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Variation in Childhood Diarrheal Morbidity and Mortality in Africa, 2000-2015
Robert C Reiner1, Nicholas Graetz1, Daniel C Casey1
1From the Institute for Health Metrics and Evaluation (R.C.R., N.G., D.C.C., C.T., G.M.G., J.F.M., A.D., S.J.S., S.E.R., B.F.B., P.C.R., A.O.-Z., R.B., D.M.P., I.M.D., I.D.L., L.E., J.M.R., I.A.K., T.H.F., D.L.S., N.J.K., A.H.M., C.J.L.M., S.I.H.) and the Division of Allergy and Infectious Diseases, Department of Medicine (J.M.R.), University of Washington, and the Divisions of Pediatric Infectious Diseases (J.F.M.) and Pediatric Anesthesiology and Pain Medicine (N.J.K.), Seattle Children's Hospital - all in Seattle; the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (O.J.B.), and the Department of Infectious Disease Epidemiology, Imperial College London (S.B.), London, and the Department of Zoology (M.U.G.K.) and the Big Data Institute, Li Ka Shing Centre for Health Information and Discovery (S.B., D.J.W., P.W.G.), University of Oxford, Oxford - all in the United Kingdom; and the Computational Epidemiology Lab, Boston Children's Hospital, and Harvard Medical School - both in Boston (M.U.G.K.).
Insights
Diarrheal diseases cause significant child mortality in Africa, with over half of deaths concentrated in specific regions. This study maps these high-risk areas to guide targeted interventions for child survival.
Area of Science:
- Global Health
- Epidemiology
- Pediatric Infectious Diseases
Background:
- Diarrheal diseases are a leading cause of mortality in African children under five.
- An estimated 330,000 deaths and 30 million severe cases occurred in 2015.
- Lack of detailed data hinders targeted interventions for diarrheal disease burden.
Purpose of the Study:
- To produce high-resolution, fine-scale estimates of diarrhea prevalence, incidence, and mortality across Africa.
- To identify geographic inequalities and high-risk areas for diarrheal diseases in children.
- To inform targeted public health strategies and resource allocation.
Main Methods:
- Utilized Bayesian geostatistical techniques for annual estimates from 2000-2015.
- Achieved high geographic detail (5 km²).
- Calibrated estimates with the Global Burden of Diseases, Injuries, and Risk Factors Study 2016.
Main Results:
- Revealed significant geographic disparities in diarrhea risk across Africa.
- Over 50% of 330,000 childhood diarrhea deaths in 2015 occurred in just 55 administrative subdivisions.
- Mortality rates varied up to sixfold within Nigeria; high case fatality rates noted in Benin, Lesotho, Mali, Nigeria, and Sierra Leone.
Conclusions:
- Identified concentrated areas of high diarrheal disease burden and mortality.
- Findings highlight persistent high-burden areas and regions with significant reductions.
- Data supports targeted approaches to mitigate child mortality from diarrheal diseases.
Background:
Diarrheal diseases are the third leading cause of disease and death in children younger than 5 years of age in Africa and were responsible for an estimated 30 million cases of severe diarrhea (95% credible interval, 27 million to 33 million) and 330,000 deaths (95% credible interval, 270,000 to 380,000) in 2015. The development of targeted approaches to address this burden has been hampered by a paucity of comprehensive, fine-scale estimates of diarrhea-related disease and death among and within countries.
Methods:
We produced annual estimates of the prevalence and incidence of diarrhea and diarrhea-related mortality with high geographic detail (5 km2) across Africa from 2000 through 2015. Estimates were created with the use of Bayesian geostatistical techniques and were calibrated to the results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016.
Results:
The results revealed geographic inequality with regard to diarrhea risk in Africa. Of the estimated 330,000 childhood deaths that were attributable to diarrhea in 2015, more than 50% occurred in 55 of the 782 first-level administrative subdivisions (e.g., states). In 2015, mortality rates among first-level administrative subdivisions in Nigeria differed by up to a factor of 6. The case fatality rates were highly varied at the national level across Africa, with the highest values observed in Benin, Lesotho, Mali, Nigeria, and Sierra Leone.
Conclusions:
Our findings showed concentrated areas of diarrheal disease and diarrhea-related death in countries that had a consistently high burden as well as in countries that had considerable national-level reductions in diarrhea burden. (Funded by the Bill and Melinda Gates Foundation.).
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