University of Liverpool Department of Women's and Children's Health, Liverpool, UK
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
BMJ Glob Health. 2021 Nov;6(11). doi: 10.1136/bmjgh-2021-007411.
Childhood malnutrition is widespread in low-income and middle-income countries (LMICs) and increases the frequency and severity of infections such as pneumonia. We aimed to identify studies investigating pneumonia deaths in malnourished children and estimate mortality risk by malnutrition severity.
We conducted a systematic review of MEDLINE, EMBASE and Global Health databases to identify relevant studies. We used a network meta-analysis to derive ORs of death from pneumonia for moderately and severely underweight children using low weight-for-age, the most reported measure of malnutrition. We compared meta-estimates of studies conducted before and after 2000 to assess changes in mortality risk over time. We estimated the prevalence of underweight hospitalised children from hospital-based cohort studies and calculated the population attributable fraction of in-hospital pneumonia deaths from being underweight using our results.
Our network meta-analysis included 33 544 underweight children from 23 studies. The estimated OR of death from pneumonia was 2.0 (95% CI 1.6 to 2.6) and 4.6 (95% CI 3.7 to 5.9) for children moderately and severely underweight, respectively. The OR of death from pneumonia for those severely underweight was 5.3 (95% CI 3.9 to 7.4) pre-2000 and remained high post-2000 at 4.1 (95% CI 3.0 to 6.0). Prevalence of underweight children hospitalised with pneumonia varied (median 40.2%, range 19.6-66.3) but was high across many LMIC settings. We estimated a median 18.3% (range 10.8-34.6) and 40.9% (range 14.7-69.9) of in-hospital pneumonia deaths were attributable to being moderately and severely underweight, respectively.
The risk of death from childhood pneumonia dramatically increases with malnutrition severity. This risk has remained high in recent years with an estimated over half of in-hospital pneumonia deaths attributable to child malnutrition. Prevention and treatment of all child malnutrition must be prioritised to maintain progress on reducing pneumonia deaths.
儿童营养不良在低收入和中等收入国家（LMICs）普遍存在，并增加了肺炎等感染的频率和严重程度。我们旨在确定研究营养不良儿童肺炎死亡的研究，并根据营养不良严重程度估计死亡率风险。
我们对 MEDLINE、EMBASE 和全球卫生数据库进行了系统综述，以确定相关研究。我们使用网络荟萃分析，使用最常报告的营养不良衡量标准——低体重与年龄，来得出中重度消瘦儿童肺炎死亡的比值比（OR）。我们比较了 2000 年前和后进行的研究的荟萃估计，以评估随着时间的推移死亡率风险的变化。我们从基于医院的队列研究中估计了消瘦住院儿童的患病率，并使用我们的结果计算了消瘦导致住院肺炎死亡的人群归因分数。
我们的网络荟萃分析包括来自 23 项研究的 33544 名消瘦儿童。患有肺炎的儿童的死亡率的估计 OR 分别为 2.0（95%CI 1.6-2.6）和 4.6（95%CI 3.7-5.9），分别为中度和重度消瘦儿童。2000 年前严重消瘦儿童肺炎死亡率的 OR 为 5.3（95%CI 3.9-7.4），2000 年后仍居高不下，为 4.1（95%CI 3.0-6.0）。患有肺炎住院的消瘦儿童的患病率各不相同（中位数为 40.2%，范围为 19.6-66.3%），但在许多 LMIC 环境中都很高。我们估计，中度和重度消瘦分别导致住院肺炎死亡的中位数为 18.3%（范围为 10.8-34.6%）和 40.9%（范围为 14.7-69.9%）。
儿童肺炎死亡率随着营养不良严重程度的增加而显著增加。近年来，这种风险仍然很高，估计有一半以上的住院肺炎死亡归因于儿童营养不良。必须优先考虑预防和治疗所有儿童营养不良，以维持减少肺炎死亡方面的进展。
