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CARO, Lizzette ISHIMURA, Marie PASCUA, Rodelia

Acute Lower Respiratory Infections (ALRI) in childhood: Opportunities for reducing the global burden through nutritional interventions. CARO, Lizzette ISHIMURA, Marie PASCUA, Rodelia. Burden of Disease.

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CARO, Lizzette ISHIMURA, Marie PASCUA, Rodelia

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  1. Acute Lower Respiratory Infections (ALRI) in childhood: Opportunities for reducing the global burden through nutritional interventions CARO, Lizzette ISHIMURA, Marie PASCUA, Rodelia

  2. Burden of Disease • Estimated ALRI deaths and disease burden in children under 5 years of age attributable to nutritional risk factors, in 2004 • Insert table 1 here

  3. Methods • Meta-analyses and Large scale randomized controlled trials that measured at least 1 childhood ALRI outcome (incidence, morbidity, mortality) • Micronutrient supplementation • Breastfeeding promotion • Complementary food provision or counselling • Antenatal nutritional interventions

  4. Literature review • Systematic reviews (Lancet Undernutrition Series) • PubMed

  5. ALRI Outcome • At least one specific lower respiratory tract sign reported by a caregiver or study personnel • Fast breathing • Difficulty breathing • Chest wall indrawing AND/OR abnormal auscultatory findings • Crackles/ crepitations • Wheeze, bronchial breath sounds

  6. No documentation • Viral diagnostics • Isolation of pathogens • Radiographic findings

  7. RESULTS

  8. Insert Table 1 again

  9. Breastfeeding promotion • Suboptimal breastfeeding accounts for 44% of infection-related neonatal deaths/DALYs and 20% of postnatal ALRI deaths/DALYs lost • Breast milk influences immune system maturation. • Breastfeeding enhances antibody response to ALRI-causing pathogens.

  10. Gap in knowledge • The specific mechanism by which breastfeeding ameliorates ALRI resistance is not yet clear. • Few studies have quantified the effect of breastfeeding programmes on ALRI reduction

  11. Some studies • 4 studies failed to distinguish URI vs LRI • PROBIT study • promotion efforts led to increased breastfeeding continuation • 40% decrease in diarrhea incidence • 15% decrease in respiratory-disease-related hospitalizations 0.85 (0.83-1.27)

  12. Insert table 1 again

  13. Complementary food supplementation or counselling • One-quarter of under-five deaths and DALYs lost were attributable to undernutrition • Theoretical solution: dietary interventions

  14. Gap in knowledge • Will improvements in the quality of complementary foods reduce the ALRI risk, incidence or mortality?

  15. Some studies • Impact of complementary feeding education or food supplementation on ALRI incidence (low statistical power) • Effect of comprehensive community-based nutrition programmes on ALRI outcomes • Small sample size • Quasi- or non-randomized • Incomplete presentation of findings

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