This article reviews the available evidence of mortality from acute respiratory infections (ARI) among children aged under 5 years in contemporary developing countries and compares the findings with European populations before 1965. In European populations before 1965, the level of mortality was found to be a determinant of the proportion of deaths due to ARI. There were marked differences according to regional patterns of mortality. Deaths from ARI played a smaller role after 1950, when the use of antibiotics became generalized. In developing countries, the role of ARI mortality seems to be similar to the European experience. The age pattern is very marked. In absolute values, ARI mortality is highest in the neonatal period and decreases with age. In relative values, ARI mortality is highest in the postneonatal period. ARI, mainly pneumonia, accounts for about 18% of underlying causes of death in developing countries. Pneumonia and other ARI are frequent complications of measles and pertussis; ARI is also commonly found after other infections and in association with severe malnutrition. Virtually no data are available in developing countries to provide final estimates of the role of ARI in mortality of children aged under 5 years. However, the WHO figure of 1 out of 3 deaths due to--or associated with--ARI may be close to the real range of the ARI-proportional mortality in children of developing countries. Results are discussed in light of the definitions of ARI used in various studies, the difficulties in ascertaining and coding multiple causes of death and the quality of data from some sources.
PIP: The available evidence of mortality from acute respiratory infections (ARI) among children less than 5 years old in contemporary developing countries is reviewed and the findings are compared with European populations before 1965. The proportion of ARI deaths in European populations prior to 1965 declined with the level of mortality; the proportion of ARI deaths was slightly higher among children 1-4 than among infants; and there was no difference by sex outside of infancy. The log-linear regression analysis of ARI deaths for children 1 and 1-4 in the European populations prior to 1965 indicated high significance for age 0-11 months and age 12-59 months. In absolute values, ARI mortality was highest in the neonatal period decreasing with age. A multivariate analysis indicated that the proportion of ARI deaths was significantly lower after 1950 among children 1-4 years old, interpreted as the effect of antibiotics on ARI mortality. The ARI deaths were significantly lower in the more developed countries at ages 1-4, but not in infancy. The data from community studies and from vital registrations were compared to the European experience by combining the 2 age groups: 1 and 1-4 years. The consistency of the data from developing countries with the experience of developed countries was striking.