Childhood Pneumonia and Diarrhoea 2 Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost?
Childhood Pneumonia and Diarrhoea 2 Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost?
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DOI：
10.1016/s0140-6736(13)60648-0
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发表时间：
2013-04-20
期刊：
影响因子：
168.9
通讯作者：
Black, Robert E.
中科院分区：
文献类型：
--
作者：
Bhutta, Zulfiqar A.;Das, Jai K.;Black, Robert E.
全球5岁以下儿童死亡率在过去20年中大幅下降，从1990年的1200多万降至2011年的690万，但各国的进展情况并不一致。肺炎和腹泻是这一年龄组的两个主要死亡原因，具有重叠的危险因素。有几种干预措施可以有效地解决这些问题，但对有需要的人却无能为力。我们系统地审查了显示各种可能的预防和治疗措施对儿童腹泻和肺炎的有效性的证据，以及相关的交付战略。我们使用拯救生命工具模型来评估当应用这些干预措施时对死亡率的影响。我们估计，如果按照目前的年增长率在75个倒计时国家中的每个国家实施，到2025年，这些干预措施和一揽子护理措施可以减少54%的腹泻和51%的肺炎死亡，成本为38亿美元。然而，如果将这些关键的循证干预措施的覆盖率扩大到至少80%，将免疫接种的覆盖率至少提高到90%，那么到2025年，5岁以下儿童中95%的腹泻和67%的肺炎死亡可以被消除，成本为67.15亿美元。新的交付平台可以促进公平获取，社区平台是这方面的重要催化剂。此外，其中几项干预措施可以减少发病率和疾病的总体负担，并可能对发展成果产生好处。
Global mortality in children younger than 5 years has fallen substantially in the past two decades from more than 12 million in 1990, to 6.9 million in 2011, but progress is inconsistent between countries. Pneumonia and diarrhoea are the two leading causes of death in this age group and have overlapping risk factors. Several interventions can effectively address these problems, but are not available to those in need. We systematically reviewed evidence showing the effectiveness of various potential preventive and therapeutic interventions against childhood diarrhoea and pneumonia, and relevant delivery strategies. We used the Lives Saved Tool model to assess the effect on mortality when these interventions are applied. We estimate that if implemented at present annual rates of increase in each of the 75 Countdown countries, these interventions and packages of care could save 54% of diarrhoea and 51% of pneumonia deaths by 2025 at a cost of US$3.8 billion. However, if coverage of these key evidence-based interventions were scaled up to at least 80%, and that for immunisations to at least 90%, 95% of diarrhoea and 67% of pneumonia deaths in children younger than 5 years could be eliminated by 2025 at a cost of $6.715 billion. New delivery platforms could promote equitable access and community platforms are important catalysts in this respect. Furthermore, several of these interventions could reduce morbidity and overall burden of disease, with possible benefits for developmental outcomes.