Global Burden of Childhood Diarrhea and PneumoniaChrista L. Fischer Walker1, Igor Rudan2, Li Liu1, Harish Nair2, EvropiThe...
A comprehensive              epidemiology review• Morbidity and mortality from childhood diarrhoea and  pneumonia are fall...
Regional burden of severe diarrhoea and    pneumonia episodes among children            aged 0-4 years in 2010            ...
Regional burden of diarrhoea and       pneumonia mortality among children             aged 0-4 years in 2011              ...
Distribution of cases of, and deaths fromdiarrhoea and pneumonia in children age 0-4                      yrs
Annual rates of change in diarrhea-specific and  pneumonia-specific mortality, 2000 - 2010
Diarrhoea and the risk of long-term                sequelae• A single episode of diarrhoea is typically self-limiting  wit...
Pneumonia and the risk of long-term              sequelae• The risk of at least one long-term major  sequela from pneumoni...
Vaccine-preventable causes of diarrhoea           severe morbidity and mortality      • Rotavirus is estimated to cause 28...
Vaccine-preventable causes of                    pneumonia severe morbidity and                               mortality   ...
Nutritional Risk Factors and Increased           Risk of Mortality• Lack of breastfeeding during the first 2 yeas of life ...
Nutritional Risk Factors and Increased              Risk of Mortality• Underweight, stunting, and wasting increase the ris...
Key Messages and Discussion• Diarrhoea and pneumonia remain the leading infectious  causes of death in children younger th...
Key Messages and Discussion• Nearly 1/3 of episodes of severe diarrhoea are  preventable by vaccination (i.e., against rot...
Upcoming SlideShare
Loading in …5
×

Global Burden of Childhood Diarrhea and Pneumonia - Dr. Christa Fischer Walker

1,106 views
943 views

Published on

Dr. Christa Fischer Walker: Global Burden of Childhood Diarrhea and Pneumonia
Johns Hopkins University

As presented at Launch of The Lancet Series on Childhood Pneumonia and Diarrhoea, at the Royal College of Pediatrics and Child Health - 12 April 2013

In support of the UNICEF & WHO Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea

View the film accompanying the presentation at:

www.wateraid.org/news/news/global-action-plan-for-pneumonia-and-diarrhoea

Published in: Health & Medicine, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,106
On SlideShare
0
From Embeds
0
Number of Embeds
388
Actions
Shares
0
Downloads
9
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Global Burden of Childhood Diarrhea and Pneumonia - Dr. Christa Fischer Walker

