Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17: analysis for the Global Burden of Disease Study 2017. Issue 10239 (6th June 2020)

• Record Type: Journal Article
• Authors: Reiner, Robert C; Wiens, Kirsten E; Deshpande, Aniruddha; Baumann, Mathew M; Lindstedt, Paulina A; Blacker, Brigette F; Troeger, Christopher E; Earl, Lucas; Munro, Sandra B; Abate, Degu; Abbastabar, Hedayat; Abd-Allah, Foad; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abebe, Getaneh; Abegaz, Kedir Hussein; Abreu, Lucas Guimarães; Abrigo, Michael R M; Accrombessi, Manfred Mario Kokou; Acharya, Dilaram; Adabi, Maryam; Adebayo, Oladimeji M; Adedoyin, Rufus Adesoji; Adekanmbi, Victor; Adetokunboh, Olatunji O; Adhena, Beyene Meressa; Afarideh, Mohsen; Ahmadi, Keivan; Ahmadi, Mehdi; Ahmed, Anwar E; Ahmed, Muktar Beshir; Ahmed, Rushdia; Ajumobi, Olufemi; Akal, Chalachew Genet; Akalu, Temesgen Yihunie; Akanda, Ali S; Alamene, Genet Melak; Alanzi, Turki M; Albright, James R; Alcalde Rabanal, Jacqueline Elizabeth; Alemnew, Birhan Tamene; Alemu, Zewdie Aderaw; Ali, Beriwan Abdulqadir; Ali, Muhammad; Alijanzadeh, Mehran; Alipour, Vahid; Aljunid, Syed Mohamed; Almasi, Ali; Almasi-Hashiani, Amir; Al-Mekhlafi, Hesham M; Altirkawi, Khalid; Alvis-Guzman, Nelson; Alvis-Zakzuk, Nelson J; Amare, Azmeraw T; Amini, Saeed; Amit, Arianna Maever Loreche; Andrei, Catalina Liliana; Anegago, Masresha Tessema; Anjomshoa, Mina; Ansari, Fereshteh; Antonio, Carl Abelardo T; Antriyandarti, Ernoiz; Appiah, Seth Christopher Yaw; Arabloo, Jalal; Aremu, Olatunde; Armoon, Bahram; Aryal, Krishna K; Arzani, Afsaneh; Asadi-Lari, Mohsen; Ashagre, Alebachew Fasil; Atalay, Hagos Tasew; Atique, Suleman; Atre, Sachin R; Ausloos, Marcel; Avila-Burgos, Leticia; Awasthi, Ashish; Awoke, Nefsu; Ayala Quintanilla, Beatriz Paulina; Ayano, Getinet; Ayanore, Martin Amogre; Ayele, Asnakew Achaw; Aynalem, Yared A Asmare; Azari, Samad; Babaee, Ebrahim; Badawi, Alaa; Bakkannavar, Shankar M; Balakrishnan, Senthilkumar; Bali, Ayele Geleto; Banach, Maciej; Barac, Aleksandra; Bärnighausen, Till Winfried; Basaleem, Huda; Bassat, Quique; Bayati, Mohsen; Bedi, Neeraj; Behzadifar, Masoud; Behzadifar, Meysam; Bekele, Yibeltal Alemu; Bell, Michelle L; Bennett, Derrick A; Berbada, Dessalegn Ajema; Beyranvand, Tina; Bhat, Anusha Ganapati; Bhattacharyya, Krittika; Bhattarai, Suraj; Bhaumik, Soumyadeep; Bijani, Ali; Bikbov, Boris; Biswas, Raaj Kishore; Bogale, Kassawmar Angaw; Bohlouli, Somayeh; Brady, Oliver J; Bragazzi, Nicola Luigi; Briko, Nikolay Ivanovich; Briko, Andrey Nikolaevich; Burugina Nagaraja, Sharath; Butt, Zahid A; Campos-Nonato, Ismael R; Campuzano Rincon, Julio