Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis
Open accessAbstract
Background The annual number of hospital admissions and in-hospital deaths due to severe acute lower respiratory infections (ALRI) in young children worldwide is unknown. We aimed to estimate the incidence of admissions and deaths for such infections in children younger than 5 years in 2010.Methods We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratified by age and region, with data from a systematic review of studies published between Jan 1, 1990, and March 31, 2012, and from 28 unpublished population-based studies. We applied these incidence estimates to population estimates for 2010, to calculate the global and regional burden in children admitted with severe ALRI in that year. We estimated in-hospital mortality due to severe and very severe ALRI by combining incidence estimates with case fatality ratios from hospital-based studies.Findings We identified 89 eligible studies and estimated that in 2010, 11·9 million (95% CI 10·3-13·9 million) episodes of severe and 3·0 million (2·1-4·2 million) episodes of very severe ALRI resulted in hospital admissions in young children worldwide. Incidence was higher in boys than in girls, the sex disparity being greatest in South Asian studies. On the basis of data from 37 hospital studies reporting case fatality ratios for severe ALRI, we estimated that roughly 265,000 (95% CI 160,000-450,000) in-hospital deaths took place in young children, with 99% of these deaths in developing countries. Therefore, the data suggest that although 62% of children with severe ALRI are treated in hospitals, 81% of deaths happen outside hospitals.Interpretation Severe ALRI is a substantial burden on health services worldwide and a major cause of hospital referral and admission in young children. Improved hospital access and reduced inequities, such as those related to sex and rural status, could substantially decrease mortality related to such infection. Community-based management of severe disease could be an important complementary strategy to reduce pneumonia mortality and health inequities.Funding WHO.
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The largest sex differences in pneumonia incidence were noted in south Asia.
“11 community-based studies had sex-specific data for pneumonia incidence, which was higher in boys than in girls (median odds ratio 1·3 [IQR 1·2–1·4]; unpublished); the largest differences were noted in south Asia.12”
From Global burden of childhood pneumonia and diarrhoea (2013) · cites this paper as [12]
In 11 community-based studies, pneumonia incidence was higher in boys than in girls (median odds ratio 1.3, IQR 1.2-1.4).
“11 community-based studies had sex-specific data for pneumonia incidence, which was higher in boys than in girls (median odds ratio 1·3 [IQR 1·2–1·4]; unpublished); the largest differences were noted in south Asia.12”
From Global burden of childhood pneumonia and diarrhoea (2013) · cites this paper as [12]
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“Every year ARIs account for over 12 million hospital admissions among children below ive years of age (Nair et al., 2013; WHO, 2019).”
- Authors
- Nair, H., Simões, E. A., Rudan, I., Gessner, B. D., Azziz-Baumgartner, E., Zhang, J. S. F., Feikin, D. R., Mackenzie, G. A., Moiïsi, J. C., Roca, A., Baggett, H. C., Zaman, S. M., Singleton, R. J., Lucero, M. G., Chandran, A., Gentile, A., Cohen, C., Krishnan, A., Bhutta, Z. A., Arguedas, A., Clara, A. W., Andrade, A. L., Ope, M., Ruvinsky, R. O., Hortal, M., McCracken, J. P., Madhi, S. A., Bruce, N., Qazi, S. A., Morris, S. S., El Arifeen, S., Weber, M. W., Scott, J. A. G., Brooks, W. A., Breiman, R. F., & Campbell, H.
- Affiliations
- Public Health Foundation of India (IN)
- Padjadjaran University (ID)
- University of Edinburgh (GB)
- Agence de Médecine Préventive (FR)
- The University of Melbourne (AU)
- Centers for Disease Control and Prevention (US)
- MRC Unit the Gambia (GM)
- Kenya Medical Research Institute (KE)
- Manhiça Health Research Centre (MZ)
- Ministry of Public Health (TH)
- Department of Health (PH)
- Johns Hopkins University (US)
- Hospital General de Niños Ricardo Gutierrez (AR)
- University of the Witwatersrand (ZA)
- All India Institute of Medical Sciences (IN)
- Aga Khan University (PK)
- Universidad de Ciencias Medicas (CR)
- Universidad de Buenos Aires (AR)
- Programa de Desarrollo de las Ciencias Básicas (UY)
- Universidad del Valle de Guatemala (GT)
- University of Liverpool (GB)
- World Health Organization (CH)
- Gates Foundation (US)
- International Centre for Diarrhoeal Disease Research (BD)
- Centers for Disease Control and Prevention (KE)
- Corresponding author
- Nair, Harish
- ORCID
- Nair, Harish
- Simões, Eric AF
- Rudan, Igor
- Gessner, Bradford D
- Feikin, Daniel R
- Mackenzie, Grant A
- Roca, Anna
- Baggett, Henry C
- Zaman, Syed MA
- Singleton, Rosalyn J
- Lucero, Marilla G
- Chandran, Aruna
- Gentile, Angela
- Cohen, Cheryl
- Krishnan, Anand
- Bhutta, Zulfiqar A
- Arguedas, Adriano
- Clara, Alexey Wilfrido
- Ope, Maurice
- McCracken, John P
- Madhi, Shabir A
- Qazi, Shamim A
- Morris, Saul S
- Scott, J Anthony G
- Breiman, Robert F
- Campbell, Harry
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2013-04
- Volume
- 381
- Issue
- 9875
- Pages
- 1380-1390
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC3986472
- OpenAlex
- W2113629675
- Cited by
- 779
- References
- 65
- Citations by year
- 2026: 18 · 2025: 43 · 2024: 54 · 2023: 60 · 2022: 69 · 2021: 79 · 2020: 84 · 2019: 59 · 2018: 52 · 2017: 67 · 2016: 56 · 2015: 73 · 2014: 41 · 2013: 22
- FWCI
- 7.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (publishedVersion, other-oa)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Funders
- Wellcome Trust (092654, 098532/B/12/Z, 098532)
- Topics
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Health Sciences › Health Professions › Emergency Medical Services › Pediatric health and respiratory diseases
- Keywords
- young children, hospitalization, in-hospital mortality, global burden of disease, incidence estimation, case fatality rate, sex disparities, health disparities, pneumonia mortality, community management, developing countries
- MeSH terms
- Acute Disease, Child, Preschool, Female, Hospitalization, Humans, Infant, Influenza, Human, Male, Respiratory Tract Infections, Global Health, Incidence, Hospital Mortality, Influenza A Virus, H1N1 Subtype
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