  1. 1. Global Burden of Childhood Diarrhea and PneumoniaChrista L. Fischer Walker1, Igor Rudan2, Li Liu1, Harish Nair2, EvropiTheodoratou2, Zulfiqar Bhutta3, Katherine L. O’Brien1, HarryCampbell2, Robert E. Black11 Johns Hopkins Bloomberg School of Public Health2 University of Edinburgh3 Aga Khan University
  2. 2. A comprehensive epidemiology review• Morbidity and mortality from childhood diarrhoea and pneumonia are falling, but action is needed globally and at country level to accelerate the reduction• We sought to compare and contrast the burden of disease for diarrhea and pneumonia among children < 5 years of age• We conducted 24 separate literature reviews to span the full epidemiologic spectrum of disease including: incidence, severe episodes, mortality, sequelae, age and sex distribution, etiology and risk factors for diarrhoea and pneumonia among children < 5 years of age
  3. 3. Regional burden of severe diarrhoea and pneumonia episodes among children aged 0-4 years in 2010 Diarrhoea Pneumonia 36.1 million episodes 14.1 million episodes WESTERN WESTERN PACIFIC PACIFIC 1.4 5.5 AFRICA AFRICA 9.6 4.2 SOUTHEAST ASIA 9.3 5.4SOUTHEAST 0.8ASIA 4.8 THE AMERICAS THE AMERICAS 1.9 4.3 EASTERN MEDITERRANEAN EUROPE 2.5 EASTERN 0.4 MEDITERRANEAN EUROPE
  4. 4. Regional burden of diarrhoea and pneumonia mortality among children aged 0-4 years in 2011 Diarrhoea Pneumonia 711,800 deaths 1,256,800 deaths Western Pacific 16.9 Western Pacific 61.9 AfricaSoutheast 227.7 AfricaAsia 540.6 353.3 Southeast 443.8 Asia Europe 6.3 96.6 Eastern 168.4 Mediterranean Europe 18.1 11 The Americas Eastern 23.9 Mediterranean The Americas
  5. 5. Distribution of cases of, and deaths fromdiarrhoea and pneumonia in children age 0-4 yrs
  6. 6. Annual rates of change in diarrhea-specific and pneumonia-specific mortality, 2000 - 2010
  7. 7. Diarrhoea and the risk of long-term sequelae• A single episode of diarrhoea is typically self-limiting with ORS and zinc for treatment• In low-income settings, multiple diarrhoea episodes per year can increase odds of stunting such that the proportion of stunting attributable to 5 episodes of diarrhoea in the first 2 years of life is 25%• Additional rare sequelae include: Guillain Barré Syndrome, Reactive arthritis, Hemolytic Uremic Syndrome
  8. 8. Pneumonia and the risk of long-term sequelae• The risk of at least one long-term major sequela from pneumonia is 5.5% (95% CI: 2.8- 8.3) in non-severe pneumonia and 13.6% (95% CI: 6.2-21.1) in hospitalized severe pneumonia• Sequelae include: reduction in lung volume and bronchiectasis (0.9% of severe cases)• The risk of sequelae is higher among children < 2 years of age (13.4%, 95% CI: 4.5-22.3)
  9. 9. Vaccine-preventable causes of diarrhoea severe morbidity and mortality • Rotavirus is estimated to cause 28% of severe diarrhoea, resulting in 9.9 million severe episodes and more than 193,000 deaths • Vibrio cholerae accounts for 1% of severe diarrhoea resulting in an estimated 456,000 severe episodes and 11,700 deaths • Estimates are based on data collected over more than 20 years and thus do not account for yearly variation as a result of epidemics or recent widespread vaccination campaigns in selected countries* Number of episodes correlates to 2011 estimates; number of deaths correlates to 2010 estimates
  10. 10. Vaccine-preventable causes of pneumonia severe morbidity and mortality • Streptococcus pneumoniae is the most common vaccine-preventable pathogen and accounts for 18.3% of severe episodes (2.6 million) and 32.7% of deaths (411,000) • Haemophilus influenzae type B accounts for 4.1% of severe episodes (574,000) and 15.7% of deaths (197,000) • Influenza virus led to 982,000 episodes (7%) and 137,000 deaths (10.9%)* Number of episodes correlates to 2011 estimates; number of deaths correlates to 2010 estimates
  11. 11. Nutritional Risk Factors and Increased Risk of Mortality• Lack of breastfeeding during the first 2 yeas of life increases the risk of diarrhoea morbidity and mortality and pneumonia mortality Diarrhea Mortality Pneumonia MortalityLack of exclusive Partially breastfed Partially breastfedbreastfeeding (0- RR = 4.62 (1.81 – 11.76) RR = 2.50 (1.03-6.04)5 mos) Not breastfed Not breastfed RR=10.52 (2.79-39.6) RR = 14.97 (0.7-332.7)Lack of anybreastfeeding (6- RR=2.18 (1.14-4.16)23 mos)
  12. 12. Nutritional Risk Factors and Increased Risk of Mortality• Underweight, stunting, and wasting increase the risk of mortality from both diarrhoea and pneumonia with the risk increasing as the degree of undernutrition increases Stunting Diarrhoea Pneumonia Stunted -2 to <-1 HAZ OR = 1.2 (0.9 – 1.7) OR = 1 (0.6 – 1.6) -3 to <-2 HAZ OR= 1.6 (1.1-2.5) OR= 1.3 (0.9-2.1) <-3 HAZ OR = 4.6 (2.7-8.1) OR = 3.2 (1.5-6.7)• Vitamin A deficiency increases the risk of mortality from diarrhoea (RR =1.47) by increasing the risk of severe disease• Zinc deficiency increases the risk of diarrhoea incidence (RR=1.15) and severe pneumonia and may increases risk of both diarrhoea and pneumonia mortality
  13. 13. Key Messages and Discussion• Diarrhoea and pneumonia remain the leading infectious causes of death in children younger than 5 years, and together caused an estimated 2 million deaths, in 2011.• 72% of deaths associated with diarrhoea and 81% of those associated with pneumonia happen in the first 2 years of life, suggesting that an increased emphasis on prevention and treatment in neonates and children younger than 2 years is crucial• The global burden of incidence and severe disease for both diarrhoea and pneumonia is highest in southeast Asia and Africa.
  14. 14. Key Messages and Discussion• Nearly 1/3 of episodes of severe diarrhoea are preventable by vaccination (i.e., against rotavirus and cholera).• At least 1/3 of severe episodes and 2/3 of deaths are caused by vaccine-preventable pneumonias (Streptococcus pneumoniae, Haemophilus influenzae, and the influenza virus).• Nearly ¾ of diarrhoea and pneumonia mortality are concentrated in 15 high-burden countries yet data sources from these countries are scant• Undernutrition is a key shared risk factor for morbidity and mortality associated with diarrhoea and pneumonia

×