Quantifying risks and interventions that have reduced mortality due to diarrhea among children younger than 5 years old: An analysis of the Global Burden of Disease study 2017

Aremu, Olatunde (2019) Quantifying risks and interventions that have reduced mortality due to diarrhea among children younger than 5 years old: An analysis of the Global Burden of Disease study 2017. Lancet (London, England), 19. pp. 30401-30403. ISSN 1474-547X

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Abstract

Abstract
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.

Item Type:	Article
Identification Number:	10.1016/S1473-3099(19)30401-3
Dates:	Date Event 13 May 2019 Submitted 30 October 2019 Published
Subjects:	CAH01 - medicine and dentistry > CAH01-01 - medicine and dentistry > CAH01-01-01 - medical sciences (non-specific) CAH02 - subjects allied to medicine > CAH02-06 - allied health > CAH02-06-02 - nutrition and dietetics CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-01 - nursing (non-specific) CAH09 - mathematical sciences > CAH09-01 - mathematical sciences > CAH09-01-02 - operational research CAH15 - social sciences > CAH15-01 - sociology, social policy and anthropology > CAH15-01-03 - social policy
Divisions:	Faculty of Health, Education and Life Sciences > College of Nursing and Midwifery
Depositing User:	Olatunde Aremu
Date Deposited:	13 Nov 2019 09:00
Last Modified:	03 Mar 2022 15:37
URI:	https://www.open-access.bcu.ac.uk/id/eprint/8324

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