Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provides an up-to-date analysis of the burden of diarrhoea in 195 countries. This study assesses cases, deaths, and aetiologies in 1990–2016 and assesses how the burden of diarrhoea has changed in people of all ages. Methods: We modelled diarrhoea mortality with a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We modelled diarrhoea incidence with a compartmental meta-regression tool that enforces an association between incidence and prevalence, and relies on scientific literature, population representative surveys, and health-care data. Diarrhoea deaths and episodes were attributed to 13 pathogens by use of a counterfactual population attributable fraction approach. Diarrhoea risk factors are also based on counterfactual estimates of risk exposure and the association between the risk and diarrhoea. Each modelled estimate accounted for uncertainty. Findings: In 2016, diarrhoea was the eighth leading cause of death among all ages (1 655944 deaths, 95% uncertainty interval [UI] 1244 073–2366 552) and the fifth leading cause of death among children younger than 5 years (446 000 deaths, 390 894–504 613). Rotavirus was the leading aetiology for diarrhoea mortality among children younger than 5 years (128 515 deaths, 105138–155 133) and among all ages (228 047 deaths, 183 526–292737). Childhood wasting (low weight-for-height score), unsafe water, and unsafe sanitation were the leading risk factors for diarrhoea, responsible for 80·4% (95% UI 68·2–85·0), 72·1% (34·0–91·4), and 56·4% (49·3–62·7) of diarrhoea deaths in children younger than 5 years, respectively. Prevention of wasting in 1762 children (95% UI 1521–2170) could avert one death from diarrhoea. Interpretation: Substantial progress has been made globally in reducing the burden of diarrhoeal diseases, driven by decreases in several primary risk factors. However, this reduction has not been equal across locations, and burden among adults older than 70 years requires attention

Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016

Barreto, Mauricio Lima. Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil. Christopher Troeger, Brigette F Blacker, Ibrahim A Khalil, Puja C Rao, Shujin Cao, Stephanie R M Zimsen, Sam Albertson, Jeffery D Stanaway, Aniruddha Deshpande, Alexandria Brown, Zegeye Abebe, Nelson Alvis-Guzman, Azmeraw T Amare, Solomon Weldegebreal Asgedom, Zelalem Alamrew Anteneh, Carl Abelardo T Antonio, Olatunde Aremu, Ephrem Tsegay Asfaw, Tesfay Mehari Atey, Suleman Atique, Euripide Frinel G Arthur Avokpaho, Ashish Awasthi, Henok Tadesse Ayele, Aleksandra Barac, Mauricio L Barreto, Quique Bassat, Saba Abraham Belay, Isabela M Bensenor, Zulfiqar A Bhutta, Ali Bijani, Hailemichael Bizuneh, Carlos A Castañeda-Orjuela, Abel Fekadu Dadi, Lalit Dandona, Rakhi Dandona, Huyen Phuc Do, Manisha Dubey, Eleonora Dubljanin, Dumessa Edessa, Aman Yesuf Endries, Babak Eshrati, Tamer Farag, Garumma Tolu Feyissa, Kyle J Foreman, Mohammad H Forouzanfar, Nancy Fullman, Peter W Gething, Melkamu Dedefo Gishu, William W Godwin, Harish Chander Gugnani, Rahul Gupta, Gessessew Bugssa Hailu, Hamid Yimam Hassen, Desalegn Tsegaw Hibstu, Olayinka S Ilesanmi, Jost B Jonas, Amaha Kahsay, Gagandeep Kang, Amir Kasaeian, Yousef Saleh Khader, Ejaz Ahmad Khan, Muhammad Ali Khan, Young-Ho Khang, Niranjan Kissoon, Sonali Kochhar, Karen L Kotloff, Ai Koyanagi, G Anil Kumar, Hassan Magdy Abd El Razek, Reza Malekzadeh, Deborah Carvalho Malta, Suresh Mehata, Walter Mendoza, Desalegn Tadese Mengistu, Bereket Gebremichael Menota, Haftay Berhane Mezgebe, Fitsum Weldegebreal Mlashu, Srinivas Murthy, Gurudatta A Naik, Cuong Tat