Emory University announced its largest ever one-time research grant on Thursday, a $180 million gift from the Bill & Melinda Gates Foundation that will fund analyses aimed at lowering child mortality rates in some of the world’s poorest communities.
The grant money is earmarked for the Child Health and Mortality Prevention Surveillance network (CHAMPS), which analyzes data to help identify and better understand the causes of child mortality in children under 5 years old. The latest donation will bring the foundation’s total investment in CHAMPS to $271 million over a 10-year-period.
Launched in 2015, CHAMPS has established sites in seven countries — Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa, with plans to add a sites in India and another location yet to be determined.
The program network includes a diverse group of research institutes, universities and ministries of health.
“It’s like the poet Maya Angelou said, ‘When you know better, you do better,’” said Dr. Robert Breiman, director of the Emory Global Health Institute. “The causes of death, as previously understood, have been so non-specific and often inaccurate. We are enabling people in countries where child mortality is highest to know better, so they can do better to save lives.”
Due to poor medical access, many children die without seeing a doctor.
“Some of these early deaths, we don’t know much at all,” Bill Gates said in an interview in 2017 with GeekWire. “Was there an infection there? Is there some new tool – an antibiotic, a vaccine — that could have saved that child’s life?”
The gold standard for investigating potential causes of death is a complete diagnostic autopsy. But those are invasive, expensive and, in many cases, culturally inappropriate. A group at the Barcelona Institute of Global Health, which partners with CHAMPS, pioneered a tool that is far less expensive and less invasive than a traditional autopsy — Minimally Invasive Tissue Sampling, or MITS.
The MITS method uses needle biopsies — the same kind used routinely to diagnose cancer. These needles don’t leave visible marks on the body of a deceased child, and the procedure can be done relatively quickly, preventing it from interfering with family and cultural burial practices.
CHAMPS workers approach families to explain how post-mortem testing might allow the illnesses that led to deaths to be pinpointed and possibly prevented in other children. Breiman said between 35% and 70% percent of families agree. CHAMPS has about 1,000 locals working at the seven sites.
Breiman said the results of the testing offer an unprecedented level of precision and accuracy, especially if a child’s death was related to an infectious disease. Instead of only identifying major syndromes, like pneumonia, it can determine the specific pathogen that caused the pneumonia.
The medical community can use the information to determine, for example, which antibiotics to use, as well as to develop new vaccines to prevent the most common infectious causes of death. This allows public health leaders to better target limited resources to combat the major threats to children’s health.
CHAMPS partners with governments and national public health institutes, including the International Association of National Public Health Institutes, which, along with CHAMPS, has offices based in the Emory Global Health Institute; the U.S. Centers for Disease Control and Prevention; and Public Health Informatics Institute, a program of The Task Force for Global Health.
Breiman said 5.4 million children die every year, mostly in the sub-Saharan Africa and South Asia and mostly from preventable causes, such as malaria, diarrheal diseases and acute respiratory infections. In each country where CHAMPS operates, the mortality rate is at least 50 per 1,000 for children under 5. In the United States, it’s about 6 per 1,000.
Dr. Scott Dowell, deputy director, epidemiology and surveillance, Bill & Melinda Gates Foundation, said the Foundation was “going out on a limb” when it first decided to fund CHAMPS.
He said he was concerned CHAMPS would not be able to get family members to allow post-mortem testing on their children. But he said Foundation officials have been impressed with by the level of acceptance, and by the data and information already being collected.
“There is nothing like this. There is no other program like CHAMPS in the world,” Dowell said. “This is part of our overarching goal to support the most definitive system to track the cause of death and to use this information to drive down the causes of childhood mortality. That is a good investment from our perspective.”
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