Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective LiST analysis for Bangladesh, Chad, and Ethiopia

Summary Pneumonia remains the leading cause of mortality in children under five outside the neonatal period. Progress has slowed down in the last decade and increased efforts to scale-up effective pneumonia interventions are needed. We used the Lives Saved Tool (LiST), a modelling software for child mortality in low- and middle- income settings, to prospectively analyse the potential impact of upscaling pneumonia interventions in Bangladesh, Chad, and Ethiopia from 2023-2030. Haemophilus influenzae type B (Hib) vaccination, pneumococcal conjugate vaccine (PCV), oral antibiotics, pulse oximetry and oxygen were included as pneumonia interventions in our analysis. Outcomes were number of pneumonia deaths averted, proportion of deaths averted by intervention, and changes in the under-five mortality rate. Our results show that 19,775 lives of children under five could be saved in Bangladesh, 76,470 in Chad, and 97,343 in Ethiopia by scaling intervention coverages to ≥90% by 2030. Our estimated reductions in pneumonia deaths among children under five range from 44.61% to 57.91% in the respective countries. Increased coverage of oral antibiotics, pulse oximetry, and oxygen show similar effects in all three countries, averting between 18.80% and 23.65% of expected pneumonia deaths. Scaling-up PCV has a prominent effect, especially in Chad where it could avert 14.04% of expected pneumonia deaths. Under-five mortality could be reduced by 1.42/1000, live births in Bangladesh, 22.52/1000, in Chad, and 5.48/1000, in Ethiopia. This analysis shows the high impact of upscaling pneumonia interventions. The lack of data regarding coverage indicators is a barrier for further research, as well as policy and implementation, all requiring increased attention. Lay summary Pneumonia remains the leading cause of death in children under five after the first 28 days of live. However, progress in decreasing pneumonia deaths has stagnated in the worst-affected regions. This study used a modelling software called the Lives Saved Tool (LiST) to project pneumonia deaths and the number of lives saved in children under five in Bangladesh, Chad, and Ethiopia if four key pneumonia interventions (vaccinations, oral antibiotic treatment, pulse oximetry, and oxygen treatment) were scaled up to a coverage ≥ 90% by 2030. Our results show that from 2023 to 2030 19,775 lives of children under five with pneumonia could be saved in Bangladesh, 76,470 in Chad, and 97,343 in Ethiopia. Increasing oral antibiotics, pulse oximetry, and oxygen coverages proved highly valuable for reducing pneumonia deaths in all three countries. Pneumococcal vaccination had an especially prominent effect in Chad. Our analysis shows the potential of the four interventions for improving child health in high burden pneumonia countries and highlights the importance of increased funding to reduce childhood pneumonia. The lack of up-to-date accurate data, especially for pulse oximetry and oxygen coverage indicators, is a barrier not only for research but also for evidence-based policy-making that needs to be addressed.