Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015

Abstract

SummaryBackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides an up-to-date analysis of the burden of diarrhoeal diseases. This study assesses cases, deaths, and aetiologies spanning the past 25 years and informs the changing picture of diarrhoeal disease worldwide.MethodsWe estimated diarrhoeal mortality by age, sex, geography, and year using the Cause of Death Ensemble Model (CODEm), a modelling platform shared across most causes of death in the GBD 2015 study. We modelled diarrhoeal morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for diarrhoeal diseases using a counterfactual approach that incorporates the aetiology-specific risk of diarrhoeal disease and the prevalence of the aetiology in diarrhoea episodes. We used the Socio-demographic Index, a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in diarrhoeal mortality. The two leading risk factors for diarrhoea—childhood malnutrition and unsafe water, sanitation, and hygiene—were used in a decomposition analysis to establish the relative contribution of changes in diarrhoea disability-adjusted life-years (DALYs).FindingsGlobally, in 2015, we estimate that diarrhoea was a leading cause of death among all ages (1·31 million deaths, 95% uncertainty interval [95% UI] 1·23 million to 1·39 million), as well as a leading cause of DALYs because of its disproportionate impact on young children (71·59 million DALYs, 66·44 million to 77·21 million). Diarrhoea was a common cause of death among children under 5 years old (499 000 deaths, 95% UI 447 000–558 000). The number of deaths due to diarrhoea decreased by an estimated 20·8% (95% UI 15·4–26·1) from 2005 to 2015. Rotavirus was the leading cause of diarrhoea deaths (199 000, 95% UI 165 000–241 000), followed by Shigella spp (164 300, 85 000–278 700) and Salmonella spp (90 300, 95% UI 34 100–183 100). Among children under 5 years old, the three aetiologies responsible for the most deaths were rotavirus, Cryptosporidium spp, and Shigella spp. Improvements in safe water and sanitation have decreased diarrhoeal DALYs by 13·4%, and reductions in childhood undernutrition have decreased diarrhoeal DALYs by 10·0% between 2005 and 2015.InterpretationAt the global level, deaths due to diarrhoeal diseases have decreased substantially in the past 25 years, although progress has been faster in some countries than others. Diarrhoea remains a largely preventable disease and cause of death, and continued efforts to improve access to safe water, sanitation, and childhood nutrition will be important in reducing the global burden of diarrhoea.FundingBill & Melinda Gates Foundation.

Prominent Influence of Socioeconomic and Governance Factors on the Food‐Energy‐Water Nexus in sub‐Saharan Africa

“…Although diarrhea has decreased by 20% over a decade in Nigeria, over a hundred thousand U5 deaths were attributed to diarrhea in Nigeria in 2015, accounting for 20% of the global U5 diarrhea-caused deaths (Troeger et al, 2017). Although diarrhea has decreased by 20% over a decade in Nigeria, over a hundred thousand U5 deaths were attributed to diarrhea in Nigeria in 2015, accounting for 20% of the global U5 diarrhea-caused deaths (Troeger et al, 2017).…”

Analysis of Suspended Particulate Matter and Its Drivers in Sahelian Ponds and Lakes by Remote Sensing (Landsat and MODIS): Gourma Region, Mali

“…Indeed, SPM commonly favors bacteria development and, at the same time, decreases their mortality through ultraviolet protection [11]. Some of these bacteria or microbes cause widespread water diseases like diarrhea, which is one of the major causes of mortality in children under five years in developing countries [12]. In the Gourma, like in most rural areas in the Sahel, surface water, in addition to being a fundamental resource for livestock, is largely employed for domestic activities [13,14].…”

Rotavirus infection

“…Diarrhoeal diseases are one of the leading causes of illness and death in children <5 years of age, particularly those in low-income countries, and cause >500,000 deaths per year globally 1 . Before the 1970s, the aetiologic agent in many cases of infantile gastroenteritis was not identified, but a breakthrough occurred in 1973 with the identification of virus particles in duodenal biopsy samples from children with severe diarrhoea 2 and in faecal samples from children with acute diarrhoea 3 .…”