International Vaccine Access Center, Baltimore, MD, USA.
International Vaccine Access Center, Baltimore, MD, USA.
Lancet Child Adolesc Health. 2020 Sep;4(9):678-687. doi: 10.1016/S2352-4642(20)30129-2.
The absolute number of pneumonia deaths in India has declined substantially since 2000. However, pneumonia remains a major cause of morbidity in children in the country. We used a risk factor-based model to estimate pneumonia and severe pneumonia morbidity in Indian states in 2000 and 2015.
In this modelling study, we estimated the burden of pneumonia and severe pneumonia in children younger than 5 years using a risk factor-based model. We did a systematic literature review to identify published data on the incidence of pneumonia from community-based longitudinal studies and calculated summary estimates. We estimated state-specific incidence rates for WHO-defined clinical pneumonia between 2000 and 2015 using Poisson regression and the prevalence of risk factors in each state was obtained from National Family Health Surveys. From clinical pneumonia studies, we identified studies reporting the proportion of clinical pneumonia cases with lower chest wall indrawing to estimate WHO-defined severe pneumonia cases. We used the estimate of the proportion of cases with lower chest wall indrawing to estimate WHO-defined severe pneumonia cases for each state.
Between 2000 and 2015, the estimated number of pneumonia cases in Indian HIV-uninfected children younger than 5 years decreased from 83·8 million cases (95% uncertainty interval [UI] 14·0-300·8) to 49·8 million cases (9·1-174·2), representing a 41% reduction in pneumonia cases. The incidence of pneumonia in children younger than 5 years in India was 657 cases per 1000 children (95% UI 110-2357) in 2000 and 403 cases per 1000 children (74-1408) in 2015. The estimated national pneumonia case fatality rate in 2015 was 0·38% (95% UI 0·11-2·10). In 2015, the estimated number of severe pneumonia cases was 8·4 million (95% UI 1·2-31·7), with an incidence of 68 cases per 1000 children (9-257) and a case fatality ratio of 2·26% (0·60-16·30). In 2015, the estimated number of pneumonia cases in HIV-uninfected children was highest in Uttar Pradesh (12·4 million [95% UI 2·1-45·0]), Bihar (7·3 million [1·3-26·1]), and Madhya Pradesh (4·6 million [0·7-17·0]). Between 2000 and 2015, the greatest reduction in pneumonia cases was observed in Kerala (82% reduction). In 2015, pneumonia incidence was greater than 500 cases per 1000 children in two states: Uttar Pradesh (565 cases per 1000 children [95% UI 94-2047]) and Madhya Pradesh (563 cases per 1000 children [88-2084]).
The estimated number of pneumonia and severe pneumonia cases among children younger than 5 years in India decreased between 2000 and 2015. Improvements in socioeconomic indicators and specific government initiatives are likely to have contributed to declines in the prevalence of pneumonia risk factors in many states. However, pneumonia incidence in many states remains high. The introduction of new vaccines that target pneumonia pathogens and reduce risk factors will help further reduce the burden of pneumonia in the country.
Bill & Melinda Gates Foundation.
自 2000 年以来，印度肺炎死亡的绝对人数大幅下降。然而，肺炎仍然是该国儿童发病的主要原因。我们使用基于风险因素的模型来估计 2000 年和 2015 年印度各州的肺炎和严重肺炎发病率。
在这项建模研究中，我们使用基于风险因素的模型来估计 5 岁以下儿童的肺炎和严重肺炎负担。我们进行了系统的文献回顾，以确定来自社区纵向研究的肺炎发病率的已发表数据，并计算了综合估计数。我们使用泊松回归估计 2000 年至 2015 年之间世界卫生组织（WHO）定义的临床肺炎的州特异性发病率，并从国家家庭健康调查中获得每个州的风险因素流行率。从临床肺炎研究中，我们确定了报告有下胸壁凹陷的临床肺炎病例比例的研究，以估计 WHO 定义的严重肺炎病例。我们使用下胸壁凹陷病例的比例估计每个州的 WHO 定义的严重肺炎病例数。
2000 年至 2015 年间，印度 HIV 阴性 5 岁以下儿童的肺炎病例数从 8380 万例（95%不确定性区间[UI]140-3008）下降至 4980 万例（91-1742），下降了 41%。2000 年，印度 5 岁以下儿童的肺炎发病率为每 1000 名儿童 657 例（95% UI 110-2357），2015 年为每 1000 名儿童 403 例（74-1408）。2015 年全国肺炎病死率估计为 0.38%（95% UI 0.11-2.10）。2015 年，严重肺炎病例估计数为 840 万例（95% UI 12-317），发病率为每 1000 名儿童 68 例（9-257），病死率为 2.26%（0.60-16.30）。2015 年，HIV 阴性儿童的肺炎病例数在北方邦（1240 万例[95% UI 21-450]）、比哈尔邦（730 万例[13-261]）和中央邦（460 万例[0.7-170]）最高。2000 年至 2015 年间，在喀拉拉邦观察到肺炎病例数下降幅度最大（82%）。2015 年，有两个州的肺炎发病率超过每 1000 名儿童 500 例：北方邦（每 1000 名儿童 565 例[95% UI 94-2047]）和中央邦（每 1000 名儿童 563 例[88-2084]）。
2000 年至 2015 年间，印度 5 岁以下儿童的肺炎和严重肺炎病例数有所减少。社会经济指标的改善和政府的具体举措可能有助于降低许多州肺炎风险因素的流行率。然而，许多州的肺炎发病率仍然很高。新疫苗的引入可以针对肺炎病原体并降低风险因素，这将有助于进一步降低该国的肺炎负担。
比尔及梅琳达·盖茨基金会。
