Burden Of Pneumonia In Children Research Articles

The economic burden of pneumonia in children under five in Uganda

BackgroundThere were about 138 million new episodes of pneumonia and 0.9 million deaths globally in 2015. In Uganda, pneumonia was the fourth leading cause of death in children under five years of age in 2017–18. However, the economic burden of pneumonia, particularly for households and caregivers, is poorly documented. AimTo estimate the costs associated with an episode of pneumonia from the household, government, and societal perspectives. MethodsWe selected 48 healthcare facilities from the public and private sector across all care levels (primary, secondary, and tertiary), based on the number of pneumonia episodes reported for 2015–16. Adult caregivers of children with pneumonia diagnosis at discharge were selected. Using an ingredient-based approach, we collected cost and utilization data from administrative databases, medical records, and patient caregiver surveys. Household costs included direct medical and non-medical costs, as well as indirect costs estimated through a human capital approach. All costs are presented in 2018 U.S. dollars. ResultsThe treatment of pneumonia puts a substantial economic burden on households. The average societal cost per episode of pneumonia across all sectors and types of visits was $42; hospitalized episodes costed an average of $62 per episode, while episodes only requiring ambulatory care was $16 per episode. Public healthcare facilities covered $12 and $7 on average per hospitalized or ambulatory episode, respectively. Caregivers using the public system faced lower out-of-pocket payments, evaluated at $17, than those who used private for-profit ($21) and not-for-profit ($50) for hospitalized care. For ambulatory care, out-of-pocket payments amounted to $8, $18, and $9 for public, private for-profit, and not-for-profit healthcare facilities, respectively. About 39% of households experienced catastrophic health expenditures due to out-of-pocket payments related to the treatment of pneumonia.

Pneumonia dominance in under-five mortalities in sub-Saharan Africa- Urgency for more research and capacity improvement

Pneumonia is the highest cause of death in children under five (5) especially in sub-Saharan Africa. It accounts for 16 % of all deaths in Africa, deadlier than Malaria. Sub-Saharan Africa carries about half of the burden of the world’s under-five deaths. Progress in the fight against pneumonia has slacked behind that of the others. Pneumonia mortality rates in children have fallen by just 50 per cent compared to an 85 per cent decline in measles deaths, and 60 per cent in deaths from malaria, AIDS and tetanus in the last 15 years. The global funding to address the burden of pneumonia in children is low and this is potentially hindering the effort to reduce the mortalities associated with the disease.

Perspectives on the burden of pneumonia in children

In the US at the beginning of the 20th century, the infant mortality rate was high (150/1000 live births); 19% of deaths were due to pneumonia. In the pre-antibiotic era, childhood pneumonia case fatality rates were age dependant with most deaths occurring in infants. The introduction of antibiotics in the late 1930s lowered the mortality, but in the US most of the improvements in pneumonia mortality since 1900 had already occurred, probably due to improvements in nutrition and child care. Today, efforts to control pneumonia mortality are focused on case management and vaccines. History suggests that a more holistic approach may be needed.

The burden of pneumonia in children: an Australian perspective

SummaryThe burden of pneumonia in Australian children is significant with an incidence of 5–8 per 1000 person-years. Pneumonia is a major cause of hospital admission in children less than 5 years of age. Indigenous children are at particular risk with a 10–20-fold higher risk of hospitalisation compared to non-Indigenous children. They also have longer admissions and are more likely to have multiple admissions with pneumonia. There are limited data on pathogen-specific causes of pneumonia, however Streptococcus pneumonia is the most common bacterial cause in children under 5 years of age and respiratory syncytial virus (RSV) and influenza are the predominant viral causes in young children. Pneumonia due to Haemophilus influenza type b (Hib) has been virtually eliminated by the introduction of universal Hib immunisation. Further studies are needed to accurately define the epidemiology of pneumonia due to specific pathogens to help target treatment and immunisation strategies.

The burden of pneumonia in children in Latin America

Under-five mortality varies widely between countries, ranging from four to over 300 deaths/1000 live births. The World Summit for Children established the aim of a two-thirds reduction in worldwide child mortality by 2015. Progress toward this goal during 1990-2000 was variable between world regions. In 2000, 70% of the 1.89 million deaths of children under the age of 5 years due to acute respiratory infections occurred in developing countries. Among Latin American countries, Chile and Uruguay had the lowest percentage of deaths (5-10%), while Bolivia, Peru and Guyana had the highest (15-20%). Mortality rates due to lower respiratory infections have declined in most countries, increased in some and remained unacceptably high in others. To reach the 2015 goal of reducing mortality in the under-fives, effective interventions, such as breastfeeding and complementary feeding, Haemophilus influenzae type B vaccine, zinc supplementation and the use of antibiotics to treat pneumonia need to be implemented in all Latin American countries.

The burden of pneumonia in children in the developed world

There are few comprehensive epidemiological studies of pneumonia in the developed world. Ascertainment and definition are important variables in the estimation of pneumonia incidence both in primary care and from hospital data. The available figures suggest a burden of disease in the order of 10-15 cases/1000 children per year and a hospital admission rate of 1-4/1000 per year. Both incidence and hospital admission are greatest in the youngest children and rapidly fall after the age of 5 years. In a majority of cases of community acquired pneumonia an organism is not identified. Viral infections are common and influenza A, B, respiratory syncitial virus (RSV) and parainfluenza 1, 2 and 3 are the most common viruses identified. Streptococcus pneumoniae is the most common bacterial cause. Broad brush calculations suggest that the NHS cost of childhood pneumonia in England is 6-8 million pound sterling per annum. This does not include family and social costs. There is potential for new vaccine strategies to decrease childhood pneumonia.

The burden of pneumonia in children: an Asian perspective

Pneumonia results in two million deaths each year among children worldwide (20% of all child deaths), 70% of them in Africa and South-east Asia. Most countries in Africa and Asia record 2-10 times more children with pneumonia (7-40/100 annually) than in the USA. Apart from resource constraints and an overburdened health system, there is lack of uniformity in defining pneumonia. Most nations employ a WHO standard case management protocol using age-specific cut-offs for increased respiratory rates and chest in-drawing for a clinical definition of pneumonia. The limited data available on the causative organisms have identified Streptococcus pneumoniae, Haemophilus influenzae and viruses such as respiratory syncytial virus (RSV), influenza, para influenza and adenoviruses as the major pathogens. Measles infection increases pneumonia morbidity and mortality. Low birth weight, under-nutrition, hypovitaminosis A, zinc deficiency, lack of breastfeeding, air pollution (including environmental tobacco smoke) and over-crowding increase the risk for pneumonias in children. Standard case management protocols used for acute respiratory infections (ARIs) in these countries have brought down the disease burden but an improvement in the diagnostic algorithm is needed to appropriately recognise those with associated wheeze. Research is needed to find effective and affordable preventive strategies.