Burden of Pneumonia in Children

Transcription

1 Burden of Pneumonia in Children

2 Objectives 1. Provide an overview of pneumonia: symptoms and diagnosis 2. Characterize the burden of pneumonia morbidity and mortality globally and in South Asia 3. Characterize the burden of pneumonia morbidity and mortality in India 4. Describe findings from key global and locally relevant sources of data 2

3 Pneumonia Pneumonia Abnormal inflammation of lung parenchyma (alveoli) Diagnosis confirmed by chest X-ray Other terms for respiratory disease Acute Respiratory Infections (ARI) Upper and lower respiratory tract Acute Lower Respiratory Tract Infection (ALRI) Bronchiolitis Clinical pneumonia Severe Acute Respiratory Infections (SARI) Respiratory symptoms + hospitalization 3

4 Pneumonia Symptoms: cough, chest pain, fever, difficulty breathing Diagnosis: Clinical diagnosis: Pneumonia: cough, difficulty breathing, elevated respiratory rate Severe or very severe pneumonia: pneumonia PLUS chest indrawing, stridor, or danger signs (inability to eat/drink, convulsions, unconsciousness, severe respiratory distress) Clinical diagnosis plus x-ray: clinical signs PLUS lung consolidation and/or pleural effusion on x-ray 4

5 Global Child Mortality in million deaths 64% of deaths (4.9 million) due to infections 5 countries account for half of all child deaths: India, Pakistan, Nigeria, DR Congo, China Liu, et al Lancet 379:

6 Global Causes of Death in Children Under 5 in ,396,000 deaths Liu, et al Lancet 379:

7 Regional Causes of Death in Children Under 5 in 2010 Liu, et al Lancet 379:

8 Regional Causes of Death in Children Under 5 in 2010 Liu, et al Lancet 379:

9 Pneumonia mortality in India 9

10 Sources of Mortality Estimates for India Child Health Epidemiology Reference Group (CHERG) Million Death Study (MDS) 10

11 CHERG: Causes of Death in Indian Children Under 5 in 2010 Congenital abnormalities 4% Neonatal infection* 8% Intrapartum complications 10% *includes sepsis, tetanus, and meningitis Other 15% Preterm birth complications 18% Pneumonia 24% Injury 3% Diarrhea 13% Measles 3% Meningitis 2% Total under 5: 1.68 million Neonatal (52%): 875,000 Pneumonia: 397,000 Liu, et al Lancet 379:

12 MDS: Causes of Death in Indian Children Under 5 in 2005 Total under 5: 2.35 million Neonatal (43%): 1.01 million Pneumonia: 369,000 MDS Collaborators. Lancet :

13 Pneumonia Mortality Rates 1-59 months of Age in India, 2005 ~ 5 fold difference Addressing inequity critical to reducing pneumonia mortality MDS Collaborators. Lancet :

14 Pneumonia morbidity in India 14

15 Pneumonia Morbidity in India 9 Studies in India 4 Studies in neighboring countries 15

16 Studies of Pneumonia Incidence Incidence: 9 India, 4 neighboring countries Study design Community-based 5 4 Hospital-based 3 0 Modeled 1 0 Time period

17 Studies of Pneumonia Incidence ALRI: Incidence per 1000 child-years India (N=4): Neighboring countries (N=3): Developing countries = 290 Severe ALRI: Incidence per 1000 child-years India (N=5): Neighboring countries (N=3):

18 Three Year Prospective Study in Rural Haryana Age 1 IR (95% CI) 2 IR (95% CI) % total ARI IR (95% CI) % total ARI IR (95% CI) % total ARI Total ARI URI ALRI Severe ALRI ( ) 3073 ( ) 87.7% 370 ( ) 10.6% 62 (33-106) 1.8% ( ) 2094 ( ) 70.9% 831 ( ) 28.2% 26 (7-66) 0.9% ( ) 1059 ( ) 71.8% 389 ( ) 26.4% 27 (3-97) 1.8% Total 2966 ( ) 2387 ( ) 80.5% 536 ( ) 18.1% 43 (26-67) 1.4% 1 - age in months 2 - Incidence rate per 1000 child-years, with 95% confidence intervals Broor, et al. PLoS One (6):

19 Incidence of Pneumonia in India Indian children U5 have ~3 episodes of respiratory infection per year heavier burden in younger children 1 in 5 episodes is a lower or severe lower respiratory tract infection Pneumonia incidence is ~0.5 per child per year 19

20 Results comparable to Haryana study 20 Gupta et al. Indian J Med Res : Incidence of Severe Hospitalized Pneumonia 1-5 months 6-11 months months Total Haryana Incidence (per 1,000 cyo) (59.63, 86.17) (19.72, 33.16) 9.43 (6.76, 13.15) (23.13, 31.91) West Bengal Incidence (per 1,000 cyo) (130.38, ) (71.66, ) (38.17, 59.66) (69.17, 90.00) Tamil Nadu Incidence (per 1,000 cyo) (59.98, ) (18.40, 45.30) (10.98, 22.06) (24.76, 38.19)

21 Global under 5 mortality ( per 100,000 children) Global Progress Towards Millennium Development Goal /3 reduction in U5 mortality Current trend Trend necessary to reach MDG 4a Lawn et al, Lancet

22 Progress towards MDG4 in Southern Asia and India Southern Asia MDG4 Target : 41 deaths per 1,000 live births by 2015 India MDG4 Target : 39 deaths per 1,000 live births by Out of 1000 live births, number of children dying before age five 22

23 Key Messages Pneumonia accounts for 24% of all deaths in Indian children younger than 5 years The incidence of pneumonia in children in India is similar to that of neighboring countries Reducing mortality from pneumonia is critical to achieving MDG 4 goals 23