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Quantifying Risks and Interventions That Have Affected the Burden of Lower Respiratory Infections Among Children Younger Than 5 Years: An Analysis for the Global Burden of Disease Study 2017 Publisher Pubmed



Troeger CE1, 205 ; Khalil IA1, 205 ; Blacker BF205 ; Biehl MH205 ; Albertson SB205 ; Zimsen RM205 ; Rao PC205 ; Abate D6 ; Admasie A7 ; Ahmadi A8 ; Ahmed MLCB9, 10 ; Akal CG12 ; Alahdab F13 ; Alam N14 Show All Authors
Authors
  1. Troeger CE1, 205
  2. Khalil IA1, 205
  3. Blacker BF205
  4. Biehl MH205
  5. Albertson SB205
  6. Zimsen RM205
  7. Rao PC205
  8. Abate D6
  9. Admasie A7
  10. Ahmadi A8
  11. Ahmed MLCB9, 10
  12. Akal CG12
  13. Alahdab F13
  14. Alam N14
  15. Alene KA16, 17
  16. Alipour V18
  17. Aljunid SM19, 20
  18. Alraddadi RM21
  19. Alvisguzman N22, 23
  20. Amini S25
  21. Anjomshoa M26
  22. Antonio CAT27, 29
  23. Arabloo J18
  24. Aremu O30
  25. Atalay HT31
  26. Atique S32, 33
  27. Avokpaho EFGA34, 35
  28. Awad S36
  29. Awasthi A37
  30. Badawi A38
  31. Balakrishnan K39
  32. Banoub JAM40
  33. Barac A41
  34. Bassat Q42
  35. Bedi N43
  36. Bennett DA44
  37. Bhattacharyya K45
  38. Bhutta ZA46
  39. Bijani A47
  40. Bills CB48
  41. Car J49
  42. Carvalho F50
  43. Castanedaorjuela CA51
  44. Causey K205
  45. Christopher DJ52
  46. Cohen AJ69, 205
  47. Dandona L39, 205
  48. Dandona R39, 205
  49. Daryani A53
  50. Demeke FM12
  51. Djalalinia S54
  52. Dubey M55
  53. Dubljanin E56
  54. Duken EE57
  55. Zaki MES58
  56. Endries AY59
  57. Fernandes E60
  58. Fischer F61
  59. Frostad J205
  60. Fullman N205
  61. Gardner WM205
  62. Geta B62
  63. Ghadiri K8
  64. Gorini G63
  65. Goulart AC64
  66. Guo Y65
  67. Hailu GB66
  68. Hajmirzaian A67
  69. Hajmirzaian A67
  70. Hamidi S69
  71. Hassen HY70
  72. Hoang CL71
  73. Horita N72
  74. Hostiuc M73
  75. Hussain Z74
  76. Irvani SSN75
  77. James SL205
  78. Jha RP76
  79. Jonas JB77
  80. Karch A78
  81. Kasaeian A79
  82. Kassa TD80, 81
  83. Kassebaum NJ2
  84. Kefale AT82
  85. Khader YS83
  86. Khan EA84
  87. Khan G85
  88. Khan MN86
  89. Khang YH87
  90. Khoja AT88
  91. Kimokoti RW89
  92. Kisa A90
  93. Kisa S91
  94. Kissoon N92
  95. Knibbs LD93
  96. Kochhar S3
  97. Kosen S94
  98. Koul PA95
  99. Koyanagi A96
  100. Defo BK97
  101. Anil Kumar G98
  102. Lal DK99
  103. Leshargie CT100
  104. Lewycka S101
  105. Li S102
  106. Lodha R103
  107. Macarayan ERK28
  108. Majdan M104
  109. Mamun AA105
  110. Manguerra H205
  111. Mehta V106
  112. Melese A12
  113. Memish ZA11
  114. Mengistu DT107
  115. Meretoja TJ108
  116. Mestrovic T109
  117. Miazgowski B110
  118. Mirrakhimov EM111
  119. Moazen B112
  120. Mohammad KA113
  121. Mohammed S114
  122. Monasta L115
  123. Moore CE116
  124. Morawska L117
  125. Mosser JF205
  126. Mousavi SM118
  127. Murthy S119
  128. Mustafa G120, 159, 160
  129. Nazari J24, 161
  130. Nguyen CT121
  131. Nguyen HLT122
  132. Nguyen LH123
  133. Nguyen SH124, 162
  134. Nielsen KR3, 4
  135. Nisar MI125
  136. Nixon MR205
  137. Ogbo FA126, 163
  138. Okoro A127, 164
  139. Olagunju AT128
  140. Olagunju TO129, 165, 166, 167
  141. Oren E5, 168
  142. Ortiz JR3, 169
  143. Mahesh PA130, 170
  144. Pakhale S131, 171
  145. Postma MJ132, 172
  146. Qorbani M133, 173
  147. Quansah R134, 174
  148. Rafiei A135
  149. Rahim F136
  150. Rahimimovaghar V137, 138, 175
  151. Rai RK139, 176, 177
  152. Reitsma MB205
  153. Rezai MS140
  154. Rezapour A18
  155. Riosblancas MJ141, 178
  156. Ronfani L142
  157. Rothenbacher D143, 179
  158. Rubino S144, 180
  159. Saleem Z145, 181
  160. Sambala EZ146, 182
  161. Samy AM147, 183
  162. Milicevic MMS148
  163. Sarmientosuarez R149, 184
  164. Sartorius B1, 185
  165. Savic M150, 186
  166. Sawhney M151, 187
  167. Saxena S152
  168. Sbarra A205
  169. Seyedmousavi S153
  170. Shaikh MA154
  171. Sheikh A155, 188, 190
  172. Shigematsu M189
  173. Smith DL1, 205
  174. Sreeramareddy CT190
  175. Stanaway JD1, 205
  176. Sufiyan MB156
  177. Temsah MH144, 191
  178. Tessema B15
  179. Tran BX157
  180. Tran KB192, 193, 194
  181. Tsadik AG158
  182. Ullah I195, 196
  183. Updike RL205
  184. Vasankari TJ197
  185. Veisani Y198
  186. Wada FW7, 199
  187. Waheed Y200, 201
  188. Welgan K205
