Global childhood pneumonia: the good news, the bad news, and the way ahead

Globally, pneumonia accounts for a substantial burden of disease among young children, and consequently must be a major focus of efforts to improve child health. In their systematic analysis published in The Lancet Global Health, David A McAllister and colleagues1McAllister DA Liu L Shi T et al.Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis.Lancet Glob Health. 2018; (published online Nov 26.)http://dx.doi.org/10.1016/S2214-109X(18)30408-XSummary Full Text Full Text PDF Scopus (250) Google Scholar report encouraging estimates: between 2000 and 2015, the global incidence of pneumonia in young children (aged <5 years) reduced by 30% and the number of pneumonia deaths in young children almost halved in that time. However, pneumonia remains a leading cause of preventable illness and death in this age group, and overcoming this will require considerable effort. The systematic analysis by McAllister and colleagues focuses on developing countries, which have the heaviest burden of childhood pneumonia. The authors estimated pneumonia burden for the Millennium Development Goals period (2000–15), during which the UN aimed to reduce mortality in children younger than 5 years by two-thirds compared with 1990 mortality estimates.2UNThe Millennium Development Goals Report.http://wwwunorg/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%20(July%201)pdfDate: 2015Date accessed: September 10, 2018Google Scholar In addition to the 30% reduction in incidence of WHO-defined pneumonia (absolute reduction in annual episodes from 178 million [95% uncertainty interval [UI] 110–289] in 2000 to 138 million [86–226] in 2015) and 51% reduction in mortality (absolute reduction in deaths from 1·7 million [95% UI 1·7–2·0] in 2000 to 0·9 million [0·8–1·1] in 2015), the investigators estimate that half of all deaths occurred in just five countries: India, Nigeria, Pakistan, Democratic Republic of Congo, and Ethiopia. Across all low-income and middle-income regions, the prevalence of most key risk factors for pneumonia decreased, including non-exclusive breastfeeding, crowding, malnutrition, indoor air pollution, and paediatric HIV infection, with the exception of low birthweight, which presents a persistent problem. The overall estimates in this report are slightly higher than—but broadly consistent with—those of the 2016 Global Burden of Disease study3GBD 2016 Lower Respiratory Infections CollaboratorsEstimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Infect Dis. 2018; 18: 1191-1210Summary Full Text Full Text PDF PubMed Scopus (705) Google Scholar and provide direction for future global coordinated action. However, it is reasonable and necessary to question how reliable these estimates are as efforts continue to address global childhood pneumonia. As we have previously suggested,4Murdoch DR Howie SRC The global burden of lower respiratory infections: making progress, but we need to do better.Lancet Infect Dis. 2018; 18: 1162-1163Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar the “elephant in the room” is the poor quality of data available and the competing methods used to turn them into global burden estimates. Variation in accuracy and availability of data is unavoidable while efforts continue to improve it. Importantly, these problems do not render such estimates worthless. It is not surprising that different ways to analyse data exist or that methods will evolve over time. One strength of the current study is that the methods used by McAllister and colleagues were consistent during the 15-year time period of the analysis, making the analysis of the change in burden more robust. The methods used are described clearly, which is another strength. Maintaining transparency with regard to methods can be difficult, and it is helpful that the differences in methods used by competing author groups are clearly explained. So where to now? Most childhood pneumonia deaths are preventable. The global community must remain determined not to be content with avoidable deaths, which the UN Sustainable Development Goals advocate against,5United NationsSustainable Development Goals.https://sustainabledevelopmentunorg/?menu=1300Date accessed: September 10, 2018Google Scholar and must promote the child survival agenda. Many of the activities needed to reduce the pneumonia burden are well known. Collective action is needed to ensure children have access to effective vaccines, to improve living conditions worldwide, and to target the key risk factors for pneumonia to prevent this disease. Continuation of efforts to improve pneumonia diagnosis and to ensure prompt and effective treatment is required, with prevention and cure as joint aims. Coordinating action more effectively to achieve these aims will not be easy: there are barriers to contend with. Pneumonia suffers from a low profile. Pneumonia burden is highest among the poor and voiceless, both socially and geographically, and presents a complex problem with no simple solutions that requires horizontal strengthening of health systems, thus pneumonia is often ignored.6Watkins K Sridhar D Pneumonia: a global cause without champions.Lancet. 2018; 392: 718-719Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar This problem cannot be solved through isolated national efforts alone. The UN Millennium Development Goals have contributed substantially to the reductions in pneumonia incidence and mortality reported by McAllister and colleagues and they demonstrate the power of collective coordinated global action, which is something we must value, foster, and commit to. SRCH has a patent pending for lipocalin-2 as a biomarker for pneumococcal infection status. DRM declares no competing interests. Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysisGlobally, the incidence of child pneumonia decreased by 30% and mortality decreased by 51% during the Millennium Development Goal period. These reductions are consistent with the decrease in the prevalence of some of the key risk factors for pneumonia, increasing socioeconomic development and preventive interventions, improved access to care, and quality of care in hospitals. However, intersectoral action is required to improve socioeconomic conditions and increase coverage of interventions targeting risk factors for child pneumonia to accelerate decline in pneumonia mortality and achieve the Sustainable Development Goals for health by 2030. Full-Text PDF Open Access