Introduction: Auditing of paediatric deaths has rarely been evaluated in hospitals especially in low and middle-income countries. The aim of the study is to describe the characteristics of paediatric death in hospitalised children and determine the predictors of death location in Hospital Universiti Sains Malaysia (USM). Method: Paediatric mortality cases for children aged between 29 days and 18 years old at the time of death were analyzed. These were documented cases between the year 2013 and 2020 at Hospital USM. Case notes were reviewed, and data were captured retrospectively. Multiple Logistic Regression was used to assess predictors of the location of death especially in the ward setting.Results: Out of 841 paediatric deaths identified during the period of the study, 544 cases were enrolled. The male gender has a higher proportion (1.4:1). The median age was 56 months, with infancy being the predominant age group. The median length of hospital stay was 10.5 days. More than half of the cases (58.3%) had underlying life-limiting illnesses. The majority of the patients had “Do Not Resuscitate” orders. A longer length of stay (prevalence odds ratio (POR 0.99, 95% CI 0.98, 0.99), being on ventilator (POR 3.42,95% CI 1.95, 6.01), being terminally ill (POR 0.40,95% CI 0.23, 0.70) and having underlying life limiting illness (POR 0.50, 95% CI 0.33, 0.75) were the significant predictors for the ward death. Conclusion: Understanding the characteristics of child death and the factors associated with death location is critical for improving paediatric care and treatment.

This is a report of 8-months progression of circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants in Brunei Darussalam from November 2021. Whole-genome sequencing (WGS) was performed on nearly 3,000 random local COVID-19 patients in samples with a cycle-threshold (CT) of less than 25. Phylogenetic analysis revealed that the Delta variant, particularly AY.24.1, was the predominant variant towards the end of 2021. The same variant was then completely superseded by the Omicron variants in mid-January 2022. During the early wave of Omicron variants, BA.2.3.19 and its paternal BA.2.3 were found to be the prominent sublineage until it was replaced by BA.5 lineages four months later, mainly BA.5.2 and BF.5. Further analysis revealed that AY.24.1 and BA.2.3.19 that was once a prevalent variant are predominantly observed in Brunei. Both variants can be differentiated by the presence of a particular mutation in the S gene that encodes the viral spike protein that is essential for host cell interaction. Brunei is continuously monitoring the circulating SARS-CoV-2 variants as part of its genomic surveillance following the World Health Organization (WHO) guidance for surveillance.