The Lancet, Early Online Publication, 29 January 2013-
Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis
Dr Harish Nair DNB a b, Prof Eric AF Simoões MD c d, Prof Igor Rudan MD a, Bradford D Gessner MD e, Eduardo Azziz-Baumgartner MD f, Jian Shayne F Zhang MPH g h, Daniel R Feikin MD I j, Grant A Mackenzie PhD k, Jennifer C Moiïsi PhD l, Anna Roca PhD m n, Henry C Baggett MD o, Syed MA Zaman PhD k p, Rosalyn J Singleton MD q r, Marilla G Lucero MD s, Aruna Chandran MD j, Prof Angela Gentile MD t, Cheryl Cohen MBBCH u v, Anand Krishnan MD x, Prof Zulfiqar A Bhutta PhD y, Prof Adriano Arguedas MD z, Alexey Wilfrido Clara MPH aa, Prof Ana Lucia Andrade MD ab, Maurice Ope MBChB ac, Prof Raúl Oscar Ruvinsky MD ad, Prof María Hortal MD ae, John P McCracken ScD af, Prof Shabir A Madhi MD u w, Prof Nigel Bruce PhD ag, Shamim A Qazi MD ah, Saul S Morris PhD ai, Shams El Arifeen DrPH aj, Martin W Weber MD ak, Prof J Anthony G Scott FRCP l, W Abdullah Brooks MD aj, Robert F Breiman MD i, Prof Harry Campbell MD a, for the Severe Acute Lower Respiratory Infections Working Group†
The annual number of hospital admissions and in-hospital deaths due to severe acute lower respiratory infections (ALRI) in young children worldwide is unknown. We aimed to estimate the incidence of admissions and deaths for such infections in children younger than 5 years in 2010.
We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratified by age and region, with data from a systematic review of studies published between Jan 1, 1990, and March 31, 2012, and from 28 unpublished population-based studies. We applied these incidence estimates to population estimates for 2010, to calculate the global and regional burden in children admitted with severe ALRI in that year. We estimated in-hospital mortality due to severe and very severe ALRI by combining incidence estimates with case fatality ratios from hospital-based studies.
We identified 89 eligible studies and estimated that in 2010, 11·9 million (95% CI 10·3—13·9 million) episodes of severe and 3·0 million (2·1—4·2 million) episodes of very severe ALRI resulted in hospital admissions in young children worldwide. Incidence was higher in boys than in girls, the sex disparity being greatest in South Asian studies. On the basis of data from 37 hospital studies reporting case fatality ratios for severe ALRI, we estimated that roughly 265 000 (95% CI 160 000—450 000) in-hospital deaths took place in young children, with 99% of these deaths in developing countries. Therefore, the data suggest that although 62% of children with severe ALRI are treated in hospitals, 81% of deaths happen outside hospitals.
Severe ALRI is a substantial burden on health services worldwide and a major cause of hospital referral and admission in young children. Improved hospital access and reduced inequities, such as those related to sex and rural status, could substantially decrease mortality related to such infection. Community-based management of severe disease could be an important complementary strategy to reduce pneumonia mortality and health inequities.
a Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK; b Public Health Foundation of India, New Delhi, India; c University of Colorado Denver and Children's Hospital, Denver, CO, USA; d The University of Padjadjaran, Bandung, Indonesia; e Agence de Médecine Préventive, Paris, France; f Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA; g School of Population Health, The University of Melbourne, VIC, Australia; h Social Insurance Fund Management Centre, Jiangsu, China; i Centers for Disease Control and Prevention, Nairobi, Kenya; j Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; k Child Survival Theme, The Gambia Unit, Medical Research Council, Banjul, The Gambia; l Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; m Barcelona Centre for International Health Research (CRESIB), Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain; n Centro de Investigação em Saúde da Manhiça, Ministerio de Saúde, Maputo, Mozambique; o International Emerging Infections Program, Global Disease Detection Regional Centre, Thailand MOPH—US CDC Collaboration, Nonthaburi, Thailand; p Health Protection Services Colindale, Health Protection Agency, London, UK; q Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Anchorage, AK, USA; r Alaska Native Tribal Health Consortium, Anchorage, AK, USA; s Research Institute for Tropical Medicine, Department of Health, Alabang, Muntinlupa, Philippines; t Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina; u Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham, South Africa; v School of Public Health and Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; w Department of Science and Technology, and National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; x Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India; y Division of Women and Child Health, Aga Khan University, Karachi, Pakistan; z Instituto de Atención Pediatrica, Universidad de Ciencias Médicas de Centro América, San José, Costa Rica; aa CDC-Central American Region, Guatemala City, Guatemala; ab Federal University of Goiás, Goiânia, Brazil; ac East African Community Secretariat, Arusha, Tanzania; ad National University of Buenos Aires, Buenos Aires, Argentina; ae Program for Basic Sciences Development, National University/PNUD, Montevideo, Uruguay; af Center for Health Studies, Universidad del Valle de Guatemala, Guatemala; ag University of Liverpool, Liverpool, UK; ah Department of Maternal, Neonatal and Child and Adolescent Health, WHO, Geneva, Switzerland; ai Bill & Melinda Gates Foundation, Seattle, WA, USA; aj International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; ak WHO, Indonesia Country Office, Jakarta, Indonesia
Correspondence to: Dr Harish Nair, Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh EH8 9AG, UK
† Members listed at end of paper