Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials

Lancet Infect Dis. 2003 Sep;3(9):547-56. doi: 10.1016/s1473-3099(03)00737-0.


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.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Case Management / statistics & numerical data*
  • Child, Preschool
  • Clinical Trials as Topic
  • Community-Acquired Infections* / drug therapy
  • Community-Acquired Infections* / epidemiology
  • Community-Acquired Infections* / mortality
  • Developing Countries*
  • Female
  • Humans
  • Infant
  • Infant Mortality*
  • Infant, Newborn
  • Male
  • Pneumonia* / epidemiology
  • Pneumonia* / mortality
  • Pneumonia* / therapy


  • Anti-Bacterial Agents