TY - JOUR
T1 - The prevalence of hypoxaemia among children with pneumonia in low- and middle-income countries
T2 - a systematic review and meta-analysis
AU - Rahman, Ehsan
AU - Hossain, Aniqa Tasnim
AU - Nair, Harish
AU - Chisti, Mohammod Jobayer
AU - Dockrell, David H
AU - El Arifeen, Shams
AU - Campbell, Harry
N1 - Funding Information:
HN reports grants from Innovative Medicines Initiative, Pfizer, and WHO and honoraria from Sanofi, Janssen, Novavax, and ReViral, outside the submitted work. HC reports consulting fees from the Bill & Melinda Gates Foundation via his institution, and funding to attend meetings from the National Institute for Health Research via his institution, outside the submitted work.
Funding Information:
This study was funded by the UK National Institute for Health Research (Global Health Research Unit on Respiratory Health [RESPIRE]; 16/136/109) with UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the UK National Institute for Health Research or the UK Department of Health and Social Care. The International Centre for Diarrhoeal Disease Research, Bangladesh thanks the governments of Bangladesh, Canada, and Sweden and UKAID for their contribution. The RESPIRE collaboration comprises the UK grant holders, partners, and research teams, as listed at www.ed.ac.uk/usher/respire, including Prof Hilary Pinnock and Prof Aziz Sheikh. We thank Sabrina Jabeen (as a second reviewer), Shema Mhajabin, Goutom Banik, Shafiqul Ameen, Tania Sultana Tanwi, Md Hafizur Rahman, Ema Akter, Nowrin Nusrat, and Ashraful Kibria from The International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, for their support in this study. We thank Marshall Dozier from the University of Edinburgh, Edinburgh, UK, for her support with finalising the search strategy, library searches, and resources.
Funding Information:
This study was funded by the UK National Institute for Health Research (Global Health Research Unit on Respiratory Health [RESPIRE]; 16/136/109) with UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the UK National Institute for Health Research or the UK Department of Health and Social Care. The International Centre for Diarrhoeal Disease Research, Bangladesh thanks the governments of Bangladesh, Canada, and Sweden and UKAID for their contribution. The RESPIRE collaboration comprises the UK grant holders, partners, and research teams, as listed at www.ed.ac.uk/usher/respire, including Prof Hilary Pinnock and Prof Aziz Sheikh. We thank Sabrina Jabeen (as a second reviewer), Shema Mhajabin, Goutom Banik, Shafiqul Ameen, Tania Sultana Tanwi, Md Hafizur Rahman, Ema Akter, Nowrin Nusrat, and Ashraful Kibria from The International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, for their support in this study. We thank Marshall Dozier from the University of Edinburgh, Edinburgh, UK, for her support with finalising the search strategy, library searches, and resources.
Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Background: Pneumonia accounts for around 15% of all deaths of children younger than 5 years globally. Most happen in resource-constrained settings and are potentially preventable. Hypoxaemia is one of the strongest predictors of these deaths. We present an updated estimate of hypoxaemia prevalence among children with pneumonia in low-income and middle-income countries. Methods: We conducted a systematic review using the following key concepts “children under five years of age” AND “pneumonia” AND “hypoxaemia” AND “low- and middle-income countries” by searching in 11 bibliographic databases and citation indices. We included all articles published between Nov 1, 2008, and Oct 8, 2021, based on observational studies and control arms of randomised and non-randomised controlled trials. We excluded protocol papers, articles reporting hypoxaemia prevalence based on less than 100 pneumonia cases, and articles published before 2008 from the review. Quality appraisal was done with the Joanna Briggs Institute tools. We reported pooled prevalence of hypoxaemia (SpO
2 <90%) by classification of clinical severity and by clinical settings by use of the random-effects meta-analysis models. We combined our estimate of the pooled prevalence of pneumonia with a previously published estimate of the number of children admitted to hospital due to pneumonia annually to calculate the total annual number of children admitted to hospital with hypoxaemic pneumonia. Findings: We identified 2825 unique records from the databases, of which 57 studies met the eligibility criteria: 26 from Africa, 23 from Asia, five from South America, and four from multiple continents. The prevalence of hypoxaemia was 31% (95% CI 26–36; 101 775 children) among all children with WHO-classified pneumonia, 41% (33–49; 30 483 children) among those with very severe or severe pneumonia, and 8% (3–16; 2395 children) among those with non-severe pneumonia. The prevalence was much higher in studies conducted in emergency and inpatient settings than in studies conducted in outpatient settings. In 2019, we estimated that over 7 million children (95% CI 5–8 million) were admitted to hospital with hypoxaemic pneumonia. The studies included in this systematic review had high τ
2 (ie, 0·17), indicating a high level of heterogeneity between studies, and a high I
2 value (ie, 99·6%), indicating that the heterogeneity was not due to chance. This study is registered with PROSPERO, CRD42019126207. Interpretation: The high prevalence of hypoxaemia among children with severe pneumonia, particularly among children who have been admitted to hospital, emphasises the importance of overall oxygen security within the health systems of low-income and middle-income countries, particularly in the context of the COVID-19 pandemic. Even among children with non-severe pneumonia that is managed in outpatient and community settings, the high prevalence emphasises the importance of rapid identification of hypoxaemia at the first point of contact and referral for appropriate oxygen therapy. Funding: UK National Institute for Health Research (Global Health Research Unit on Respiratory Health [RESPIRE]; 16/136/109).
