Abstract
Lower respiratory infections (LRIs) are the leading cause of death in children under the age of 5, despite the existence of vaccines against many of their aetiologies. Furthermore, more than half of these deaths occur in Africa. Geospatial models can provide highly detailed estimates of trends subnationally, at the level where implementation of health policies has the greatest impact. We used Bayesian geostatistical modelling to estimate LRI incidence, prevalence and mortality in children under 5 subnationally in Africa for 2000–2017, using surveys covering 1.46 million children and 9,215,000 cases of LRI. Our model reveals large within-country variation in both health burden and its change over time. While reductions in childhood morbidity and mortality due to LRI were estimated for almost every country, we expose a cluster of residual high risk across seven countries, which averages 5.5 LRI deaths per 1,000 children per year. The preventable nature of the vast majority of LRI deaths mandates focused health system efforts in specific locations with the highest burden.
Highlights
Lower respiratory infections (LRIs) are estimated to account for 38.6% of infectious disease deaths and 14.9% of all deaths in African children1
Given the 56% increase in the population of children under the age of 5 in Africa, this is a moderate increase in LRI episodes from 20.6 million (UI 19.9–21.3) in 2000 (Fig. 1a,b)
The average incidence rate of LRI for African children in 2000 was 165.8 episodes (UI 160.1–171.9) per 1,000, and this rate decreased to 122.2 episodes (UI 109.7–141.6) per 1,000 in 2017 (Fig. 1c,d)
Summary
Lower respiratory infections (LRIs) are estimated to account for 38.6% of infectious disease deaths and 14.9% of all deaths in African children1 These deaths are largely preventable; in particular, reducing risk factors such as household air pollution, stunting and no or partial breastfeeding have been shown to protect children against infection and death resulting from infection. There are several direct interventions that can prevent or treat infections, including vaccines to the predominant causes of LRI4,5, most notably Streptococcus pneumoniae, which is estimated to be responsible for 46.7% of LRIs across Africa. There are several direct interventions that can prevent or treat infections, including vaccines to the predominant causes of LRI4,5, most notably Streptococcus pneumoniae, which is estimated to be responsible for 46.7% of LRIs across Africa6 Proven treatments such as antibiotics and supplemental oxygen can prevent death once an individual is infected. To fully understand the relative local drivers and causes of under-5 mortality, accurately capturing the covariation in risk factors and associated diseases is of paramount importance
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