Wanyana Mercy Wendy, Migisha Richard, King Patrick, Bulage Lilian, Kwesiga Benon, Kadobera Daniel, Ario Alex Riolexus, Harris Julie R
Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda.
Ministry of Health, Kampala, Uganda.
PLOS Glob Public Health. 2025 Jan 6;5(1):e0002980. doi: 10.1371/journal.pgph.0002980. eCollection 2025.
Pneumonia is the second leading cause of hospital admissions and deaths among children <5 years in Uganda. In 2014, Uganda officially rolled out the introduction of the pneumococcal conjugate vaccine (PCV) into routine immunization schedule. However, little is known about the long-term impact of PCV on pneumonia admissions and deaths. In this study, we described the trends and spatial distribution of pneumonia hospital admissions and mortality among children <5 years in Uganda, 2014-2021. We analysed secondary data on pneumonia admissions and deaths from the District Health Information System version 2 during 2014-2021. The proportion of pneumonia cases admitted and case-fatality rates (CFRs) for children <5 years were calculated for children <5 years presenting at the outpatient department. At national, regional, and district levels, pneumonia mortality rates were calculated per 100,000 children <5 years. The Mann-Kendall Test was used to assess trend significance. We found 667,122 pneumonia admissions and 11,692 (2%) deaths during 2014-2021. The overall proportion of pneumonia cases admitted among children <5 years was 22%. The overall CFR was 0.39%, and the overall pneumonia mortality rate among children <5 years was 19 deaths per 100,000. From 2014 to 2021, there were declines in the proportion of pneumonia cases admitted (31% to 15%; p = 0.051), mortality rates (24/100,000 to 14 per 100,000; p = 0.019), and CFR (0.57% to 0.24%; p = 0.019), concomitant with increasing PCV coverage. Kotido District had a persistently high proportion of pneumonia cases that were admitted (>30%) every year while Kasese District had persistently high mortality rates (68-150 deaths per 100,000 children <5 years). Pneumonia admissions, mortality, and case fatality among children <5 years declined during 2013-2021 in Uganda after the introduction of PCV. However, with these trends it is unlikely that Uganda will meet the 2025 GAPPD targets. There is need to review implementation of existing interventions and identify gaps in order to highlight priority actions to further accelerate declines.
肺炎是乌干达5岁以下儿童住院和死亡的第二大主要原因。2014年，乌干达正式将肺炎球菌结合疫苗（PCV）纳入常规免疫计划。然而，关于PCV对肺炎住院和死亡的长期影响知之甚少。在本研究中，我们描述了2014 - 2021年乌干达5岁以下儿童肺炎住院和死亡率的趋势及空间分布。我们分析了2014 - 2021年期间地区卫生信息系统第2版中关于肺炎住院和死亡的二手数据。计算了在门诊部就诊的5岁以下儿童中肺炎病例的住院比例和病死率（CFR）。在国家、区域和地区层面，计算了每10万5岁以下儿童的肺炎死亡率。使用曼 - 肯德尔检验来评估趋势的显著性。我们发现在2014 - 2021年期间有667,122例肺炎住院病例和11,692例（2%）死亡。5岁以下儿童中肺炎病例的总体住院比例为22%。总体病死率为0.39%，5岁以下儿童的总体肺炎死亡率为每10万例中有19例死亡。从2014年到2021年，肺炎病例的住院比例（从31%降至15%；p = 0.051）、死亡率（从每10万例24例降至每10万例14例；p = 0.019）和病死率（从0.57%降至0.24%；p = 0.019）均有所下降，同时PCV覆盖率上升。科蒂多区每年肺炎病例的住院比例持续居高不下（>30%），而卡塞塞区的死亡率持续居高（每10万5岁以下儿童中有68 - 150例死亡）。在乌干达引入PCV后，2013 - 2021年期间5岁以下儿童的肺炎住院、死亡和病死率有所下降。然而，按照这些趋势，乌干达不太可能实现2025年全球肺炎和腹泻病行动计划（GAPPD）的目标。有必要审查现有干预措施的实施情况并找出差距，以突出进一步加速下降的优先行动。
