Epidemiology and Etiology of Childhood Pneumonia/ Epidemiologie et Etiologie De la Pneumonie Chez L'enfant/ Epidemiologia Y Etiologia De la Neumonia En la Ninez

By Rudan, Igor; Boschi-Pinto, Cynthia et al. | Bulletin of the World Health Organization, May 2008 | Go to article overview

Epidemiology and Etiology of Childhood Pneumonia/ Epidemiologie et Etiologie De la Pneumonie Chez L'enfant/ Epidemiologia Y Etiologia De la Neumonia En la Ninez


Rudan, Igor, Boschi-Pinto, Cynthia, Biloglav, Zrinka, Mulholland, Kim, Campbell, Harry, Bulletin of the World Health Organization


Introduction

In the early 1970s Cockburn & Assaad (1) generated one of the earliest estimates of the worldwide burden of communicable diseases. In a subsequent review, Bulla & Hitze (2) described the substantial burden of acute respiratory infections and, in the following decade, with data from 39 countries, Leowski (3) estimated that acute respiratory infections caused 4 million child deaths each year--2.6 million in infants (0-1 years) and 1.4 million in children aged 1-4 years. In the 1990s, also making use of available international data, Garenne et al.4 further refined these estimates by modelling the association between all-cause mortality in children aged less than 5 years and the proportion of deaths attributable to acute respiratory infection. Results revealed that between one-fifth and one-third of deaths in preschool children were due to or associated with acute respiratory infection. The 1993 World Development Report 5 produced figures showing that acute respiratory infection caused 30% of all childhood deaths.

The increasing focus on the reduction of child mortality arising from the Millennium Declaration and from the Millennium Development Goal (MDG) 4 of "reducing by two-thirds, between 1990 and 2015, the under-five mortality rate", (6) has generated renewed interest in the development of more accurate assessments of the number of deaths in children aged less than 5 years by cause. Moreover, the monitoring of the coverage of interventions to control these deaths has become crucial if MDG 4 is to be achieved; thus a more accurate establishment of the causes of deaths in children aged less than 5 years becomes crucial. In 2001, WHO established the Child Health Epidemiology Reference Group (CHERG)--a group of independent technical experts, to systematically review and improve data collection, methods and assumptions underlying the estimates of the distribution of the main causes of death for the year 2000. In this paper, we summarize the findings ofthis group on the morbidity and mortality burden of childhood pneumonia. We also provide new regional and country pneumonia morbidity estimates for the year 2000, and review the current understanding ofthe distribution of the main etiological agents of pneumonia among children aged less than 5 years.

Search strategy and selection criteria

Most of the morbidity and mortality estimates in this paper are based on work published by CHERG's pneumonia working group. (7,8) As a first step, the group reviewed publications on childhood pneumonia and created a database including more than 2200 sources of information. Further details on the literature search strategies, inclusion criteria, methods and models used for estimating pneumonia burden were published elsewhere. (7-9) However, the results of the distribution of global pneumonia episodes by regions and countries with the prevalence of exposure to main risk factors have not yet been published. Thus, we present the details on methods and models used for estimating these disaggregated figures in Appendix A (available at: http://www.who.int/bulletin/volumes/86/5/07048769/en/index.html). (10-27)

Incidence of clinical pneumonia

Rudan et al. (8) calculated and published the first global estimate of the incidence of clinical pneumonia in children aged less than 5 years for the year 2000. This estimate was based on the analysis of data from selected 28 community-based longitudinal studies done in developing countries that were published between 1969 and 1999. These studies were the only sources meeting the predefined set of minimum-quality criteria for inclusion in the analysis. (8) The estimated median incidence for developing countries was 0.28 episodes per child-year, with an interquartile range 0.21-0.71 episodes per child-year. (8) The variation in incidence between the selected studies was very large, most probably due to the distinct study designs and real differences in the prevalence of risk factors in the various study settings. …

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