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

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

    Research output: Contribution to journalArticlepeer-review

    77 Scopus citations

    Abstract

    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.
    Original languageEnglish (US)
    Pages (from-to)1779-1801
    Number of pages23
    JournalThe Lancet
    Volume395
    Issue number10239
    DOIs
    StatePublished - Jun 6 2020

    Bibliographical note

    Generated from Scopus record by KAUST IRTS on 2021-03-16

    ASJC Scopus subject areas

    • General Medicine

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