Cesar; Cárdenas, Rosario; Carvalho, Félix; Castro, Franz; Chansa, Collins; Chatterjee, Pranab; Chattu, Vijay Kumar; Chauhan, Bal Govind; Chin, Ken Lee; Christopher, Devasahayam J; Chu, Dinh-Toi; Claro, Rafael M; Cormier, Natalie M; Costa, Vera M; Damiani, Giovanni; Daoud, Farah; Dandona, Lalit; Dandona, Rakhi; Darwish, Amira Hamed; Daryani, Ahmad; Das, Jai K; Das Gupta, Rajat; Dasa, Tamirat Tesfaye; Davila, Claudio Alberto; Davis Weaver, Nicole; Davitoiu, Dragos Virgil; De Neve, Jan-Walter; Demeke, Feleke Mekonnen; Demis, Asmamaw Bizuneh; Demoz, Gebre Teklemariam; Denova-Gutiérrez, Edgar; Deribe, Kebede; Desalew, Assefa; Dessie, Getenet Ayalew; Dharmaratne, Samath Dhamminda; Dhillon, Preeti; Dhimal, Meghnath; Dhungana, Govinda Prasad; Diaz, Daniel; Ding, Eric L; Diro, Helen Derara; Djalalinia, Shirin; Do, Huyen Phuc; Doku, David Teye; Dolecek, Christiane; Dubey, Manisha; Dubljanin, Eleonora; Duko Adema, Bereket; Dunachie, Susanna J; Durães, Andre R; Duraisamy, Senbagam; Effiong, Andem; Eftekhari, Aziz; El Sayed, Iman; El Sayed Zaki, Maysaa; El Tantawi, Maha; Elemineh, Demelash Abewa; El-Jaafary, Shaimaa I; Elkout, Hajer; Elsharkawy, Aisha; Enany, Shymaa; Endalamfaw, Aklilu; Endalew, Daniel Adane; Eskandarieh, Sharareh; Esteghamati, Alireza; Etemadi, Arash; Farag, Tamer H; Faraon, Emerito Jose A; Fareed, Mohammad; Faridnia, Roghiyeh; Farioli, Andrea; Faro, Andre; Farzam, Hossein; Fazaeli, Ali Akbar; Fazlzadeh, Mehdi; Fentahun, Netsanet; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Foroutan, Masoud; Francis, Joel Msafiri; Franklin, Richard Charles; Frostad, Joseph Jon; Fukumoto, Takeshi; Gayesa, Reta Tsegaye; Gebremariam, Kidane Tadesse; Gebremedhin, Ketema Bizuwork Bizuwork; Gebremeskel, Gebreamlak Gebremedhn; Gedefaw, Getnet Azeze; Geramo, Yilma Chisha Dea; Geta, Birhanu; Gezae, Kebede Embaye; Ghashghaee, Ahmad; Ghassemi, Fariba; Gill, Paramjit Singh; Ginawi, Ibrahim Abdelmageed; Goli, Srinivas; Gomes, Nelson G M; Gopalani, Sameer Vali; Goulart, Bárbara Niegia Garcia; Grada, Ayman; Gugnani, Harish Chander; Guido, Davide; Guimares, Rafael Alves; Guo, Yuming; Gupta, Rajeev; Gupta, Rahul; Hafezi-Nejad, Nima; Haile, Michael Tamene; Hailu, Gessessew Bugssa; Haj-Mirzaian, Arvin; Haj-Mirzaian, Arya; Hall, Brian James; Handiso, Demelash Woldeyohannes; Haririan, Hamidreza; Hariyani, Ninuk; Hasaballah, Ahmed I; Hasan, Md. Mehedi; Hasanzadeh, Amir; Hassankhani, Hadi; Hassen, Hamid Yimam; Hayelom, Desta Haftu; Heidari, Behnam; Henry, Nathaniel J; Herteliu, Claudiu; Heydarpour, Fatemeh; Hidru, Hagos D de; Hoang, Chi Linh; Hoogar, Praveen; Hoseini-Ghahfarokhi, Mojtaba; Hossain, Naznin; Hosseini, Mostafa; Hosseinzadeh, Mehdi; Househ, Mowafa; Hu, Guoqing; Humayun, Ayesha; Hussain, Syed