AB - Background: Pneumonia accounts for around 15% of all deaths of children younger than 5 years globally. Most happen in resource-constrained settings and are potentially preventable. Hypoxaemia is one of the strongest predictors of these deaths. We present an updated estimate of hypoxaemia prevalence among children with pneumonia in low-income and middle-income countries. Methods: We conducted a systematic review using the following key concepts “children under five years of age” AND “pneumonia” AND “hypoxaemia” AND “low- and middle-income countries” by searching in 11 bibliographic databases and citation indices. We included all articles published between Nov 1, 2008, and Oct 8, 2021, based on observational studies and control arms of randomised and non-randomised controlled trials. We excluded protocol papers, articles reporting hypoxaemia prevalence based on less than 100 pneumonia cases, and articles published before 2008 from the review. Quality appraisal was done with the Joanna Briggs Institute tools. We reported pooled prevalence of hypoxaemia (SpO
2 <90%) by classification of clinical severity and by clinical settings by use of the random-effects meta-analysis models. We combined our estimate of the pooled prevalence of pneumonia with a previously published estimate of the number of children admitted to hospital due to pneumonia annually to calculate the total annual number of children admitted to hospital with hypoxaemic pneumonia. Findings: We identified 2825 unique records from the databases, of which 57 studies met the eligibility criteria: 26 from Africa, 23 from Asia, five from South America, and four from multiple continents. The prevalence of hypoxaemia was 31% (95% CI 26–36; 101 775 children) among all children with WHO-classified pneumonia, 41% (33–49; 30 483 children) among those with very severe or severe pneumonia, and 8% (3–16; 2395 children) among those with non-severe pneumonia. The prevalence was much higher in studies conducted in emergency and inpatient settings than in studies conducted in outpatient settings. In 2019, we estimated that over 7 million children (95% CI 5–8 million) were admitted to hospital with hypoxaemic pneumonia. The studies included in this systematic review had high τ
2 (ie, 0·17), indicating a high level of heterogeneity between studies, and a high I
2 value (ie, 99·6%), indicating that the heterogeneity was not due to chance. This study is registered with PROSPERO, CRD42019126207. Interpretation: The high prevalence of hypoxaemia among children with severe pneumonia, particularly among children who have been admitted to hospital, emphasises the importance of overall oxygen security within the health systems of low-income and middle-income countries, particularly in the context of the COVID-19 pandemic. Even among children with non-severe pneumonia that is managed in outpatient and community settings, the high prevalence emphasises the importance of rapid identification of hypoxaemia at the first point of contact and referral for appropriate oxygen therapy. Funding: UK National Institute for Health Research (Global Health Research Unit on Respiratory Health [RESPIRE]; 16/136/109).
KW - Child, Preschool
KW - Comorbidity
KW - Developing Countries/statistics & numerical data
KW - Humans
KW - Hypoxia/epidemiology
KW - Infant
KW - Internationality
KW - Pneumonia/epidemiology
KW - Poverty
KW - Prevalence
U2 - 10.1016/S2214-109X(21)00586-6
DO - 10.1016/S2214-109X(21)00586-6
M3 - Article
C2 - 35180418
SN - 2214-109X
VL - 10
SP - e348-e359
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 3
ER -