5.2.1 One of the greatest threats to child health

ARI include viral and bacterial infections of the lungs and respiratory tract, the most severe and fatal being bacterial pneumonia (Shann, 1986). Certain of the vaccine-preventable infectious diseases (such as measles and whooping cough) can include severe symptoms affecting the respiratory tract and contribute to the global burden of these diseases.

Most ARI episodes are mild and self-limiting and do not require specific treatment, but some progress to pneumonia. Pneumonia incidence is sufficiently high to make it the biggest cause of childhood mortality. It is also the cause of death in many elderly people. Approximately 2.7 million of the estimated 11 million deaths that occur every year in children under the age of 5 are due to pneumonia (WHO, 1996a). This does not include the one million or so who die as a result of measles or whooping cough, although most of these deaths are also ARI deaths. Most pneumonia deaths occur in developing countries in infants under one year of age. In fact, children are most susceptible to ARI during their first month of life; thereafter the risk falls steadily (Garenne, Ronsmans & Campbell, 1992).

The large variation in the burden of disease due to ARI among countries at different stages of economic development is shown in Fig. 5.1. In sub-Saharan Africa (SSA), ARIs cause about 300 DALYs per 1000 children, compared to about 3 DALYs per 1000 children in the established market economies (EME). Therefore, each year in SSA countries, 30% of children's potential healthy life is lost due to ARI. The very low per capita DALY rate in the EME countries indicates what can be achieved through interventions. Fig. 5.1 shows that "other developing countries", represented by Latin America and the Caribbean (LAC), have per capita ARI disease burdens that are about 5 times lower than those of the "least developed countries" (represented by SSA) and an additional 3 times lower than "economies in transition", represented by the former socialist economies of Europe (FSE). Thus the per capita disease burdens correspond to the level of economic development (see Chapter 2).

Fig. 5.1 Acute respiratory infections among children aged 0-4 years, by region - DALYs per 1000 children (log scale)

Source: Murray & Lopez, 1996b.