Ather; Ibitoye, Segun Emmanuel; Ilesanmi, Olayinka Stephen; Ilic, Milena D; Inbaraj, Leeberk Raja; Irvani, Seyed Sina Naghibi; Islam, Sheikh Mohammed Shariful; Iwu, Chinwe Juliana; Jaca, Anelisa; Jafari Balalami, Nader; Jahanmehr, Nader; Jakovljevic, Mihajlo; Jalali, Amir; Jayatilleke, Achala Upendra; Jenabi, Ensiyeh; Jha, Ravi Prakash; Jha, Vivekanand; Ji, John S; Jia, Peng; Johnson, Kimberly B; Jonas, Jost B; Jozwiak, Jacek Jerzy; Kabir, Ali; Kabir, Zubair; Kahsay, Amaha; Kalani, Hamed; Kanchan, Tanuj; Karami Matin, Behzad; Karch, André; Karki, Surendra; Kasaeian, Amir; Kasahun, Gebremicheal Gebreslassie; Kayode, Gbenga A; Kazemi Karyani, Ali; Keiyoro, Peter Njenga; Ketema, Daniel Bekele; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khalid, Nauman; Khalil, Ali Talha; Khalil, Ibrahim; Khalilov, Rovshan; Khan, Md Nuruzzaman; Khan, Ejaz Ahmad; Khan, Gulfaraz; Khan, Junaid; Khatab, Khaled; Khater, Amir; Khater, Mona M; Khatony, Alireza; Khayamzadeh, Maryam; Khazaei, Mohammad; Khazaei, Salman; Khodamoradi, Ehsan; Khosravi, Mohammad Hossein; Khubchandani, Jagdish; Kiadaliri, Aliasghar A; Kim, Yun Jin; Kimokoti, Ruth W; Kisa, Sezer; Kisa, Adnan; Kissoon, Niranjan; Kondlahalli, Shivakumar KM KM M; Kosek, Margaret N; Koyanagi, Ai; Kraemer, Moritz U G; Krishan, Kewal; Kugbey, Nuworza; Kumar, G Anil; Kumar, Manasi; Kumar, Pushpendra; Kusuma, Dian; La Vecchia, Carlo; Lacey, Ben; Lal, Aparna; Lal, Dharmesh Kumar; Lami, Faris Hasan; Lansingh, Van C; Lasrado, Savita; Lee, Paul H; Leili, Mostafa; Lenjebo, Tsegaye Tsegaye Lolaso Lolaso; Levine, Aubrey J; Lewycka, Sonia; Li, Shanshan; Linn, Shai; Lodha, Rakesh; Longbottom, Joshua; Lopukhov, Platon D; Magdeldin, Sameh; Mahasha, Phetole Walter; Mahotra, Narayan Bahadur; Malta, Deborah Carvalho; Mamun, Abdullah A; Manafi, Navid; Manafi, Farzad; Manda, Ana-Laura; Mansournia, Mohammad Ali; Mapoma, Chabila Christopher; Marami, Dadi; Marczak, Laurie B; Martins-Melo, Francisco Rogerlândio; März, Winfried; Masaka, Anthony; Mathur, Manu Raj; Maulik, Pallab K; Mayala, Benjamin K; McAlinden, Colm; Mehndiratta, Man Mohan; Mehrotra, Ravi; Mehta, Kala M; Meles, Gebrekiros Gebremichael; Melese, Addisu; Memish, Ziad A; Mena, Alemayehu Toma; Menezes, Ritesh G; Mengesha, Melkamu Merid; Mengistu, Desalegn Tadese; Mengistu, Getnet; Meretoja, Tuomo J; Miazgowski, Bartosz; Mihretie, Kebadnew Mulatu M; Miller-Petrie, Molly K; Mills, Edward J; Mir, Seyed Mostafa; Mirabi, Parvaneh; Mirrakhimov, Erkin M; Mohamadi-Bolbanabad, Amjad; Mohammad, Karzan Abdulmuhsin; Mohammad, Yousef; Mohammad, Dara K; Mohammad Darwesh, Aso; Mohammad