Dear CHIFA colleagues, thank you for the ongoing discussion on child health reviews, inititated by Hajime Takeuchi (Japan). We encourage further discussion on this topic. The facilitate, the discussion I have summarised the contributions so far below.
From 9-15 January 2026 there was a spontaneous discussion on CHIFA on the topic of child death reviews. You can read the messages in full, including the profiles of participants, here: https://www.hifa.org/rss-feeds/10
There have been 10 messages exchanged to date and participants have included Hajime Takeuchi (Japan), Evelyn Eisenstein (Brazil), Trevor Duke (Australia), Uzodinma Adirieje (Nigeria), Ochiawunma Ibe (Nigeria), Obinna O E Oleribe (Nigeria), and Chia Benard Ful (Cameroon).
1. Hajime Takeuchi opened the discussion: "According to 2023 data, Japan's infant mortality rate is 1.8, one of the lowest in the world. However, when looking only at infants from unemployed households, the rate is 19.0, more than 10 times higher. Furthermore, suicide is the leading cause of death among teenagers, accounting for 26% of all deaths in their early teens and 50% in their late teens. Given this, we need to understand the social paediatric context of these issues, conduct death reviews using a refined social model rather than a medical model, and work to solve the problem. What kind of child death review is in your country? Could you please introduce some inspiring initiatives or papers from your country, region or the world?" "The [Japanese] government has initiated a model Child Death Review programme in each prefecture. It started six years ago. While its goal is to effectively prevent child deaths, its primary focus is on identifying medical causes of death in the narrow sense, including whether or not they were criminal, and it does not appear to address structural social issues."
2. Evelyn Eisenstein (Brazil) noted: "Unemployed households mean poverty and all the diversity and lack of survival needs for children and adolescents. Including the very first one: abandonment and lack of affection bonds by "stressed" parents or one-parent household.
3. Trevor Duke (Australia): "Your observations in Japan are mirrored in Australia; that there is a mortality gradient based on social deprivation. We have statutory Child Mortality Review committees in each state, which are charged with reviewing each death and assigning causation, and identifying preventable factors. This committee structure has been operational for about 40 years. Over the last 2 decades we have identified the complex causal pathway to child deaths, which often includes an underlying condition, an acute intercurrent event, and social and economic disadvantage... WHO has a framework for mortality auditing, which is a little different if done at a hospital level compared to at a state jurisdictional level. But it may also be useful: Improving the quality of paediatric care: an operational guide for facility-based audit and review of paediatric mortality<https://iris.who.int/items/4dc2f21a-b6d1-4692-8e65-d957f53720cf>. New WHO guidelines on paediatric mortality and morbidity auditing<https://adc.bmj.com/content/archdischild/104/9/831.full.pdf>"
4. Uzodinma Adirieje (Nigeria): "Nigeria continues to lose thousands of children every year to largely preventable causes, yet the country has no comprehensive system to understand why these deaths occur. Presently, the nation relies on the Maternal and Perinatal Death Surveillance and Response (MPDSR) framework, which focuses only on maternal, stillbirth, and neonatal deaths. The implication is that once a child survives the first 28 days of life, their death is largely invisible to formal review processes... Establishing a National Child Death Review and Accountability System is critical for saving lives, improving healthcare quality, and protecting Nigerian children."
5. Ochiawunma Ibe (Nigeria): "In general, medical negligence has very little attention in Nigeria, and as practitioners, we should be at the forefront of establishing accountability structures."
6. Obinna O E Oleribe (Nigeria): "For decades of medical practice in Nigeria, we have witnessed countless children, women, and men die who should not have died. Many succumbed because they could not afford care, presented late, or sought help from unqualified practitioners due to the prohibitive cost of medical services. We have watched trained doctors leave Nigeria in large numbers for Europe, North America, the Middle East, and Asia, driven by poor hospital management, inadequate remuneration, and a persistent lack of political will to meaningfully reform the health system... Nigerians have died, are dying, and will continue to die until government, communities, and individuals commit to sustained, systemic action.
7. Chia Benard Ful (Cameroon): "We should also focus on child death in conflict zones of the world at large.... Often recent in the armed conflict in anglophone Cameroon, there has been the targeted killing of children by armed men. Some humanitarian organizations have even seen their work frustrated by government officials, sending them away and causing the death tool in children to increase. We are calling on the international and human rights organizations to intervene in this situation. Humanitarian organizations in anglophone Cameroon are unable to deliver their services for fear that they will be accused of treating or assisting Non state armed groups (NSAGS)."
CHIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org