  189. Wiens KE205
  190. Wiysonge CS181, 182, 203
  191. Yimer EM159
  192. Yonemoto N202
  193. Zaidi Z203
  194. Zar HJ204
  195. Lim SS1, 205
  196. Vos T1, 205
  197. Mokdad AH1, 205
  198. Murray CJL1, 205
  199. Kyu HH205
  200. Hay SI1, 205
  201. Reiner RC1, 205
Show Affiliations
Authors Affiliations
  1. 1. Department of Health Metrics Sciences, School of Medicine
  2. 2. Department of Anesthesiology & Pain Medicine, Seattle, WA, United States
  3. 3. Department of Global Health, Seattle, WA, United States
  4. 4. Department of Pediatrics, Seattle, WA, United States
  5. 5. University of Washington, Seattle, WA, United States
  6. 6. Department of Medical Laboratory Sciences, Haramaya University, Harar, Ethiopia
  7. 7. Department of Medicine, School of Public Health, Wolaita Sodo University, Addis Ababa, Ethiopia
  8. 8. Department of Anesthesiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
  9. 9. Department of Biology, University Mohammed v, Rabat, Morocco
  10. 10. National Institute of Researches on Public Health, Ministry of Health, Nouakchott, Mauritania
  11. 11. Research Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
  12. 12. Department of Medical Laboratory Science, Bahir Dar University, Bahir Dar, Ethiopia
  13. 13. Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, United States
  14. 14. Prevention Division, Queensland Health, Herston, QLD, Australia
  15. 15. Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia
  16. 16. Institute of Public Health, University of Gondar, Gondar, Ethiopia
  17. 17. Research School of Population Health, Australian National University, Canberra, ACT, Australia
  18. 18. Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
  19. 19. Department of Health Policy and Management, Kuwait University, Safat, Kuwait
  20. 20. International Centre for Casemix and Clinical Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
  21. 21. Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  22. 22. Research Group in Health Economics, Universidad de Cartagena, Cartagena, Colombia
  23. 23. Research Group in Hospital Management and Health Policies, Universidad de la Costa, Barranquilla, Colombia
  24. 24. Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran
  25. 25. Health Services Management Department, Arak University of Medical Sciences, Arak, Iran
  26. 26. Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
  27. 27. Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
  28. 28. Development and Communication Studies, University of the Philippines Manila, Manila, Philippines
  29. 29. Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, Hong Kong
  30. 30. School of Health Sciences, Birmingham City University, Birmingham, United Kingdom
  31. 31. Department of Nursing, Aksum University, Aksum, Ethiopia
  32. 32. University Institute of Public Health, The University of Lahore, Lahore, Pakistan
  33. 33. Public Health Department, University of Hail, Hail, Saudi Arabia
  34. 34. Benin Clinical Research Institute, Abomey-Calavi, Benin
  35. 35. Controle des Maladies Infectieuses, Laboratory of Studies and Research-Action in Health, Porto Novo, Benin
  36. 36. Department of Pediatrics and Neonatology, Jordan University of Science and Technology, Ramtha, Jordan
  37. 37. Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan
  38. 38. Indian Institute of Public Health, Gandhinagar, India
  39. 39. Public Health Foundation of India, Gurugram, India
  40. 40. Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, ON, Canada
  41. 41. Department of Nutritional Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
  42. 42. The Centre for Global Child Health, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
  43. 43. Department of Environmental Health Engineering, Sri Ramachandra Medical College and Research Institute, Chennai, India
  44. 44. Faculty of Medicine, Alexandria University, Alexandria, Egypt
  45. 45. Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
  46. 46. Centre School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia
  47. 47. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  48. 48. Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain
  49. 49. Catalan Institution for Research and Advanced Studies, Barcelona, Spain
