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Impact of community-based case management of pneumonia on infant and child mortality: a meta-analysis of six intervention trials.
In: Child health priorities for the 1990s. Report of a seminar held June 20-22, 1991 at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, edited by Kenneth Hill. Baltimore, Maryland, Johns Hopkins University, School of Hygiene and Public Health, Institute for International Programs, 1992 Oct. 161-90.Respiratory tract infections, and pneumonia in particular, account for 25-33% (4-5 million/year) of all childhood deaths in developing countries. There have been 7 published studies of WHO child survival intervention trials for evaluating pneumonia case management strategy out of 9 possible studies; 6 were used in this review. Statistical analysis was performed for the combination of studies. The objectives were to ascertain a stable estimate of the intervention effect, to examine variability among trials, to resolve conflicting results, and to help decision makers in research or pneumonia case control programs. Methods of report collection are indicated and the process of data abstraction delineated. An evaluation framework was established to assess the design and methodology of studies; the detailed checklist is provided in the appendix. The analytical strategy of the meta-analysis centered on an impact assessment using the absolute difference scale. Rate differences were computed for each study at concurrent, before, and after time periods for 12 causes of mortality by age group (infants, 1-4 years, 0-4 years). Cocharan's Q test was used to evaluate the homogeneity of intervention impact across studies. Estimated and summary odds ratios and 95% confidence limits with exact conditional maximum likelihood estimates were generated to determine the association between the impact and the co-intervention of these studies. The Breslow and Day method was used to analyze homogeneity and the Miettinen method was used for confirmation were estimated using the DerSimonian and Laird modified Cocharan method. The generalizable results were that pneumonia case management is an effective intervention for reducing childhood mortality. The impact may be greater than oral rehydration therapy and comparable to measles vaccination impact. The pooled infant mortality. For children 1-4 years, the pooled impact on total mortality was 5.1 and on ALRI specific mortality 1.1. The estimated cumulative reduction in mortality of those under 5 year old was 36 deaths/1000 births or a 25% reduction. The analysis is limited by the quality of the studies and the difficulty is distinguishing the case management strategy of pneumonia itself because of the multiple focus of interventions.