Pneumonia Mortality among Children under 5 in China from 1996 to 2013: An Analysis from National Surveillance System

OBJECTIVES: We investigated the mortality rate of pneumonia (PMR) among children under 5 and its time trend from 1996 to 2013 to determine the priorities for ending preventable deaths from pneumonia in children under 5, and share China’s successful experience in reducing PMR with other developing countries. METHODS: We used data from China’s Under 5 Child Mortality Surveillance System (U5CMSS) to calculate the PMR and the proportion of pneumonia deaths to total deaths of children under 5. The data were grouped by urban and rural areas with Cochran-Mantel-Haensel (CMH) test and Chi-square test to examine the differences of PMR and proportion. The time trend was tested by Cochran-Armitage trend test. RESULTS: The overall PMR of children under 5 was reduced by 85.5% (from 1053.2 to 153.2 per 100,000 live births) from 1996 to 2013, with the urban and rural areas reduced by 69.1% (from 188.4 to 58.2 per 100,000 live births) and 84.7% (from 1252.8 to 191.9 per 100,000 live births), respectively. The overall proportion of pneumonia deaths to total deaths was also declined from 23.4% in 1996 to 12.8% in 2013, with the rural areas decreased from 24.4% to 13.2% and the urban areas decreased from 11.1% to 9.7%. The PMRs in neonates (0-27 days), post-neonates (1-11 months), and childhood (12-59 months) were reduced by 80.7%, 77.4%, and 80.1%, respectively in rural areas, and 71.7%, 69.6%, and 39.0%, respectively in urban areas. During 1996-2013, the PMR in children under 5 years was 4.9 fold higher in rural areas relative to that in urban areas, with relative risk (RR) of 3.6 and 6.4 in neonates and 1- to 59-month-old children, respectively. CONCLUSIONS: PMR in children under 5 significantly declined in China from 1996 to 2013, especially in rural areas. However, huge disparities still existed between rural and urban areas. Infants had the highest PMR, which indicated that interventions aiming at prevention and control of infant pneumonia should be the priority for further reducing PMR in China.