Nguyen, Trang Huyen Nguyen, Dina Nur Anggraini Ningrum, Felix Akpojene Ogbo, Andrew Toyin Olagunju, Deepak Paudel, James A Platts-Mills, Mostafa Qorbani, Anwar Rafay, Rajesh Kumar Rai, Saleem M Rana, Chhabi Lal Ranabhat, Davide Rasella, Sarah E Ray, Cesar Reis, Andre M N Renzaho, Mohammad Sadegh Rezai, George Mugambage Ruhago, Saeid Safiri, Joshua A Salomon, Juan Ramon Sanabria, Benn Sartorius, Monika Sawhney, Sadaf G Sepanlou, Mika Shigematsu, Mekonnen Sisay, Ranjani Somayaji, Chandrashekhar T Sreeramareddy, Bryan L Sykes, Getachew Redae Taffere, Roman Topor-Madry, Bach Xuan Tran, Kald Beshir Tuem, Kingsley Nnanna Ukwaja, Stein Emil Vollset, Judd L Walson, Marcia R Weaver, Kidu Gidey Weldegwergs, Andrea Werdecker, Abdulhalik Workicho, Muluken Yenesew, Biruck Desalegn Yirsaw, Naohiro Yonemoto, Maysaa El Sayed Zaki, Theo Vos, Stephen S Lim, Mohsen Naghavi, Christopher J L Murray, Ali H Mokdad, Simon I Hay*, and Robert C Reiner Jr*. Affiliations Institute for Health Metrics and Evaluation (C Troeger MPH, B F Blacker MPH, P C Rao MPH, S Cao MSc, S R M Zimsen MA, S B Albertson BSc, J D Stanaway PhD, A Deshpande MPH, A Brown MA, Prof L Dandona MD, Prof R Dandona PhD, T Farag PhD, K J Foreman PhD, M H Forouzanfar MD, N Fullman MPH, W W Godwin BSc, I A Khalil MD, S E Ray BSc, Prof S E Vollset DrPH, M R Weaver PhD, Prof T Vos PhD, Prof S S Lim PhD, Prof M Naghavi PhD, Prof C J L Murray DPhil, Prof A H Mokdad PhD, Prof S I Hay DSc, Prof R C Reiner PhD), Department of Global Health (S Kochhar MD), University of Washington, Seattle, WA, USA (R Somayaji MD, J L Walson MD); University of Gondar, Gondar, Ethiopia (Z Abebe MSc, A F Dadi MPH); Universidad de Cartagena, Cartagena de Indias, Colombia (Prof N Alvis-Guzman PhD); Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia (A T Olagunju MD, A T Amare MPH); College of Medicine and Health Sciences (A T Amare MPH), Bahir Dar University, Bahir Dar, Ethiopia (Z A Anteneh MPH, M Yenesew MPH); Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines (C A T Antonio MD); University Department of Public Health and Therapies, Birmingham, UK (O Aremu PhD); College of Health Sciences (D T Mengistu MSc), Institute of Biomedical Sciences, Medical Microbiology and Immunology Unit (E T Asfaw MSc), School of Public Health (G R Taffere PhD), Mekelle University, Mekelle, Ethiopia (S W Asgedom MSc, T M Atey MSc, G B Hailu MSc, A Kahsay MPH, H B Mezgebe MSc, K B Tuem MSc, K G Weldegwergs MSc); Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan (S Atique MSc, D N A Ningrum MPH); Institut de Recherche Clinique du Bénin (IRCB), Cotonou, Benin (E F G A Avokpaho MPH); Laboratoire d’Etudes et de Recherche-Action en Santé (LERAS Afrique), Parakou, Benin (E F G A Avokpaho MPH); Indian Institute of Public Health, Gandhinagar, India (A Awasthi PhD); Department of Epidemiology, Biostatiststics, and Occupational Health, McGill University, Montreal, QC, Canada (H T Ayele PhD); Dilla University, Dilla, Gedeo, Ethiopia (H T Ayele PhD); Faculty of Medicine (A Barac PhD), Institute of Microbiology and Immunology, Faculty of Medicine (E Dubljanin PhD), University of Belgrade, Belgrade, Serbia; Instituto Gonçalo Muniz (Prof D Rasella PhD), Fundação Oswaldo Cruz, Salvador, Brazil (Prof M L Barreto PhD); Barcelona Institute for Global health (ISGlobal), Universitat de Barcelona, Barcelona, Spain (Prof Q Bassat MD); ICREA, Barcelona, Spain (Prof Q Bassat MD); Dr. Tewelde Legesse Health Sciences College, Mekelle, Ethiopia (S A Belay MPH); University of São Paulo, São Paulo, Brazil (I M Bensenor PhD); Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan (Z A Bhutta PhD); Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada (Z A Bhutta PhD); Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran (A Bijani PhD); St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia (H Bizuneh MPH); Jigjiga University, Jigjiga, Ethiopia (H Bizuneh MPH); Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Colombia (C A Castañeda-Orjuela MSc); Epidemiology and Public Health Evaluation Group, Public Health Department, Universidad Nacional de Colombia, Bogota, Colombia (C A Castañeda-Orjuela MSc); Flinders University, Adelaide, SA, Australia (A F Dadi MPH); Public Health Foundation of India, Gurugram, India (Prof L Dandona MD, Prof R Dandona PhD, G A Kumar PhD); Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam (H P Do MSc, C T Nguyen MSc, T H Nguyen MSc); International Institute for Population Sciences, Mumbai, India (M Dubey MPhil); Haramaya University, Harar, Ethiopia (D Edessa MSc, M D Gishu MSc, F W Mlashu MSc, M Sisay MSc); Arba Minch University, Arba Minch, Ethiopia (A Y Endries MPH); Ministry of Health and Medical Education, Tehran, Iran (B Eshrati PhD); Arak University of Medical Sciences, Arak, Iran (B Eshrati PhD); Jimma University, Jimma, Ethiopia (G T Feyissa MPH, A Workicho MPH); Imperial College London, London, UK (K J Foreman PhD); Department of Zoology, University of Oxford, Oxford, UK (P W Gething PhD); Kersa Health and Demographic Surveillance System, Harar, Ethiopia (M D Gishu MSc); Departments of Microbiology and Epidemiology & Biostatistics, Saint James School of Medicine, The Quarter, Anguilla (Prof H C Gugnani PhD); West Virginia Bureau for Public Health, Charleston, WV, USA (R Gupta MD); Kilte Awlaelo Health and Demographic Surveillance System, Mekelle, Ethiopia (G B Hailu MSc); Mizan Tepi University, Mizan Teferi, Ethiopia (H Y Hassen MPH); College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia (D T Hibstu MPH); National Public Health Institute, Monrovia, Liberia (O S Ilesanmi MD); Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany (Prof J B Jonas MD); Christian Medical College, Vellore, India (Prof G Kang PhD); Digestive Diseases Research Institute (Prof R Malekzadeh MD, S G Sepanlou PhD), Hematologic Malignancies Research Center (A Kasaeian PhD), Hematology-Oncology and Stem Cell Transplantation Research Center (A Kasaeian PhD), Tehran University of Medical Sciences, Tehran, Iran; Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan (Prof Y S Khader ScD); Health Services Academy, Islamabad, Pakistan (E A Khan MD); University of Alabama at Birmingham, Birmingham, AL, USA (M A Khan MD, G A Naik MPH); University of Tennessee Health Science Center, Memphis, TN, USA (M A Khan MD); Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea (Prof Y Khang MD); Institute of Health Policy and Management, Seoul National University Medical Center, Seoul, South Korea (Prof Y Khang MD); University of British Columbia, Vancouver, BC, Canada (Prof N Kissoon MD, S Murthy MD); Global Healthcare Consulting, New Delhi, India (S KochharMD); University of Maryland School of Medicine, Baltimore, MD, USA (K L Kotloff MD); Research and Development Unit, Parc Sanitari Sant Joan de Deu (CIBERSAM), Barcelona, Spain (A Koyanagi MD); Mansoura Faculty of Medicine, Mansoura, Egypt (H Magdy Abd El Razek MBBCH); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Prof D C Malta PhD); Ipas Nepal, Kathmandu, Nepal (S Mehata PhD); United Nations Population Fund, Lima, Peru (W Mendoza MD); Addis Ababa University, Addis Ababa, Ethiopia (B G Menota MSc, B D Yirsaw PhD); Department of Public Health, Semarang State University, Semarang City, Indonesia (D N A Ningrum MPH); Centre for Health Research (F A Ogbo MPH), Western Sydney