Age- and cause-specific childhood mortality in Lombok, Indonesia, as a factor for determining the appropriateness of introducing Haemophilus influenzae type b and pneumococcal vaccines

Using age and cause-specific childhood mortality in Lombok, Indonesia, as a factor for determining the appropriateness of introducing Haemophilus infl uenzae type b (Hib) and pneumococcal vaccines, the study describes a cross- sectional, hamlet-level mortality survey in 40 of 305 villages in Lombok Is land, Indonesia. Causes of death were assessed with a standardized verbal-a utopsy questionnaire. One thousand four hundred ninety-nine births and 141 deaths occurring among children aged less than 2 years were identified, wit h 43% of deaths occurring during the first 2 months of life. The infant mor tality rate was 89 (95% CT: 75, 104) per 1,000 live-births. All mortality r ates are reported per 1,000 live-births. To examine children whose deaths c ould potentially have been prevented through vaccination with Hib or pneumo coccal vaccine, deaths due to acute respiratory infection (ARI) and central nervous system (CNS) infections among children, aged 2-23 months, were ana lyzed. ARI and CNS infections caused 58% (mortality rate: 31 per 1,000 live -births; 95% CI: 23, 41) and 17% (mortality rate: 9 per 1,000 live-births; 95% CI: 5, 16), respectively, of all deaths within this age group. Between the ages of 2 and 23 months, 5% of all babies born alive died of ARI, and a nother 1% died of CNS infections. Our results indicate that current efforts to reduce childhood mortality should focus on reducing ARI and meningitis. These efforts should include evaluating the impact of Hib and pneumococcal vaccines within the routine Expanded Programme on Immunization system.