ArgentinaFil: De Luca, Julian. Fundación Infant; ArgentinaFil: Zea, Cristian M. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Caporal, Paula. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor María Ludovica" de La Plata; ArgentinaFil: Labanca, Maria Jose. Instituto Universitario del Hospital Italiano de Buenos Aires; ArgentinaFil: Diamanti, Adriana. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Álvarez Paggi, Damián Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Infant; ArgentinaFil: Bassat, Quique. Consorcio de Investigación Biomédica En Red de Epidemiología y Salud Pública; España. Centro de Investigação Em Saúde de Manhiça; Mozambique. Universidad de Barcelona; España. Institució Catalana de Recerca i Estudis Avancats; EspañaFil: Polack, Fernando Pedro. Fundación Infant; ArgentinaFil: Carballo, Ana M. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Hernandez, Gabriela. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Figueroa, Paola. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Ares, Patricia E.. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; ArgentinaFil: Rodriquez Paquete, Cesar A.. Gobierno de la Provincia de Buenos Aires. Ministerio Publico; Argentin