Trends in the global burden of paediatric lower respiratory infections

Key factors in these reductions have been the roll-out and scale-up of vaccine coverage against Haemophilus influenzae type b (Hib) and pneumococcal infections (pneumococcal conjugate vaccine [PCV]), improved childhood nutrition and feeding practices, and declines in household air pollution. According to the GBD 2017 Lower Respiratory Infections Collaborators,3 improved nutrition-related factors and reductions in household air pollution were the main contributors to impressive reductions in mortality in India. A 2016 study reported that the odds of low birthweight was 10·6 times higher in the northwest than in the southwest of Nigeria,7 and the 2018 Demographic and Health Survey, which gathered data from national household surveys, report vaccine coverage to range from 73% for PCV and 74% for Hib in Abuja state to 6% for PCV and 7% for Hib in Sokoto state.8 These estimates highlight the need for caution in extrapolating broader conclusions on the roles of different interventions and the public health gains made across heterogeneous countries with little subnational data.