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
Summary. 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 L...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
October 30, 2019
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| In: |
The lancet. Infectious diseases
Year: 2019, Volume: 20, Issue: 1, Pages: 60-79 |
| ISSN: | 1474-4457 |
| DOI: | 10.1016/S1473-3099(19)30410-4 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/S1473-3099(19)30410-4 Verlag, kostenfrei, Volltext: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30410-4/abstract 
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| Author Notes: | Christopher E. Troeger, Ibrahim A. Khalil, Brigette F. Blacker, Molly H. Biehl, Samuel B. Albertson, Stephanie R.M. Zimsen, Puja C. Rao, Degu Abate, Amha Admasie, Alireza Ahmadi, Mohamed Lemine Cheikh Brahim Ahmed, Chalachew Genet Akal, Fares Alahdab, Noore Alam, Kefyalew Addis Alene, Vahid Alipour, Syed Mohamed Aljunid, Rajaa M. Al-Raddadi, Nelson Alvis-Guzman, Saeed Amini, Mina Anjomshoa, Carl Abelardo T. Antonio, Jalal Arabloo, Olatunde Aremu, Hagos Tasew Atalay, Suleman Atique, Euripide F.G.A. Avokpaho, Samah Awad, Ashish Awasthi, Alaa Badawi, Kalpana Balakrishnan, Joseph Adel Mattar Banoub, Aleksandra Barac, Quique Bassat, Neeraj Bedi, Derrick A. Bennett, Krittika Bhattacharyya, Zulfiqar A. Bhutta, Ali Bijani, Corey B. Bills, Josip Car, Félix Carvalho, Carlos A. Castañeda-Orjuela, Kate Causey, Devasahayam J. Christopher, Aaron J. Cohen, Lalit Dandona, Rakhi Dandona, Ahmad Daryani, Feleke Mekonnen Demeke, Shirin Djalalinia, Manisha Dubey, Eleonora Dubljanin, Eyasu Ejeta Duken, Maysaa El Sayed Zaki, Aman Yesuf Endries, Eduarda Fernandes, Florian Fischer, Joseph Frostad, Nancy Fullman, William M. Gardner, Birhanu Geta, Keyghobad Ghadiri, Giuseppe Gorini, Alessandra C. Goulart, Yuming Guo, Gessessew Bugssa Hailu, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Samer Hamidi, Hamid Yimam Hassen, Chi Linh Hoang, Nobuyuki Horita, Mihaela Hostiuc, Zakir Hussain, Seyed Sina Naghibi Irvani, Spencer L. James, Ravi Prakash Jha, Jost B. Jonas, André Karch, Amir Kasaeian, Tesfaye Dessale Kassa, Nicholas J. Kassebaum, Adane Teshome Kefale, Yousef Saleh Khader, Ejaz Ahmad Khan, Gulfaraz Khan, Md Nuruzzaman Khan, Young-Ho Khang, Abdullah T. Khoja, Ruth W. Kimokoti, Adnan Kisa, Sezer Kisa, Niranjan Kissoon, Luke D. Knibbs, Sonali Kochhar, Soewarta Kosen, Parvaiz A. Koul, Ai Koyanagi, Barthelemy Kuate Defo, G. Anil Kumar, Dharmesh Kumar Lal, Cheru Tesema Leshargie, Sonia Lewycka, Shanshan Li, Rakesh Lodha, Erlyn Rachelle King Macarayan, Marek Majdan, Abdullah A. Mamun, Helena Manguerra, Varshil Mehta, Addisu Melese, Ziad A. Memish, Desalegn Tadese Mengistu, Tuomo J. Meretoja, Tomislav Mestrovic, Bartosz Miazgowski, Erkin M. Mirrakhimov, Babak Moazen, Karzan Abdulmuhsin Mohammad, Shafiu Mohammed, Lorenzo Monasta, Catrin E. Moore, Lidia Morawska, Jonathan F. Mosser, Seyyed Meysam Mousavi, Srinivas Murthy, Ghulam Mustafa, Javad Nazari, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Long Hoang Nguyen, Son Hoang Nguyen, Katie R. Nielsen, Muhammad Imran Nisar, Molly R. Nixon, Felix Akpojene Ogbo, Anselm Okoro, Andrew T. Olagunju, Tinuke O. Olagunju, Eyal Oren, Justin R. Ortiz, Mahesh P.A., Smita Pakhale, Maarten J. Postma, Mostafa Qorbani, Reginald Quansah, Alireza Rafiei, Fakher Rahim, Vafa Rahimi-Movaghar, Rajesh Kumar Rai, Marissa Bettay Reitsma, Mohammad Sadegh Rezai, Aziz Rezapour, Maria Jesus Rios-Blancas, Luca Ronfani, Dietrich Rothenbacher, Salvatore Rubino, Zikria Saleem, Evanson Zondani Sambala, Abdallah M. Samy, Milena M. Santric Milicevic, Rodrigo Sarmiento-Suárez, Benn Sartorius, Miloje Savic, Monika Sawhney, Sonia Saxena, Alyssa Sbarra, Seyedmojtaba Seyedmousavi, Masood Ali Shaikh, Aziz Sheikh, Mika Shigematsu, David L. Smith, Chandrashekhar T. Sreeramareddy, Jeffrey D. Stanaway, Mu'awiyyah Babale Sufiyan, Mohamad-Hani Temsah, Belay Tessema, Bach Xuan Tran, Khanh Bao Tran, Afewerki Gebremeskel Tsadik, Irfan Ullah, Rachel L. Updike, Tommi Juhani Vasankari, Yousef Veisani, Fiseha Wadilo Wada, Yasir Waheed, Katie Welgan, Kirsten E. Wiens, Charles Shey Wiysonge, Ebrahim M. Yimer, Naohiro Yonemoto, Zoubida Zaidi, Heather J. Zar, Stephen S. Lim, Theo Vos, Ali H. Mokdad, Christopher J.L. Murray, Hmwe Hmwe Kyu, Simon I. Hay, Robert C. Reiner |
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| 520 | |a Summary. 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. Methods: We 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 contribute to the reduction of preventable deaths.Funding: Bill & Melinda Gates Foundation | ||
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