Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017

Abstract

Background Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. MethodsWe used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years.Findings In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286-873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5-68·5) and in mortality rate (from 362·7 deaths [330·1-392·0] per 100 000 children to 118·9 deaths [109·8-128·3] per 100 000 children; 67·2% decrease, 63·5-70·1). LRI incidence declined globally (32·4% decrease, 27·2-37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0-24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1-6·3), and reductions in household air pollution (8·4%, 6·8-9·2).Interpretation Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribut...

Associations between infant and young child feeding practices and acute respiratory infection and diarrhoea in Ethiopia: A propensity score matching approach

“…suggests that the increased risk of ARI in children depends on a range of factors, including sub-optimal breastfeeding, malnutrition, household environment (such as crowding and air pollution), poor vaccine coverage and antibiotic misuse [57][58][59][60]. Consistent with the literature, our findings showed that children who commenced breastfeeding within the first hour of birth and were exclusively breastfed had a reduced risk of experiencing ARI compared to their counterparts.…”

“…Since 1990, despite substantial declines in global child mortality, respiratory infections still remain leading causes of death among children younger than five year of age [57]. Evidence Table 3.…”

Incidence and Risk Factors for Severe Pneumonia in Children Hospitalized with Pneumonia in Ujjain, India

“…During our study, severe pneumonia was more common in children between two and 12 months of age compared with children between 13 and 60 months of age. The global prevalence of pneumonia is highest in the age group of 1-4 years [18]. Children residing in rural areas were more affected with severe pneumonia compared with children living in urban areas, and the condition showed a marked male predilection.…”

“…Studies from low/middle-income countries (LMICs) have tried to identify the risk factors for severe pneumonia [6][7][8][9][10][11][12][13][14][15][16][17], but only a few studies from India have reported the risk factors for severe pneumonia [6,8,13]. More clinical studies from India are needed as the country alone contributes to 32% of the annual global burden of pediatric pneumonia [18]. India had the highest number of global U-5 deaths due to pneumonia with an estimated 508 deaths per day in 2017 [18].…”

“…More clinical studies from India are needed as the country alone contributes to 32% of the annual global burden of pediatric pneumonia [18]. India had the highest number of global U-5 deaths due to pneumonia with an estimated 508 deaths per day in 2017 [18]. No clinical study on the risk factors for child pneumonia has been published from the state of Madhya Pradesh (MP), India.…”