The burden and etiology of lower respiratory tract infections in children under five years of age in Indonesia

Introduction: Lower respiratory tract infections (LRTI) are a substantial threat for children worldwide. Currently, there is a lack of knowledge about the burden and etiology of LRTI in children under five years of age in Indonesia. Methodology: We have systematically searched the available English and Indonesian scientific literature to review and summarize data on LRTI and LRTI-associated invasive disease, and bacterial carriage in the upper respiratory tract in children under five years of age in Indonesia. Results: Overall, data on the burden and etiology of LRTI in children under five years of age in Indonesia is very limited. The data are primarily collected in Java. Data from other parts of Indonesia, including Sumatra, Kalimantan, and Sulawesi, are scarce. The case fatality rate (CFR) of LRTI in children under five years of age in Indonesia was 0.11%. Influenza was the most commonly reported viral etiological agent of LRTI in children under five years of age in Indonesia. Klebsiella pneumoniae was the most frequently reported bacterial agent of LRTI. Streptococcus pneumoniae showed the highest carriage rates. Conclusions: Surveillance and diagnostic studies are urgently needed and should be conducted in different parts of Indonesia to improve insight in the burden and etiology of LRTI in Indonesia. These data are pivotal to increase the effectiveness of public health strategies, including vaccination and prevention of antimicrobial resistance.