Quantifying risks and interventions that have affected the burden of diarrhea among children younger than 5 years: an analysis of the Global Burden of Disease Study 2017

Abstract

Many countries have shown marked declines in diarrheal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrheal 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. Diarrhea mortality was modeled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modeling tool; and the attribution of risk factors and interventions for diarrhea were modeled in a counterfactual framework that combines modeled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhea given exposure to that factor. We assessed the relative and absolute change in diarrhea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhea mortality among children younger than 5 years.

Findings

Diarrhea 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 diarrhea mortality rate ranged between countries by over 685 deaths per 100,000 children. Diarrhea 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 diarrhea 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

Diarrhea 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 diarrhea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhea that have already reduced diarrhea mortality could further avert many thousands of deaths due to this illness.