TY - JOUR
T1 - Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010
T2 - A systematic analysis
AU - Nair, Harish
AU - Simões, Eric A.F.
AU - Rudan, Igor
AU - Gessner, Bradford D.
AU - Azziz-Baumgartner, Eduardo
AU - Zhang, Jian Shayne F.
AU - Feikin, Daniel R.
AU - MacKenzie, Grant A.
AU - Moïsi, Jennifer C.
AU - Roca, Anna
AU - Baggett, Henry C.
AU - Zaman, Syed M.A.
AU - Singleton, Rosalyn J.
AU - Lucero, Marilla G.
AU - Chandran, Aruna
AU - Gentile, Angela
AU - Cohen, Cheryl
AU - Krishnan, Anand
AU - Bhutta, Zulfiqar A.
AU - Arguedas, Adriano
AU - Clara, Alexey Wilfrido
AU - Andrade, Ana Lucia
AU - Ope, Maurice
AU - Ruvinsky, Raúl Oscar
AU - Hortal, María
AU - McCracken, John P.
AU - Madhi, Shabir A.
AU - Bruce, Nigel
AU - Qazi, Shamim A.
AU - Morris, Saul S.
AU - Arifeen, Shams El
AU - Weber, Martin W.
AU - G. Scott, J. Anthony
AU - Brooks, W. Abdullah
AU - Breiman, Robert F.
AU - Campbell, Harry
N1 - Funding Information:
Financial support for this work was provided by WHO Global Influenza Program (Grant number HQGIP1002906). The findings and conclusions in this report are those of the authors and do not necessarily represent the policies of the United States Centers for Disease Control and Prevention or WHO. This work was done as part of the wider programme of the Child Health Epidemiology Working Group (CHERG) and Global Health Epidemiology Reference Group (GHERG) to establish the major causes of global childhood disease burden. Endang Sedyaningsih sadly died suddenly and unexpectedly while this paper was being prepared for publication. We would like to acknowledge her important contribution to this study and her role as a promoter of child health in Indonesia. We thank Johannes Forster (Department of Paediatrics, St Josefskrankenhaus Freiburg and University of Freiburg, Freiburg, Germany); Gabriele Ihorst (Clinical Trials Center, University Medical Center Freiburg, Freiburg, Germany); and Carlos G Grijalva (Vanderbilt University, US) for providing additional data from their published papers. We are grateful to Felicity Cutts (London School of Hygiene and Tropical Medicine, London, UK); Fatema Khatun, Peter Kim Streatfield, Sajal Kumar Saha, Kamrun Nahar, Amina Tahia Sharmeen, Anjali Bilkis Ara, Sultana Yeasmin (International Centre for Diarrhoeal Disease Research, Bangladesh); Leilani T Nillos (Research Institute for Tropical Medicine, Philippines); Elias Jimenez, Ana Laura Jimenez, Carolina Soley (Instituto de Atención Pediatrica, Costa Rica); Ron Dagan, Nurith Porat (Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Guiron University of the Negav, Beer-Sheva, Israel); Gail Rodgers, Sharon Gray, Darmendra Ramcharran (Pfizer Inc. Collegeville, PA, USA); Uchendu Uchendu, David Ameh, Bolanle Akinsola, Readon Ideh, Bernard Ebruke, Debasish Saha, Momodou Jasseh (MRC Unit, The Gambia); Pedro L Alonso, Llorenç Quinto (Barcelona Centre for International Health Research (CRESIB, Hospital Clinic–Universitat de Barcelona) and Centro de Investigação em Saúde de Manhiça, Mozambique); Maria Aparecida da Silva Vieira (Pontifical Catholic University of Goiás, Goiânia, Brazil); Renato Maurício Oliveira (Federal University of Goiás, Goiânia, Brazil); Vicente Porfírio Pessoa-Jr (Secretariat of Health of Municipality of Goiânia, Brazil); Simonne Nouer (UTHSC–Department of Preventive Medicine, Memphis, TN, USA); Lícia Kamilla Assis Melo Thorn (Karolinska Institutet, Stockholm); Luiza Helena Ribeiro (Samaritano Hospital, Goiânia, Brazil); José Cássio de Moraes (Santa Casa School of Medical Sciences, Saõo Paulo, Brazil); David Rodriguez (Ministry of Health of El Salvador); Celina de Lozano (National Influenza Center of El Salvador); Kim A Lindblade, Jennifer Verani (US Centers for Disease Control and Prevention Regional Office for Central America and Panama, International Emerging Infections Program, Guatemala); Somsak Thamthitiwat, Sununta Henchaichon, Prabda Prapasiri, Sathapana Naorat (International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand); Peera Areerat (Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand); Asadang Ruayajin (Sa Kaeo Provincial Health Office, Sa Kaeo, Thailand) for their assistance. The Indian Council for Medical Research (ICMR) led a multisite study with funding provided by the Hib Initiative; we thank the investigators at ICMR and the study sites of Christian Medical College, Vellore; Post Graduate Institute of Medical Education and Research, Chandigarh; and the National Institute of Cholera and Enteric Diseases, Kolkata. Costa Rica's LEAP study team thank all the physicians within the study area, in private practice, and from the Caja Costarricense de Seguro Social for referring their patients to participate in the active epidemiological surveillance. We thank the South African Severe Acute Respiratory Infections Surveillance Group, Wyeth-Pfizer, CNPq-Brazilian Council for Scientific Development and Technology, MRC Gambia Pneumococcal Surveillance Project and Severe Pneumonia Studies teams, MRC Gambia Basse Health and Demographic Surveillance System, Gambia Government, Basse Health Centre staff, the MRC Gambia Pneumococcal Vaccine Trial team for their assistance; Ana Ceballos, (CEDEPAP, Cordoba, Argentina), Jane Crawley (University of Oxford), and Olaf Muller (Ruprecht-Karls-University Heidelberg, Germany) for participating in the Working Group Meeting and providing valuable inputs; and Arti Nair (University of Edinburgh) for assistance with extracting data from the DHS and MICS databases.
PY - 2013/4
Y1 - 2013/4
N2 - Background 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. Methods We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratifi ed 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. Findings We identifi ed 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. Interpretation 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.
AB - Background 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. Methods We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratifi ed 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. Findings We identifi ed 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. Interpretation 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.
UR - https://www.scopus.com/pages/publications/84876282317
U2 - 10.1016/S0140-6736(12)61901-1
DO - 10.1016/S0140-6736(12)61901-1
M3 - Article
C2 - 23369797
AN - SCOPUS:84876282317
SN - 0140-6736
VL - 381
SP - 1380
EP - 1390
JO - The Lancet
JF - The Lancet
IS - 9875
ER -