The latest findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) network, spearheaded by researchers at the University of the Witwatersrand (Wits) in South Africa, have shed critical light on the leading causes of neonatal deaths. Published today in The Lancet Infectious Diseases, the study analyzed over 2,600 neonatal deaths across Africa and South Asia from 2016 to 2023, revealing that infections play a role in 44% of these tragedies. In South Africa specifically, the data points to preventable hospital-acquired and community pathogens, offering clear pathways to save lives through targeted interventions.

At the Wits Vaccines and Infectious Diseases Analytics Research Unit (Wits VIDA), located within the Faculty of Health Sciences, Professor Shabir A. Madhi and his team employed minimally invasive tissue sampling (MITS)—a needle-based post-mortem technique—to pinpoint exact causes that traditional methods often miss. This approach identified pathogens in cases where conventional diagnostics failed up to 73% of the time. The Soweto site, one of CHAMPS' key locations, reported a neonatal mortality rate of 16 per 1,000 live births, exceeding the national average of 10 and underscoring urban disparities even in a middle-income context.

🔬 Unpacking the Pathogen Landscape in South African Neonatal Deaths

Infections frequently intertwine with prematurity and birth complications, amplifying risks. The study categorized pathogens as hospital-acquired or community-acquired. Hospital-acquired infections dominated South African cases, with Acinetobacter baumannii accounting for 74.3%—a multidrug-resistant bacterium thriving in neonatal intensive care units due to lapses in infection prevention and control (IPC). Community threats included Group B Streptococcus (GBS) at 30.6% and Escherichia coli at 24.7%, often linked to maternal health issues during pregnancy.

Notably, South Africa uniquely reported emerging fungal infections like Candida auris and Nakaseomyces glabratus, highlighting the need for vigilant surveillance. Over 80% of these infection-related deaths were deemed preventable, with modifiable factors including IPC (50.8%), clinical management (50.7%), and antenatal care (42.2%). Antimicrobial resistance further complicates treatment, as current empirical antibiotics prove inadequate against rising superbugs like Klebsiella pneumoniae.

Historical Context: Building on CHAMPS' Decade of Data

CHAMPS, launched in 2016 with Bill & Melinda Gates Foundation support, operates across nine countries, including South Africa's Soweto and Thembelihle sites managed by Wits VIDA. Earlier 2023 research in JAMA Network Open across the network identified malnutrition (16.5%), HIV (11.9%), malaria (11.2%), and congenital defects (10.1%) as top under-5 killers, with 78% preventable. South Africa's data aligns, emphasizing infections' role in the neonatal phase, where nearly half of under-5 deaths occur.

Wits' involvement exemplifies how South African universities drive global health research. The Faculty of Health Sciences trains next-generation scientists in advanced diagnostics, fostering collaborations with the National Department of Health (NDoH) for real-time policy input.

From Data to Action: Urgent Prevention Strategies

The study urges multifaceted responses. First, overhaul empirical antibiotic protocols to combat resistance, incorporating local resistance patterns. Second, bolster IPC in neonatal units—hand hygiene, sterile equipment, and isolation protocols could slash hospital-acquired cases. Third, accelerate maternal GBS vaccination trials, as GBS vaccines show promise in preventing vertical transmission.

• Enhance antenatal care: Early booking and regular check-ups reduce community-acquired risks by addressing maternal hypertension (10%) and labor complications (8%).
• Invest in diagnostics: Scale MITS nationally for precise etiology, informing targeted therapies.
• Community education: Raise awareness on danger signs like fever or poor feeding, prompting timely care-seeking.
• Prematurity focus: Improve obstetric care to mitigate co-factors in many deaths.

CHAMPS South Africa routinely briefs NDoH, influencing guidelines and awareness campaigns. For universities like Wits, this translates to expanded research funding and training programs in pediatric epidemiology.

Photo by Roman Kraft on Unsplash

University of the Witwatersrand: Pioneering Pediatric Research

Wits VIDA, directed by Prof. Madhi—a globally renowned vaccinologist—leads CHAMPS in South Africa. The unit's state-of-the-art labs enable MITS, molecular diagnostics, and AI-driven analysis, positioning Wits as Africa's premier infectious disease research hub. Faculty mentor PhD students and postdocs, producing alumni who staff NDoH and NGOs.

This study reinforces Wits' impact: Similar efforts identified naphthalene poisoning in child deaths and GBS in stillbirths, prompting interventions. Amid South Africa's 20.4 under-5 mortality rate (2023 UNICEF data), university-led surveillance bridges evidence-to-policy gaps.

Socioeconomic and Regional Disparities Fueling the Crisis

Soweto's 16/1,000 rate reflects inequalities: Overcrowded homes, limited sanitation, and HIV prevalence exacerbate vulnerabilities. Premature infants (under 32 weeks) face 10-fold risks, often compounded by infections. Rural-urban divides persist, but urban sites like Soweto reveal hospital system strains—overburdened NICUs breed resistant pathogens.

Cultural factors, like delayed care-seeking due to mistrust or transport barriers, worsen outcomes. Wits research highlights how poverty intersects with biology: Malnourished mothers birth vulnerable neonates prone to sepsis.

Global Lessons from South African Innovation

CHAMPS' MITS outperforms verbal autopsies, identifying causes in 80%+ cases vs. 50%. South Africa's data informs WHO guidelines, with GBS vaccine advocacy gaining traction. Comparable to Ethiopia or Kenya sites, SA's fungal threats signal emerging risks from global travel.

For higher education, CHAMPS exemplifies interdisciplinary training—epidemiology, genomics, ethics—preparing graduates for research jobs at AcademicJobs.com/research-jobs.

Stakeholder Perspectives: Policymakers, Clinicians, and Communities

NDoH praises CHAMPS for actionable insights, integrating findings into PMTCT and IPC protocols. Clinicians advocate rapid diagnostics; Prof. Madhi notes, "Updated antibiotics could save thousands." Communities, via Wits outreach, demand better maternity services.

Challenges: Funding shortages, resistance spread. Solutions: Public-private partnerships, university-NGO ties.

Photo by Markus Winkler on Unsplash

Future Outlook: Toward SDG Targets

With SDG 3.2 aiming for <12/1,000 neonatal deaths by 2030, CHAMPS charts the path. Wits plans expanded surveillance, vaccine trials. AI dashboards will predict outbreaks, empowering real-time responses.

Actionable for academics: Pursue research assistant roles in pediatric health; for parents: Attend antenatal clinics, recognize sepsis signs.

South Africa's universities like Wits prove research drives equity, positioning the nation as an African health leader.