Variation in Childhood Diarrheal Morbidity and Mortality in Africa, 2000–2015

Abstract

BackgroundDiarrheal diseases are the third leading cause of morbidity and mortality in children under 5 in Africa, responsible for an estimated 30,000,000 (95% Uncertainty Interval [UI], 27,000,000 - 33,000,000) severe cases and 330,000 (95% UI, 270,000 - 380,000) deaths in 2015. Developing targeted approaches to combat this burden is hampered by the lack of comprehensive, fine-scale diarrhea estimates between and within countries. MethodsAnnual estimates of diarrheal prevalence, incidence, and mortality were produced with high geographic detail (5-km2) across Africa from 2000 to 2015. Estimates were created using Bayesian geostatistical techniques, and were calibrated to the results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016. ResultsThe results revealed geographic inequality in diarrhea risk in Africa. Of the estimated 330,000 childhood deaths attributable to diarrhea in 2015, over 50% occurred in only 55 (of the 782) first administrative subdivisions. In 2015, mortality rates between first administrative subdivisions in Nigeria exhibited six-fold differences. The case fatality ratio is highly variable at the national level across Africa, with the highest values observed in Lesotho, Mali, Benin, and Nigeria. ConclusionsOur findings show concentrated areas of morbidity and mortality associated with diarrhea across countries with consistently high burden as well as countries that experienced considerable national-level improvements. In the era of precision public health, the distribution of limited resources can be optimized with proven interventions, targeted at locations most likely to have a high impact, reducing the avertable burden of diarrheal diseases.

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

“…In cases in which GPS data were unavailable, we matched data points to the smallest possible areal unit (also referred to as 'polygons'). All polygon data were spatially resampled into multiple GPS coordinates and weighted based on the population distribution following a previously described procedure 5,22,23,58 and described in Supplementary Information section 3.4. Our combined global dataset contained approximately 15.9 million births and 1.1 million child deaths.…”

“…Understanding public health risks at more granular subpopulation levels is central to the emerging concept of precision public health 18 , which uses "the best available data to target more effectively and efficiently interventions…to those most in need" 18 . Efforts to produce high-resolution estimates of mortality of children under 5, determinants at scales that cover the multiple countries are emerging, including for vaccine coverage 19,20 , malaria 21 , diarrhoea 22 and child growth failure 23,24 . In a previous study, we produced comprehensive estimates of African child mortality rates at a 5 × 5-km scale for 5-year intervals 5 .…”

“…Over the 2000-2017 period, this number is 71.8 (68.5-74.9) million deaths, or 58% (55-61) of the total number of deaths of children under 5. Total deaths attributable to inequality in this scenario ranged from 13 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)…”

Global, Regional, National, and Subnational Big Data to Inform Health Equity Research: Perspectives from the Global Burden of Disease Study 2017

“…[30][31][32][33] Another IHME project is the Local Burden of Disease, designed to produce estimates of health outcomes and related measures at a very fine resolution, at 5 by 5 kilometers. [34][35][36][37][38][39] Such estimates allow decision-makers to target resources and health interventions precisely and tailor health policy for local areas rather than entire countries. Several publications from the local burden of disease showed huge variation in Africa in educational levels, anemia, diarrhea, and child growth.…”

“…Several publications from the local burden of disease showed huge variation in Africa in educational levels, anemia, diarrhea, and child growth. [34][35][36] This project provides valuable information to governments, donors, and health agencies. IHME's Future Health Scenarios project examines future potential health outcomes such as life expectancy and causes of death.…”