Economic Losses from Premature Under-Five Mortality due to Diarrhoeal Diseases in South Asia: Trends, Aetiologies,...

Diarrhoeal diseases remain a major cause of under-five mortality in South Asia despite global health progress. This study quantifies the economic losses due to premature under-five deaths from diarrhoeal diseases, analyzing trends, aetiologies, and risk factors across five South Asian countries between 2010 and 2023.

Using data from the datasets published by the Institute for Health Metrics and Evaluation (IHME) and World Bank indicators, the study applied the human capital approach to estimate the present value of lost future labour income associated with diarrhoeal deaths among children under five. Losses were estimated in both purchasing power parity (PPP)-adjusted and nominal U.S. dollars to reflect real productivity losses and fiscal implications, respectively.

While age-standardized mortality and DALY rates declined significantly across South Asia (EAPC - 5.2 for both), the economic burden of premature mortality due to childhood diarrhoeal diseases remained substantial. India accounted for the largest absolute loss in future labour income, estimated at USD 5,581 million PPP, followed by Pakistan (USD 1,571 million PPP) and Bangladesh (USD 360 million PPP). When expressed relative to national GDP using nominal estimates, Pakistan experienced the highest proportional economic loss, equivalent to approximately 0.055% of GDP in 2023, followed by India (0.020%), Bangladesh (0.012%), and Nepal (0.005%). Major etiological agents included rotavirus, Shigella, and Escherichia coli, while unsafe water, poor sanitation, and child undernutrition were the leading attributable risk factors.

Despite epidemiological gains, diarrhoeal diseases continue to impose substantial economic and developmental costs in South Asia. Strengthened investments in WASH infrastructure, nutrition, and vaccination programs can yield dual benefits by saving lives and reducing future productivity losses. Integrating child health strategies into national economic planning is imperative for sustainable growth.