Volume 381, Issue 9875, Pages (April 2013)

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Volume 381, Issue 9875, Pages 1380-1390 (April 2013) Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis Dr Harish Nair, DNB, Prof Eric AF Simões, MD, Prof Igor Rudan, MD, Bradford D Gessner, MD, Eduardo Azziz-Baumgartner, MD, Jian Shayne F Zhang, MPH, Daniel R Feikin, MD, Grant A Mackenzie, PhD, Jennifer C Moiïsi, PhD, Anna Roca, PhD, Henry C Baggett, MD, Syed MA Zaman, PhD, Rosalyn J Singleton, MD, Marilla G Lucero, MD, Aruna Chandran, MD, Prof Angela Gentile, MD, Cheryl Cohen, MBBCH, Anand Krishnan, MD, Prof Zulfiqar A Bhutta, PhD, Prof Adriano Arguedas, MD, Alexey Wilfrido Clara, MPH, Prof Ana Lucia Andrade, MD, Maurice Ope, MBChB, Prof Raúl Oscar Ruvinsky, MD, Prof María Hortal, MD, John P McCracken, ScD, Prof Shabir A Madhi, MD, Prof Nigel Bruce, PhD, Shamim A Qazi, MD, Saul S Morris, PhD, Shams El Arifeen, DrPH, Martin W Weber, MD, Prof J Anthony G Scott, FRCP, W Abdullah Brooks, MD, Robert F Breiman, MD, Prof Harry Campbell, MD The Lancet Volume 381, Issue 9875, Pages 1380-1390 (April 2013) DOI: 10.1016/S0140-6736(12)61901-1 Copyright © 2013 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Terms and Conditions

Figure 1 Flow diagram for selection of studies The Lancet 2013 381, 1380-1390DOI: (10.1016/S0140-6736(12)61901-1) Copyright © 2013 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Terms and Conditions

Figure 2 Location of the 89 studies by WHO region The Lancet 2013 381, 1380-1390DOI: (10.1016/S0140-6736(12)61901-1) Copyright © 2013 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Terms and Conditions

Figure 3 Incidence of admissions for severe acute lower respiratory infection in boys versus girls aged 0–59 months Error bars show 95% CIs. Appendix pp 14–16 show details of the unpublished studies and study numbers. The Lancet 2013 381, 1380-1390DOI: (10.1016/S0140-6736(12)61901-1) Copyright © 2013 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Terms and Conditions

Figure 4 Global burden of severe acute lower respiratory infection, including burden on hospital services Understanding how these estimates fit with previously reported estimates of the global burden of acute lower respiratory infection (ALRI) is relevant for development of health policies for control of disease mortality. The dark green boxes show previously reported estimates of the global burden of severe ALRI (based on 28 community-based studies of ALRI morbidity) and the burden of ALRI-related deaths (based on independent data that combined vital registration data and data from multicause mortality studies, mainly with verbal autopsy) in young children. Our study (white boxes), based on data from hospital-based studies, introduces a health systems perspective to these previous estimates, which were based mainly on community based studies. We used the estimate for admissions of severe ALRI and available information about health facility use in different global regions to derive an estimate of the possible cases of severe ALRI in the community (orange boxes). The grey boxes show the burden of childhood cases of severe ALRI not accessing hospital inpatient services. The Lancet 2013 381, 1380-1390DOI: (10.1016/S0140-6736(12)61901-1) Copyright © 2013 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Terms and Conditions