title: Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials.
abstract: Pneumonia still causes around two million deaths among children annually (20% of all child deaths). Any intervention that would affect pneumonia mortality is of great public health importance. This meta-analysis provides estimates of mortality impact of the case-management approach proposed by WHO. We were able to get data from nine of ten eligible community-based studies that assessed the effects of pneumonia case-management intervention on mortality; seven studies had a concurrent control group. Standardised forms were completed by individual investigators to provide information on study description, quality scoring, follow-up, and outcome (mortality) data with three age groups (<1 month, <1 year, 0-4 years) and two mortality categories (total and pneumonia-specific). Meta-analysis found a reduction in total mortality of 27% (95% CI 18-35%), 20% (11-28%), and 24% (14-33%) among neonates, infants, and children 0-4 years of age, respectively. In the same three groups pneumonia mortality was reduced by 42% (22-57%), 36% (20-48%), and 36% (20-49%). There was no evidence of publication bias and results were unaltered by exclusion of any study. A limitation of the included studies is that they were not randomised and, because of the nature of the intervention, could not be blinded. Community-based interventions to identify and treat pneumonia have a substantial effect on neonatal, infant, and child mortality and should be incorporated into primary health care.
authors.affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Sazawal
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019090:Case Management / Q000706:statistics & numerical data*; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents