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Case Management on Childhood Pneumonia Mortality

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More Intervention Effect Estimate Summaries

Theodoratou E, Al-Jilaihawi S, Woodward F, Ferguson J, Jhass A, Balliet M, Kolcic I, Sadruddin S, Duke T, Rudan I, and H. Campbell. The effect of case management on childhood pneumonia mortality in developing countries.  International Journal of Epidemiology 2010 April; 39 (Suppl 1): i55-i71.


  • According to a UNICEF-World Health Organization (WHO) report from 2006, over 2 million children die from pneumonia each year, accounting for almost one in five under-5 deaths worldwide. (1)
  • Based on current WHO guidelines, it has been estimated that ~10% of children presenting with pneumonia, i.e. those with severe or very severe pneumonia, may require referral to a first referral or district hospital for hospital treatment.  Since pneumonia is the leading cause of death in children < 5 years of age, interventions to promote the prevention and treatment of pneumonia are an essential part of child survival efforts to achieve Millennium Development Goal 4.

Intervention Effects

Community Case Management with Antibiotic Treatment of Pneumonia on Pneumonia Mortality  

  • 35% reduction (95% CI: 18-48%) in ALRI mortality among 0-5 years (9 studies)
  • Because these studies are based on a 50% estimated coverage rate for antibiotic treatment, the adjusted effectiveness is 70%

Hospital Case Management of Pneumonia on Pneumonia Mortality 

  • Because of the lack of studies with a comparison group, there is insufficient evidence to make a quantitative effect estimate of hospital case management of severe and very severe pneumonia with antibiotics.

Treatment of Pneumonia Episodes with Zinc on Pneumonia Mortality 

  • There is no clear evidence of an effect on pneumonia mortality

Treatment of Pneumonia Episodes with Vitamin A on Pneumonia Mortality 

  • There is no clear evidence of an effect on pneumonia mortality

Intervention Recommendation

  • Results of the current review reinforce the evidence of the effectiveness of community and hospital case management.  Authors estimate that community case management of pneumonia could result in a 70% reduction in mortality from pneumonia.  It is, however, difficult to quantify the effectiveness of hospital case management of severe and very severe pneumonia with antibiotics.
  • Zinc and vitamin A supportive treatment does not affect pneumonia related outcomes in children.
  • One study showed a 35% reduction in mortality (95% CI: 22-48%) with oxygen treatment for pneumonia, but further research is required. 
  • Further research is required to provide data to model the effect in HIV-affected regions.
  • The studies reviewed in this report were conducted in settings where these vaccines were not used at all or not at a significant level of coverage.  Direct and indirect effects of these vaccines at moderate to high coverage are likely to make a substantial impact.

References from Theodoratou Paper Cited Here

  1. UNICEF, World Health Organization.  Pneumonia: the Forgotten Killer of Children.

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