Gholi Mezerji, Naser; Mohammadifard, Noushin; Mohammed, Ammas Siraj; Mohammed, Shafiu; Mohammed, Jemal Abdu; Mohebi, Farnam; Mokdad, Ali H; Moodley, Yoshan; Moradi, Masoud; Moradi, Ghobad; Moradi-Joo, Mohammad; Moradi-Lakeh, Maziar; Moraga, Paula; Mosapour, Abbas; Mouodi, Simin; Mousavi, Seyyed Meysam; Mozaffor, Miliva Mozaffor Mozaffor; Muluneh, Atalay Goshu; Muriithi, Moses K; Murray, Christopher J L; Murthy, GVS; Musa, Kamarul Imran; Mustafa, Ghulam; Muthupandian, Saravanan; Naderi, Mehdi; Nagarajan, Ahamarshan Jayaraman; Naghavi, Mohsen; Najafi, Farid; Nangia, Vinay; Nazari, Javad; Ndwandwe, Duduzile Edith; Negoi, Ionut; Ngunjiri, Josephine W; Nguyen, QuynhAnh P; Nguyen, Trang Huyen; Nguyen, Cuong Tat; Nigatu, Dabere; Ningrum, Dina Nur Anggraini; Nnaji, Chukwudi A; Nojomi, Marzieh; Noubiap, Jean Jacques; Oh, In-Hwan; Okpala, Oluchi; Olagunju, Andrew T; Omar Bali, Ahmed; Onwujekwe, Obinna E; Ortega-Altamirano, Doris D V; Osarenotor, Osayomwanbo; Osei, Frank B; Owolabi, Mayowa Ojo; P A, Mahesh; Padubidri, Jagadish Rao; Pana, Adrian; Pashaei, Tahereh; Pati, Sanghamitra; Patle, Ajay; Patton, George C; Paulos, Kebreab; Pepito, Veincent Christian Filipino; Pereira, Alexandre; Perico, Norberto; Pesudovs, Konrad; Pigott, David M; Piroozi, Bakhtiar; Platts-Mills, James A; Poljak, Mario; Postma, Maarten J; Pourjafar, Hadi; Pourmalek, Farshad; Pourshams, Akram; Poustchi, Hossein; Prada, Sergio I; Preotescu, Liliana; Quintana, Hedley; Rabiee, Navid; Rabiee, Mohammad; Radfar, Amir; Rafiei, Alireza; Rahim, Fakher; Rahimi-Movaghar, Vafa; Rahman, Muhammad Aziz; Rajati, Fatemeh; Ramezanzadeh, Kiana; Rana, Saleem M; Ranabhat, Chhabi Lal; Rasella, Davide; Rawaf, Salman; Rawaf, David Laith; Rawal, Lal; Remuzzi, Giuseppe; Renjith, Vishnu; Renzaho, Andre M N; Reta, Melese Abate; Rezaei, Satar; Ribeiro, Ana Isabel; Rickard, Jennifer; Rios González, Carlos Miguel; Rios-Blancas, Maria Jesus; Roever, Leonardo; Ronfani, Luca; Roro, Elias Merdassa; Rostami, Ali; Rothenbacher, Dietrich; Rubagotti, Enrico; Rubino, Salvatore; Saad, Anas M; Sabour, Siamak; Sadeghi, Ehsan; Safari, Saeed; Safdarian, Mahdi; Sagar, Rajesh; Sahraian, Mohammad Ali; Sajadi, S. Mohammad; Salahshoor, Mohammad Reza; Salam, Nasir; Salehi, Farkhonde; Salehi Zahabi, Saleh; Salem, Marwa R Rashad; Salem, Hosni; Salimi, Yahya; Salimzadeh, Hamideh; Sambala, Evanson Zondani; Samy, Abdallah M; Sanabria, Juan; Santos, Itamar S; Saraswathy, Sivan Yegnanarayana Iyer; Sarker, Abdur Razzaque; Sartorius, Benn; Sathian, Brijesh; Satpathy, Maheswar; Sbarra, Alyssa N; Schaeffer, Lauren E; Schwebel, David C; Senbeta, Anbissa Muleta; Senthilkumaran, Subramanian; Shabaninejad, Hosein; Shaheen, Amira