Acute respiratory infection: a global challenge.

In 19th century Europe acute respiratory infection (ARI) was the most important cause of childhood death. In 1901 Sir William Osler wrote 'the most widespread and fatal of all acute diseases, pneumonia, is now Captain of the Men of Death'. As childhood mortality levels fell in Europe so the proportion of all deaths due to ARI fell. When life expectancy was below 45 years about 25% of childhood deaths were due to ARI compared with only 4% when life expectancy was higher than 70 years. The fall in ARI mortality accelerated noticeably in the 1950s when antibiotics became widely available. I This picture is remarkably similar to that in developing countries today. In 1991 there were 53 countries reporting mortality in children under 5 years of age of more than 100/1000 live births.2 Of an estimated total of 12-9 million deaths globally in 1990 in children under 5 years of age, over 3-6 million have been attributed to ARI.3 This repre- sented 28% of all deaths in young children and placed ARI as the largest single cause of childhood mortality. Within this overall estimate respiratory complications of measles accounted for 475 000 deaths and respiratory com- plication of pertussis for 205 000 deaths. The remaining 2 915 000 deaths are considered to be associated mainly with pneumonia. Although these estimates are based on broad evaluations, a study of available national registration data and of 22 longitudinal community based studies has confirmed ARI as the leading cause of childhood mortality in developing countries.'