Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates

Farooqui, Habib Hasan; Jit, Mark; Heymann, David L.; Zodpey, Sanjay

doi:10.1371/journal.pone.0129191

Cited by 65 publications

(64 citation statements)

References 18 publications

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“…There was also a marked difference in the death rates between the two centres in our studies. The variation in mortality in IPD by sites is not surprising and in agreement with other studies (22,30). In our case, the polarity observed between the two hospitals in both states were of varied socioeconomic status and health care accessibility.…”

Section: Discussionsupporting

confidence: 92%

“…Our study showed that undernourished children were more likely to present with severe pneumonia. Our ndings were supported by other published reports that malnutrition resulted in various nutritional de ciencies leading to severe infections including pneumonia (20)(21)(22). The increased predisposition of the nutrient-de cient host to infection is presumed to be largely due to impairment in the immune system (21,23).On the contrary, we found that obesity, especially among syndromic children, was associated with a fatal outcome in the disease.…”

Section: Discussionsupporting

confidence: 89%

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Paediatric Invasive Pneumococcal Disease : A 5-year Experience and Review of Hospital-Based Studies in Malaysia

Rengasamy

Othman

2020

Preprint

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Background: Invasive pneumococcal disease (IPD) is a serious preventable disease-causing significant mortality and morbidity among children below five years of age.Methods: A five-year retrospective study involving hospitalised children aged below 14-years-old with IPD to two tertiary centres of two different states in Malaysia were conducted between year 2012- 2016. IPD was defined as isolates of Streptococcus pneumoniae from normally sterile body sites. This article reviewed previous hospital-based studies on paediatric IPD in Malaysia to provide an overview of the disease over the last three decades. A comparison was also made with the current study. Results: A total of 54 children were identified with IPD in this study. Sixty per cent of the study population was below the age of two-years-old. A significantly higher number of IPD cases were found among the indigenous group. Both spectrums of malnourished children were also susceptible to the infection. This study found that the majority of children developed septicaemia (43/54, 80%), followed by pneumonia (34/54, 63%) and meningitis (13/54, 24%). Pneumonia (p=0.001) and meningitis p=0.03) were more likely to occur in children less than one-year old. The study also showed that meningitis (p=0.01) was significantly associated with fatal cases. The second component of this article focussed on the review of the disease in Malaysia. There were 8 articles included, of which four each were clinical and microbiological studies. The review concurred that the young ones were vulnerable to the disease. The overall antibiotic resistance in Malaysia was low but on an increasing trend (10-30%). The mortality documented were only from the clinical studies, which showed a disparity of fatality rates in the different regions studied. The rate was low in Selangor (0-11%), in contradiction of a higher rate in Perak, the less developed area (26%). Conclusions: The study highlighted that the younger age group, extremes of nutritional status and indigenous children were at risk of IPD. On the literature review of paediatric IPD in Malaysia, there was inadequate information on the disease. A concerted effort to better describe the disease is needed.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Paediatric Invasive Pneumococcal Disease : A 5-year Experience and Review of Hospital-Based Studies in Malaysia

Rengasamy

Othman

2020

Preprint

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“…( p < 0.05). Other studies have reported partial or lack of immunization as a significant risk factor for pneumonia [ 21 , 25 , 26 ]. This study also substantiated the higher risk of pneumonia among partially immunized children.…”

Section: Discussionmentioning

confidence: 99%

Reported incidence and risk factors of childhood pneumonia in India: a community-based cross-sectional study

et al. 2018

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BackgroundPneumonia is responsible for high morbidity and mortality amongst children under five year of age. India accounts for one-third of the total WHO South East Asia burden of under-five mortality. There is a paucity of epidemiological studies indicating the true burden of pneumonia. Identification of the risk factors associated with pneumonia will help to effectively plan and implement the preventive measures for its reduction.MethodsIt was a descriptive cross-sectional study conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. All mothers of under-five children in the selected clusters were included. A validated pretested interview schedule was filled by trained field supervisors through the house to house visits.WHO definition was used to define and classify clinical pneumonia. Height and weight of children were taken as per standard guidelines. Quality checks for data collection were done by the site investigators and critical and noncritical fields in the questionnaire were monitored during data entry. For continuous variables mean and SD were calculated. Chi-square test was applied to determine the association between the variables. Level of significance was considered at 0.05.ResultsThere were 3671 under five-year children, 2929 mothers in 10,929 households.Unclean fuel usage was found in 15.1% of households. Mean birth weight was 2.6 kg (SD;0.61). Exclusive breastfeeding till 6 months of age was practiced by 46% of mothers. Reported incidence of ARI was 0.49 per child per month and the reported incidence of pneumonia was 0.075 per child per year. It was not associated with any of the housing environment factors (p > 0.05) but was found to be associated with partial immunization (p < 0.05). Poor practices related to child feeding, hand hygiene and poor knowledge related to signs and symptoms of pneumonia amongst mother were found.ConclusionsVery low incidence of pneumonia was observed in Pune and Sangli districts of Maharashtra. Partial immunization emerged as a most important risk factor. Reasons for low incidence and lack of association of pneumonia with known risk factors may be a better literacy rate among mothers and better immunization coverage.Trial registrationRegistration number of the trial- CTRI/2017/12/010881; date of registration-14/12/2017.

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“…[49][50][51] Manual measurement, although often the reference standard, can be imprecise and is affected by intraobserver variation as it requires focused concen tration In five studies, the incidence of WHO-defined severe pneumonia or severepneumonia with radiographic confirmation was approximately five episodes per 100 child-years in children below two years of age. 11,[33][34][35][36] The RESPIRE trial documented a relative risk of 0·67 for children with severe pneumonia in households with improved cookstoves, compared with those using traditional stoves. 10 Using this information, we can calculate the necessary sample size using a difference in two proportions (assuming pneumonia events are independent).…”

Section: Respiratory Ratementioning

confidence: 99%

Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group

Goodman¹,

Pervaiz²,

McCollum³

et al. 2019

The Lancet Respiratory Medicine

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Pneumonia is a leading killer of children younger than 5 years despite high vaccination coverage, improved nutrition, and widespread implementation of the Integrated Management of Childhood Illnesses algorithm. Assessing the effect of interventions on childhood pneumonia is challenging because the choice of case definition and surveillance approach can affect the identification of pneumonia substantially. In anticipation of an intervention trial aimed to reduce childhood pneumonia by lowering household air pollution, we created a working group to provide recommendations regarding study design and implementation. We suggest to, first, select a standard case definition that combines acute (≤14 days) respiratory symptoms and signs and general danger signs with ancillary tests (such as chest imaging and pulse oximetry) to improve pneumonia identification; second, to prioritise active hospital-based pneumonia surveillance over passive case finding or home-based surveillance to reduce the risk of non-differential misclassification of pneumonia and, as a result, a reduced effect size in a randomised trial; and, lastly, to consider longitudinal follow-up of children younger than 1 year, as this age group has the highest incidence of severe pneumonia.

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Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates

Cited by 65 publications

References 18 publications

Paediatric Invasive Pneumococcal Disease : A 5-year Experience and Review of Hospital-Based Studies in Malaysia

Paediatric Invasive Pneumococcal Disease : A 5-year Experience and Review of Hospital-Based Studies in Malaysia

Reported incidence and risk factors of childhood pneumonia in India: a community-based cross-sectional study

Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group

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