  50. 50. Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India
  51. 51. Jazan University, Jazan, Saudi Arabia
  52. 52. Big Data Institute, Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, United Kingdom
  53. 53. Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
  54. 54. Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
  55. 55. Department of Statistical and Computational Genomics, National Institute of Biomedical Genomics, Kalyani, India
  56. 56. Department of Statistics, University of Calcutta, Kolkata, India
  57. 57. Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
  58. 58. Department of Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan
  59. 59. Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
  60. 60. Department of Emergency Medicine, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
  61. 61. Centre for Population Health Sciences, Nanyang Technological University, Singapore, Singapore
  62. 62. Global EHealth Unit, Imperial College London, London, United Kingdom
  63. 63. School of Public Health, Imperial College London, London, United Kingdom
  64. 64. Applied Molecular Biosciences Unit, Centre of Excellence in Green Chemistry, Chemistry and Technology Network, University of Porto, Porto, Portugal
  65. 65. Institute of Public Health, Centre of Excellence in Green Chemistry, Chemistry and Technology Network, University of Porto, Porto, Portugal
  66. 66. Colombian National Health Observatory, National Institute of Health, Bogota, Colombia
  67. 67. Epidemiology and Public Health Evaluation Group, National University of Colombia, Bogota, Colombia
  68. 68. Department of Pulmonary Medicine, Christian Medical College and Hospital, Vellore, India
  69. 69. Health Effects Institute, Boston, MA, United States
  70. 70. Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
  71. 71. Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  72. 72. Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  73. 73. Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  74. 74. Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  75. 75. Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
  76. 76. Un World Food Programme, New Delhi, India
  77. 77. Department of Health Sciences, Wollega University, Nekemte, Ethiopia
  78. 78. Mycobacteriology Research Center, Jimma University, Jimma, Ethiopia
  79. 79. Department of Clinical Pathology, Mansoura University, Mansoura, Egypt
  80. 80. Public Health Department, Saint Paul s Hospital Millennium Medical College, Addis Ababa, Ethiopia
  81. 81. Department of Public Health Medicine, Bielefeld University, Bielefeld, Germany
  82. 82. Department of Pharmacy, Wollo University, Dessie, Ethiopia
  83. 83. Occupational and Environmental Epidemiology Section, Cancer Prevention and Research Institute, Florence, Italy
  84. 84. Center for Clinical and Epidemiological Research, University Hospital and Internal Medicine Department, University of Sao Paulo, Sao Paulo, Brazil
  85. 85. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  86. 86. Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
  87. 87. Biomedical Sciences Division, Mekelle University, Mekelle, Ethiopia
  88. 88. Clinical Pharmacy Unit, Mekelle University, Mekelle, Ethiopia
  89. 89. School of Medicine, Mekelle University, Mekelle, Ethiopia
  90. 90. School of Pharmacy, Mekelle University, Mekelle, Ethiopia
  91. 91. Center of Expertise in Microbiology, Tehran University of Medical Sciences, Tehran, Iran
  92. 92. Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
  93. 93. Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
  94. 94. Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  95. 95. Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
  96. 96. Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  97. 97. Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  98. 98. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  99. 99. Obesity Research Center, India
  100. 100. Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  101. 101. Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, United States
  102. 102. Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
  103. 103. School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
  104. 104. Pharmacy Department, Mizan-Tepi University, Teppi, Ethiopia
