Elsevier

The Lancet

Volume 370, Issue 9583, 21–27 July 2007, Pages 285-289
The Lancet

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Childhood pneumonia mortality—a permanent global emergency

https://doi.org/10.1016/S0140-6736(07)61130-1Get rights and content

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Evidence for the burden of pneumonia

WHO is undertaking another analysis of the worldwide pneumonia burden that will estimate the contribution of the main bacterial causes. The analysis will not change the conclusion that pneumonia is responsible for about 20% of the overall child mortality burden. However, it is worth considering the limitations of the underlying global estimates. Of the 10·5 million yearly child deaths, almost half (4·9 million) occur in malarious areas, mainly in sub-Saharan Africa. Data from Kenya and Malawi

Historical perspective

Throughout history, child mortality rates have been high. The leading causes of child death after the neonatal period have been pneumonia and diarrhoeal disease, with variable contributions from diseases such as malaria and measles. In the USA at the beginning of the 20th century the infant mortality rate was high (over 150 per 1000 livebirths) and 19% of deaths were estimated to be due to pneumonia, a similar proportion to that in developing countries today.8 At that time there was a major

What progress has been made?

After 20 years of case-management-based approaches to pneumonia control, little objective evaluation has taken place. A group of large field trials was done in the 1980s and, with one exception, an impressive fall in pneumonia mortality was associated with introduction of an approach based on community case management.13 However, these studies usually incorporated co-interventions that might themselves have contributed to mortality reduction; the interventions were quite intensive, and were

The way forward

It is time for the international health community to adopt a balanced and unified approach to child survival in general and the control of pneumonia mortality in particular. The first step has been achieved by the Child Health Epidemiology Reference Group with the development of a set of cause-specific mortality estimates that are agreed by all groups within WHO and UNICEF.17 The breakdown of mortality estimates for pneumonia and diarrhoeal disease by cause has produced controversial results in

Conclusion

Of the available strategies to prevent pneumonia, Hib and pneumococcal vaccines are the most likely to attract support from international donors. This support is welcome, but a risk remains that increasing support for vaccines will be accompanied by a decline in support for other strategies, particularly case management—even though some of these strategies might be highly cost effective. In the near future we might see communities in poor countries in which the introduction of pneumococcal and

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