Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years: an analysis of the Global Burden of Disease Study 2017

Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017...

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Veröffentlicht in:	The Lancet infectious diseases Jg. 20; H. 1; S. 37 - 59
Hauptverfasser:	Troeger, Christopher E, Khalil, Ibrahim A., Albertson, Samuel B., Rao, Puja C, Abate, Degu, Akal, Chalachew Genet, Alam, Noore, Amini, Saeed, Anjomshoa, Mina, Antonio, Carl Abelardo T., Aremu, Olatunde, Atique, Suleman, Awad, Samah, Badawi, Alaa, Bhattacharyya, Krittika, Bhutta, Zulfiqar A, Car, Josip, Christopher, Devasahayam J, Dandona, Lalit, Demeke, Feleke Mekonnen, Deshpande, Aniruddha, Djalalinia, Shirin, Dubljanin, Eleonora, Duken, Eyasu Ejeta, El Sayed Zaki, Maysaa, Endries, Aman Yesuf, Guo, Yuming, Hailu, Gessessew Bugssa, Hassen, Hamid Yimam, Hoang, Chi Linh, Hostiuc, Mihaela, Hussain, Zakir, James, Spencer L., Jonas, Jost B., Karch, André, Kassa, Tesfaye Dessale, Kassebaum, Nicholas J, Khader, Yousef Saleh, Khan, Md Nuruzzaman, Khang, Young-Ho, Kimokoti, Ruth W, Kisa, Adnan, Kisa, Sezer, Kissoon, Niranjan, Kochhar, Sonali, Koyanagi, Ai, Leshargie, Cheru Tesema, Lodha, Rakesh, Macarayan, Erlyn Rachelle King, Majdan, Marek, Mamun, Abdullah A., Manguerra, Helena, Memish, Ziad A, Mestrovic, Tomislav, Miazgowski, Bartosz, Moazen, Babak, Monasta, Lorenzo, Moore, Catrin E, Mosser, Jonathan F., Mousavi, Seyyed Meysam, Murthy, Srinivas, Mustafa, Ghulam, Nazari, Javad, Nguyen, Cuong Tat, Nisar, Muhammad Imran, Nixon, Molly R, Olagunju, Andrew T, P A, Mahesh, Postma, Maarten J, Qorbani, Mostafa, Quansah, Reginald, Rahim, Fakher, Rahimi-Movaghar, Vafa, Rai, Rajesh Kumar, Ronfani, Luca, Rosettie, Katherine, Sambala, Evanson Zondani, Samy, Abdallah M., Seyedmousavi, Seyedmojtaba, Shigematsu, Mika, Smith, David L, Sufiyan, Mu'awiyyah Babale, Teklu, Teklay G E, Temsah, Mohamad-Hani, Tessema, Belay, Tran, Bach Xuan, Ullah, Irfan, Updike, Rachel L, Veisani, Yousef, Wada, Fiseha Wadilo, Waheed, Yasir, Weaver, Marcia, Yimer, Ebrahim M, Zar, Heather J, Zarghi, Afshin, Lim, Stephen S, Mokdad, Ali H, Murray, Christopher J L, Kyu, Hmwe Hmwe, Reiner, Robert C
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Elsevier Ltd 01.01.2020 Elsevier B.V Elsevier Limited Elsevier Science ;, The Lancet Pub. Group
Schlagworte:	Autopsies Autopsy Bayesian analysis Breastfeeding & lactation Charities Child Child Mortality - trends Child, Preschool Children Demographics Developing Countries Diarrhea Diarrhea - epidemiology Diseases Estimates Exposure Fatalities Female Global Burden of Disease - trends Global Health Humans Infant Infectious diseases Life Expectancy - trends Male Medical research Medicine, Experimental Models, Statistical Morbidity Mortality Nutrition Population Prevalence Rehydration Risk analysis Risk Assessment Risk factors Sanitation Sanitation - standards Sociodemographics Socioeconomic Factors Studies Trends Vaccines Viruses Vitamin deficiency
ISSN:	1473-3099, 1474-4457, 1474-4457
Online-Zugang:	Volltext
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Abstract	Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162–593 145) among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1–87·1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69·6% (63·1–74·6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13·3% decrease, 11·2–15·5), childhood wasting (9·9% decrease, 9·6–10·2), and low use of oral rehydration solution (6·9% decrease, 4·8–8·4). Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors—particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution—appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. Bill & Melinda Gates Foundation.
