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Background: Pneumonia remains the leading cause of mortality in children in India despite the fact that the absolute number of pneumonia deaths in the country has declined substantially since 2000. As deaths due to pneumonia continue to decline, it will be imperative to also consider interventions that target pneumonia morbidity. We used an improved risk factor-based method to calculate pneumonia and severe pneumonia morbidity in Indian states for 2000 and 2015.

Methods: We estimated the burden of pneumonia and severe pneumonia in children less than five years using a risk factor-based model. A systematic literature review was conducted to identify published data on the incidence of pneumonia from community-based longitudinal studies and a summary estimate was calculated. We estimated state-specific incidence rates for WHO-defined clinical pneumonia for 2000 and 2015 using Poisson regression and the prevalence of risk factors in each state obtained from National Family Health Surveys (NFHS). From clinical pneumonia studies, we identified studies reporting the proportion of clinical pneumonia cases with lower chest wall indrawing to estimate WHO-defined severe pneumonia cases. We used the estimate of the proportion of cases with lower chest wall indrawing to estimate WHO-defined severe pneumonia cases for each state.

Findings: We estimated there were 49.8 (95% uncertainty interval [UI]: 9.1-174.2) million pneumonia cases in HIV-uninfected children less than five years in India in 2015—a 41% reduction since 2000 when there were an estimated 83.8 (95% UI: 14.0-300.8) million pneumonia cases in this age group …