Infant- and child-level predictors of mortality in low-resource settings: the WHO Child Mortality Risk Stratification Multi-Country Pooled Cohort

BackgroundDespite impressive reductions in overall global child mortality, rates of decline have slowed during the last decade. Current guidelines for the care of at-risk children in low-resource settings mostly focus on broad clinical syndromes or undernutrition rather than childrens individual contextualized risk. We aimed to identify readily assessable child-level characteristics that can predict child mortality risk in a range of community and healthcare settings in high-burden settings. MethodsWe analysed pooled data from 33 cohorts including 75,287 children under five years of age living in low resource settings to estimate the absolute risks of death associated with risk exposures separately and combined with anthropometry. Children were grouped according to population types studied: general population (GP), selected on anthropometric criteria (A-S), and selected on the presence of illness (I-S). FindingsDuring a total of 69,085 child-years of follow-up in the pooled dataset, 2,805 (3.7%) children died. Age <24 months, low anthropometry, preterm birth, low birthweight, and absence of breastfeeding were each associated with increased mortality: risks were additive and declined with increasing age. However, overall mortality and the association between child-level characteristics and mortality differed according to the type of study population and child age. InterpretationRisk assessments combining individual child-level characteristics including anthropometry can enable programmes to identify children at high and lower risk of mortality and, thereafter, differentiate care accordingly. Such a strategy may reduce mortality and optimise health system efficiency and effectiveness.