AbstractList	Summary Background Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. Methods This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. Findings Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162–593 145) among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1–87·1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69·6% (63·1–74·6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13·3% decrease, 11·2–15·5), childhood wasting (9·9% decrease, 9·6–10·2), and low use of oral rehydration solution (6·9% decrease, 4·8–8·4). Interpretation Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors—particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution—appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. Funding Bill & Melinda Gates Foundation. Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162–593 145) among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1–87·1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69·6% (63·1–74·6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13·3% decrease, 11·2–15·5), childhood wasting (9·9% decrease, 9·6–10·2), and low use of oral rehydration solution (6·9% decrease, 4·8–8·4). Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors—particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution—appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. Bill & Melinda Gates Foundation. Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017.BACKGROUNDMany countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017.This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years.METHODSThis analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years.Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1-87·1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69·6% (63·1-74·6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13·3% decrease, 11·2-15·5), childhood wasting (9·9% decrease, 9·6-10·2), and low use of oral rehydration solution (6·9% decrease, 4·8-8·4).FINDINGSDiarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1-87·1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69·6% (63·1-74·6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13·3% decrease, 11·2-15·5), childhood wasting (9·9% decrease, 9·6-10·2), and low use of oral rehydration solution (6·9% decrease, 4·8-8·4).Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness.INTERPRETATIONDiarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness.Bill & Melinda Gates Foundation.FUNDINGBill & Melinda Gates Foundation.
Audience	Academic
Author	Khang, Young-Ho Rai, Rajesh Kumar Wiysonge, Charles Shey Kassa, Tesfaye Dessale Haj-Mirzaian, Arya Carvalho, Félix Mohammed, Shafiu Nisar, Muhammad Imran Alvis-Guzman, Nelson Rafiei, Alireza Antonio, Carl Abelardo T. Sawhney, Monika Dandona, Rakhi Wiens, Kirsten E Hamidi, Samer Nazari, Javad Biehl, Molly H. Lal, Dharmesh Kumar Irvani, Seyed Sina Naghibi Majdan, Marek Tran, Bach Xuan Ogbo, Felix Akpojene Endries, Aman Yesuf Awad, Samah Sheikh, Aziz Temsah, Mohamad-Hani Rezai, Mohammad Sadegh Pakhale, Smita Aremu, Olatunde Kisa, Adnan Alahdab, Fares Mustafa, Ghulam Shaikh, Masood Ali Mosser, Jonathan F. Rios-Blancas, Maria Jesus Rothenbacher, Dietrich Kisa, Sezer Banoub, Joseph Adel Mattar Manguerra, Helena Olagunju, Tinuke O Miazgowski, Bartosz Akal, Chalachew Genet Karch, André Fischer, Florian Kissoon, Niranjan El Sayed Zaki, Maysaa Kefale, Adane Teshome Ahmadi, Alireza Mohammad, Karzan Abdulmuhsin Balakrishnan, Kalpana Bijani, Ali Gardner, William M. Ronfani, Luca Postma, Maarten J Reiner, Robert C Avokpaho, Euripide F G A Smith, David L A
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surname: Reiner fullname: Reiner, Robert C email: bcreiner@uw.edu
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/31678029$$D View this record in MEDLINE/PubMed
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Contributor	Khang, Young-Ho Kassa, Tesfaye Dessale Haj-Mirzaian, Arya Carvalho, Félix Alvis-Guzman, Nelson Dandona, Rakhi Hamidi, Samer Lal, Dharmesh Kumar Irvani, Seyed Sina Naghibi Majdan, Marek Endries, Aman Yesuf Awad, Samah Aremu, Olatunde James, Spencer L Kisa, Adnan Alahdab, Fares Kisa, Sezer Banoub, Joseph Adel Mattar Akal, Chalachew Genet Karch, André Fischer, Florian Kissoon, Niranjan El Sayed Zaki, Maysaa Kefale, Adane Teshome Ahmadi, Alireza Balakrishnan, Kalpana Bijani, Ali Avokpaho, Euripide F G A Abate, Degu Alam, Noore Duken, Eyasu Ejeta Fernandes, Eduarda Hailu, Gessessew Bugssa Macarayan, Erlyn Rachelle King Alene, Kefyalew Addis Atalay, Hagos Tasew Gorini, Giuseppe Albertson, Samuel B Khoja, Abdullah T Deshpande, Aniruddha Kasaeian, Amir Bassat, Quique Bhattacharyya, Krittika Anjomshoa, Mina Khan, Ejaz Ahmad Goulart, Alessandra C Li, Shanshan Hussain, Zakir Kassebaum, Nicholas J Guo, Yuming Blacker, Brigette F Bedi, Neeraj Kosen, Soewarta Zimsen, Stephanie R M Barac, Aleksandra Fullman, Nancy Khader, Yousef Saleh Kochhar, Sonali Antoni
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Copyright	2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved. 2020. The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license 2020
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Snippet	Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results... Summary Background Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we...
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SubjectTerms	Autopsies Autopsy Bayesian analysis Breastfeeding & lactation Charities Child Child Mortality - trends Child, Preschool Children Demographics Developing Countries Diarrhea Diarrhea - epidemiology Diseases Estimates Exposure Fatalities Female Global Burden of Disease - trends Global Health Humans Infant Infectious diseases Life Expectancy - trends Male Medical research Medicine, Experimental Models, Statistical Morbidity Mortality Nutrition Population Prevalence Rehydration Risk analysis Risk Assessment Risk factors Sanitation Sanitation - standards Sociodemographics Socioeconomic Factors Studies Trends Vaccines Viruses Vitamin deficiency
Title	Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years: an analysis of the Global Burden of Disease Study 2017
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