A; Shaikh, Masood Ali; Shalash, Ali S; Shallo, Seifadin Ahmed; Shams-Beyranvand, Mehran; Shamsi, MohammadBagher; Shamsizadeh, Morteza; Sharif, Mehdi; Shey, Muki Shehu; Shibuya, Kenji; Shiferaw, Wondimeneh Shibabaw Shibabaw; Shigematsu, Mika; Shil, Apurba; Shin, Jae Il; Shiri, Rahman; Shirkoohi, Reza; Si, Si; Siabani, Soraya; Singh, Jasvinder A; Singh, Narinder Pal; Sinha, Dhirendra Narain; Sisay, Malede Mequanent; Skiadaresi, Eirini; Smith, David L; Sobhiyeh, Mohammad Reza; Sokhan, Anton; Soofi, Moslem; Soriano, Joan B; Sorrie, Muluken Bekele; Soyiri, Ireneous N; Sreeramareddy, Chandrashekhar T; Sudaryanto, Agus; Sufiyan, Mu'awiyyah Babale; Suleria, Hafiz Ansar Rasul; Sykes, Bryan L; Tamirat, Koku Sisay; Tassew, Aberash Abay; Taveira, Nuno; Taye, Bineyam; Tehrani-Banihashemi, Arash; Temsah, Mohamad-Hani; Tesfay, Berhe etsay; Tesfay, Fisaha Haile; Tessema, Zemenu Tadesse; Thankappan, Kavumpurathu Raman; Thirunavukkarasu, Sathish; Thomas, Nihal; Tlaye, Kenean Getaneh; Tlou, Boikhutso; Tovani-Palone, Marcos Roberto; Traini, Eugenio; Tran, Khanh Bao; Trihandini, Indang; Ullah, Irfan; Unnikrishnan, Bhaskaran; Valadan Tahbaz, Sahel; Valdez, Pascual R; Varughese, Santosh; Veisani, Yousef; Violante, Francesco S; Vollmer, Sebastian; Vos, Theo; Wada, Fiseha Wadilo; Waheed, Yasir; Wang, Yafeng; Wang, Yuan-Pang; Weldesamuel, Girmay Teklay; Welgan, Catherine A; Westerman, Ronny; Wiangkham, Taweewat; Wijeratne, Tissa; Wiysonge, Charles Shey Shey; Wolde, Haileab Fekadu; Wondafrash, Dawit Zewdu; Wonde, Tewodros Eshete; Wu, Ai-Min; Xu, Gelin; Yadollahpour, Ali; Yahyazadeh Jabbari, Seyed Hossein; Yamada, Tomohide; Yaseri, Mehdi; Yenesew, Muluken Azage; Yeshaneh, Alex; Yilma, Mekdes Tigistu; Yimer, Ebrahim M; Yip, Paul; Yirsaw, Biruck Desalegn; Yisma, Engida; Yonemoto, Naohiro; Younis, Mustafa Z; Yousof, Hebat-Allah Salah A; Yu, Chuanhua; Yusefzadeh, Hasan; Zamani, Mohammad; Zambrana-Torrelio, Carlos; Zandian, Hamed; Zeleke, Ayalew Jejaw; Zepro, Nejimu Biza; Zewale, Taye Abuhay; Zhang, Dongyu; Zhang, Yunquan; Zhao, Xiu-Ju; Ziapour, Arash; Zodpey, Sanjay; Hay, Simon I;
• Is Part Of: Lancet. Volume 395:Issue 10239(2020)
• Page Start: 1779
• Page End: 1801
• Publication Date: 2020-06-06
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(20)30114-8
• Languages: English
• ISSNs: 0140-6736

Abstract

Summary: Background: Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods: We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings: The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation: By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. Funding: Bill & Melinda Gates Foundation.