1. Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years
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Tesfaye Dessale Kassa, Félix Carvalho, Luke D. Knibbs, Sonia Lewycka, Sonali Kochhar, Aaron Cohen, Luca Ronfani, Ebrahim M Yimer, Srinivas Murthy, Ejaz Ahmad Khan, Josip Car, Rodrigo Sarmiento-Suarez, Babak Moazen, Mostafa Qorbani, Javad Nazari, Nancy Fullman, Niranjan Kissoon, Keyghobad Ghadiri, Marissa B Reitsma, Benn Sartorius, Ashish Awasthi, Aman Yesuf Endries, Christopher Troeger, Evanson Z. Sambala, Nelson Alvis-Guzman, Alessandra C. Goulart, Erlyn Rachelle King Macarayan, Ahmad Daryani, Fakher Rahim, Fiseha Wadilo Wada, Yuming Guo, Sonia Saxena, Justin R. Ortiz, Monika Sawhney, Eyal Oren, Alaa Badawi, Tomislav Mestrovic, Sezer Kisa, Cheru Tesema Leshargie, Ai Koyanagi, Long Hoang Nguyen, Alireza Rafiei, Aziz Rezapour, Huong Lan Thi Nguyen, Abdallah M. Samy, Catrin E. Moore, André Karch, Seyyed Meysam Mousavi, Chi Linh Hoang, Katie R Nielsen, Eleonora Dubljanin, Giuseppe Gorini, Charles Shey Wiysonge, Bach Xuan Tran, Christopher J L Murray, Khanh Bao Tran, Maarten J. Postma, Mohammad Sadegh Rezai, Bartosz Miazgowski, Hagos Tasew Atalay, Aziz Sheikh, Reginald Quansah, Kirsten E. Wiens, Mika Shigematsu, Devasahayam J. Christopher, Hamid Yimam Hassen, Yasir Waheed, Robert Reiner, Smita Pakhale, Joseph Adel Mattar Banoub, Fares Alahdab, Vafa Rahimi-Movaghar, Mahesh P A, Ruth W Kimokoti, Feleke Mekonnen Demeke, Mohamad-Hani Temsah, Zakir Hussain, Naohiro Yonemoto, Noore Alam, Mu'awiyyah Babale Sufiyan, Lidia Morawska, Adane Teshome Kefale, Ali H. Mokdad, Rachel L Updike, Amir Kasaeian, Yousef Veisani, Rajesh Kumar Rai, Jeffrey D. Stanaway, Mina Anjomshoa, Corey B. Bills, Puja C Rao, Euripide Frinel G Arthur Avokpaho, Lorenzo Monasta, Zoubida Zaidi, Yousef Khader, Heather J. Zar, Ali Bijani, Tommi Vasankari, Kefyalew Addis Alene, Young-Ho Khang, Afewerki Gebremeskel Tsadik, Joseph Frostad, Ghulam Mustafa, Jalal Arabloo, Rajaa Al-Raddadi, Shanshan Li, David L. Smith, Maria Jesus Rios-Blancas, Carlos A Castañeda-Orjuela, Syed Mohamed Aljunid, Andrew T Olagunju, Suleman Atique, Abdullah T Khoja, Ibrahim A Khalil, William M. Gardner, Zikria Saleem, Addisu Melese, Stephen S Lim, Eyasu Ejeta Duken, Erkin M. Mirrakhimov, Gessessew Bugssa Hailu, Hmwe H Kyu, Seyedmojtaba Seyedmousavi, Aleksandra Barac, Spencer L. James, Salvatore Rubino, Lalit Dandona, Arya Haj-Mirzaian, Kate Causey, Nicholas J Kassebaum, Simon I. Hay, Ravi Prakash Jha, Karzan Abdulmuhsin Mohammad, Son Hoang Nguyen, Belay Tessema, Muhammad Imran Nisar, Barthelemy Kuate Defo, Alireza Ahmadi, Theo Vos, Krittika Bhattacharyya, Irfan Ullah, Molly H Biehl, Kalpana Balakrishnan, Tinuke O Olagunju, Florian Fischer, Olatunde Aremu, Brigette F. Blacker, Derrick A Bennett, Vahid Alipour, Carl Abelardo T. Antonio, Manisha Dubey, Tuomo J. Meretoja, G Anil Kumar, Varshil Mehta, Molly R Nixon, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Anselm Okoro, Zulfiqar A Bhutta, Maysaa El Sayed Zaki, Shafiu Mohammed, Nuruzzaman Khan, Jost B. Jonas, Samah Awad, Miloje Savic, Soewarta Kosen, Quique Bassat, Amha Admasie, Cuong Tat Nguyen, Chalachew Genet Akal, Milena M Santric Milicevic, Adnan Kisa, Arvin Haj-Mirzaian, Jonathan F. Mosser, Stephanie R M Zimsen, Dharmesh Kumar Lal, Birhanu Geta, Nobuyuki Horita, Gulfaraz Khan, Saeed Amini, Ziad A. Memish, Rakhi Dandona, Alyssa N. Sbarra, Dietrich Rothenbacher, Samer Hamidi, Felix Akpojene Ogbo, Helena Manguerra, Shirin Djalalinia, Degu Abate, Rakesh Lodha, Samuel B. Albertson, Seyed Sina Naghibi Irvani, Abdullah Al Mamun, Neeraj Bedi, Parvaiz A Koul, Desalegn Tadese Mengistu, Katie Welgan, Masood Ali Shaikh, Marek Majdan, Mihaela Hostiuc, Mohamed Lemine Cheikh brahim Ahmed, Public Health, GBD Lower Resp Infect, Microbes in Health and Disease (MHD), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Collaborators, GBD 2017 Lower Respiratory Infections, Clinicum, Institute for Molecular Medicine Finland, HUS Comprehensive Cancer Center, Staff Services, University of Helsinki, II kirurgian klinikka, and Department of Oncology
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Male ,Psychological intervention ,Global Health ,Global Burden of Disease ,0302 clinical medicine ,Risk Factors ,Case fatality rate ,Medicine ,030212 general & internal medicine ,Respiratory Tract Infections ,INFLUENZAE TYPE-B ,education.field_of_study ,NUTRITION TRANSITION ,CHALLENGES ,Trastornos respiratorios ,Incidence (epidemiology) ,Mortality rate ,Incidence ,Enfermedades en niños ,CHILDHOOD PNEUMONIA ,Children younger than 5 years ,3. Good health ,Infectious Diseases ,Child, Preschool ,Child Mortality ,Female ,TERRITORIES ,CONJUGATE VACCINE ,030231 tropical medicine ,Population ,195 COUNTRIES ,Infections ,Article ,CHINA ,03 medical and health sciences ,Age Distribution ,Nutrition transition ,SYSTEMATIC ANALYSIS ,Humans ,Risk factor ,education ,Lower respiratory ,Models, Statistical ,business.industry ,AIR-POLLUTION ,Verbal autopsy ,Enfermedades respiratorias ,Socioeconomic Factors ,3121 General medicine, internal medicine and other clinical medicine ,Human medicine ,business ,Demography - 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. 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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- 2020
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