  105. 105. Public Health Department, Mizan-Tepi University, Teppi, Ethiopia
  106. 106. Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium
  107. 107. Center for Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Viet Nam
  108. 108. Department of Pulmonology, Yokohama City University, Yokohama, Kanazawa-ku, Japan
  109. 109. National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
  110. 110. Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  111. 111. Department of Internal Medicine, Bucharest Emergency Hospital, Bucharest, Romania
  112. 112. Provincial Tb Control Program, Department of Health, Gilgit, Pakistan
  113. 113. Department of Community Medicine, Banaras Hindu University, Varanasi, India
  114. 114. Department of Ophthalmology, Heidelberg University, Mannheim, Germany
  115. 115. Institute of Public Health, Heidelberg University, Mannheim, Germany
  116. 116. Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
  117. 117. Institute for Epidemiology and Social Medicine, University of Munster, Munster, Germany
  118. 118. Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
  119. 119. Department of Medical Microbiology & Immunology, United Arab Emirates University, Al Ain, United Arab Emirates
  120. 120. Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
  121. 121. Department of Public Health, University of Newcastle, Newcastle, NSW, Australia
  122. 122. Department of Health Policy and Management, Institute of Health Policy and Management, Seoul National University, Seoul, South Korea
  123. 123. Department of Public Health, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
  124. 124. Department of Nutrition, Simmons College, Boston, MA, United States
  125. 125. Department of Health Management and Health Economics, Kristiania University College, Oslo, Norway
  126. 126. Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, United States
  127. 127. Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
  128. 128. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
  129. 129. Institute for Social Science Research
  130. 130. School of Public Health, The University of Queensland, Herston, QLD, Australia
  131. 131. Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
  132. 132. Independent Consultant, Jakarta, Indonesia
  133. 133. Independent Consultant, Karachi, Pakistan
  134. 134. Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
  135. 135. Biomedical Research Networking Center for Mental Health Network, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
  136. 136. Department of Demography, Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
  137. 137. Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
  138. 138. Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Hanoi, Viet Nam
  139. 139. Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
  140. 140. Ariadne Labs, United States
  141. 141. Division of General Internal Medicine and Primary Care, Harvard University, Boston, MA, United States
  142. 142. Department of Public Health, Trnava University, Trnava, Slovakia
  143. 143. Department of Internal Medicine, SevenHills Hospital, Mumbai, India
  144. 144. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
  145. 145. Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
  146. 146. University of Helsinki, Helsinki, Finland
  147. 147. Clinical Microbiology and Parasitology Unit, Dr Zora Profozic Polyclinic, Zagreb, Croatia
  148. 148. University Centre Varazdin, University North, Varazdin, Croatia
  149. 149. Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
  150. 150. Faculty of General Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
  151. 151. Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
  152. 152. Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany
  153. 153. Department of Biology, Salahaddin University, Erbil, Iraq
  154. 154. Ishik University, Erbil, Iraq
  155. 155. Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
  156. 156. Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
  157. 157. Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
  158. 158. International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD, Australia
  159. 159. Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan
  160. 160. Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan
