Trends and spatial distribution of pneumonia admissions and deaths among children <5 years, Uganda, 2013–2021

Abstract

Background: Pneumonia is the second leading cause of hospital admissions and deaths among children &lt;5 years old in Uganda. In 2013, Uganda adopted various interventions to protect, prevent, and improve the treatment of pneumonia under the Global Action Plan for Prevention and Control of Pneumonia and Diarrhoea (GAPPD), including the introduction of the pneumococcal conjugate vaccine (PCV) into routine immunization schedule. However, little is known about the impact of these interventions on pneumonia admissions and deaths. We described the trends and spatial distribution of pneumonia hospital admissions and mortality among children &lt;5 years in Uganda, 2013–2021. Methods: We analysed secondary data on pneumonia admissions and deaths from the District Health Information System version 2 during 2013–2021. Reporting rates were calculated as the percentage of expected complete monthly health facility reports submitted to the national surveillance database. The proportion of pneumonia cases admitted and case-fatality rates (CFRs) for children &lt;5 years were calculated for children &lt;5 years presenting at the outpatient department. At national, regional, and district levels, pneumonia mortality rates were calculated per 100,000 children &lt;5 years. The Mann-Kendall Test was used to assess trend significance. Results: There were 753,978 pneumonia admissions and 13,632 (2%) deaths during 2013–2021. Reporting rates ranged from 78–92%. The overall proportion of pneumonia cases admitted among children &lt;5 years was 23%. The overall CFR was 0.41%, and the overall pneumonia mortality rate among children &lt;5 years was 21 deaths per 100,000. From 2013 to 2021, there were declines in the proportion of pneumonia cases admitted (33% to 15%; p=0.051), mortality rates (26/100,000 to 13 per 100,000; p=0.01), and CFR (0.61% to 0.24%; p=0.01), concomitant with increasing PCV coverage. Kotido District had a persistently high proportion of pneumonia cases that were admitted (&gt;30%) every year while Kasese District had persistently high mortality rates (68-150 deaths per 100,000 children &lt;5 years). Conclusion: Pneumonia admissions, mortality, and case fatality among children &lt;5 years declined during 2013–2021 in Uganda after the introduction of PCV. However, with these trends it is unlikely that Uganda will meet the 2025 GAPPD targets. There is therefore a need to review implementation of existing interventions, identify gaps in order to highlight priority actions to further accelerate declines.