  161. 161. Iranian Ministry of Health and Medical Education, Iran
  162. 162. Institute for Global Health Innovations, Duy Tan University, Hanoi, Viet Nam
  163. 163. Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
  164. 164. Department of Research Measurement, and Results, Society for Family Health Nigeria, Abuja, Nigeria
  165. 165. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
  166. 166. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
  167. 167. Department of Psychiatry, University of Lagos, Lagos, Nigeria
  168. 168. Graduate School of Public Health, San Diego State University, San Diego, CA, United States
  169. 169. Center for Vaccine Development, University of Maryland, Baltimore, MD, United States
  170. 170. Department of Tb & Respiratory Medicine, Jagadguru Sri Shivarathreeswara University, Mysore, India
  171. 171. Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
  172. 172. Department of Economics and Business, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
  173. 173. Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
  174. 174. School of Public Health, University of Ghana, Accra, Ghana
  175. 175. Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  176. 176. Society for Health and Demographic Surveillance, Suri, India
  177. 177. Department of Economics, University of Gottingen, Gottingen, Germany
  178. 178. Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
  179. 179. Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
  180. 180. Department of Biomedical Sciences, University of Sassari, Sassari, Italy
  181. 181. Rashid Latif College of Pharmacy, Lahore, Pakistan
  182. 182. Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
  183. 183. Department of Entomology, Ain Shams University, Cairo, Egypt
  184. 184. Department of Health and Society, Faculty of Medicine, University of Applied and Environmental Sciences, Bogota, Colombia
  185. 185. Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
  186. 186. Gsk Biologicals, Wavre, Belgium
  187. 187. Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
  188. 188. Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
  189. 189. National Institute of Infectious Diseases, Tokyo, Japan
  190. 190. Division of Community Medicine, International Medical University, Kuala Lumpur, Malaysia
  191. 191. Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
  192. 192. Department of Health Economics, Hanoi Medical University, Hanoi, Viet Nam
  193. 193. Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
  194. 194. Clinical Hematology and Toxicology, Military Medical University, Hanoi, Viet Nam
  195. 195. Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
  196. 196. Tb Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
  197. 197. Ukk Institute, Tampere, Finland
  198. 198. Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
  199. 199. Department of Microbial Cellular and Molecular Biology, Addis Ababa University, Addis Ababa, Ethiopia
  200. 200. Foundation University Medical College, Foundation University, Rawalpindi, Pakistan
  201. 201. Department of Global Health, Stellenbosch University, Cape Town, South Africa
  202. 202. Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
  203. 203. Department of Epidemiology, University Hospital of Setif, Setif, Algeria
  204. 204. Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
  205. 205. Institute for Health Metrics and Evaluation

Source: The Lancet Infectious Diseases Published:2020


Abstract

Background: Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. Methods: We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. Findings: In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286–873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5–68·5) and in mortality rate (from 362·7 deaths [330·1–392·0] per 100 000 children to 118·9 deaths [109·8–128·3] per 100 000 children; 67·2% decrease, 63·5–70·1). LRI incidence declined globally (32·4% decrease, 27·2–37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0–24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1–6·3), and reductions in household air pollution (8·4%, 6·8–9·2). Interpretation: Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4·0 license
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