University, Sydney, NSW, Australia (Prof A M N Renzaho PhD); Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria (A T Olagunju MD); Department of Psychiatry, Lagos University Teaching Hospital, Lagos, Nigeria (A T Olagunju MD); UK Department for International Development, Lalitpur, Nepal (D Paudel PhD); University of Virginia, Charlottesville, VA, USA (J A Platts-Mills MD); Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran (M Qorbani PhD); Contech International Health Consultants, Lahore, Pakistan (A Rafay MSc, Prof S M Rana PhD); Contech School of Public Health, Lahore, Pakistan (A Rafay MSc, Prof S M Rana PhD); Society for Health and Demographic Surveillance, Suri, India (R K Rai MPH); Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, South Korea (C L Ranabhat PhD); Health Science Foundation and Study Center, Kathmandu, Nepal (C L Ranabhat PhD); Loma Linda University Medical Center, Loma Linda, CA, USA (C Reis MD); Mazandaran University of Medical Sciences, Sari, Iran (M S Rezai MD); Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania (G M Ruhago PhD); Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran (S Safiri PhD); Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA (J A Salomon PhD); Department of Public Health (M Sawhney PhD), J Edwards School of Medicine (J R Sanabria MD), Marshall University, Huntington, WV, USA; Case Western Reserve University, Cleveland, OH, USA (J R Sanabria MD); Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa (Prof B Sartorius PhD); UKZN Gastrointestinal Cancer Research Centre, South African Medical Research Council, Durban, South Africa (Prof B Sartorius PhD); National Institute of Infectious Diseases, Tokyo, Japan (M Shigematsu PhD); University of Calgary, Calgary, AB, Canada (R Somayaji MD); Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia (C T Sreeramareddy MD); Departments of Criminology, Law & Society, Sociology, and Public Health, University of California, Irvine, Irvine, CA, USA (Prof B L Sykes PhD); Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland (R Topor-Madry PhD); Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland (R Topor-Madry PhD); Johns Hopkins University, Baltimore, MD, USA (B X Tran PhD); Hanoi Medical University, Hanoi, Vietnam (B X Tran PhD); Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria (K N Ukwaja MD); Center for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway (Prof S E Vollset DrPH); Natural History Museum, London, UK (J L Walson MD); Competence Center Mortality- Follow-Up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany (A Werdecker PhD); Ghent University, Ghent, Belgium (A Workicho MPH); University of South Australia, Mawson Lakes, SA, Australia (B D Yirsaw PhD); Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan (N Yonemoto MPH); and Faculty of Medicine, Mansoura University, Mansoura, Egypt (Prof M El Sayed Zaki PhD).Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2019-02-06T16:27:14Z No. of bitstreams: 1 GBD 2016 Diarrhoeal Disease Collaborators.pdf: 5320682 bytes, checksum: bf10fa178497d912a3906d986b990fc6 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2019-02-06T16:57:39Z (GMT) No. of bitstreams: 1 GBD 2016 Diarrhoeal Disease Collaborators.pdf: 5320682 bytes, checksum: bf10fa178497d912a3906d986b990fc6 (MD5)Made available in DSpace on 2019-02-06T16:57:39Z (GMT). No. of bitstreams: 1 GBD 2016 Diarrhoeal Disease Collaborators.pdf: 5320682 bytes, checksum: bf10fa178497d912a3906d986b990fc6 (MD5) Previous issue date: 2018Department of Science and Technology, Government of India, through the INSPIRE Faculty scheme. AB is funded by the Ministry of Education, Science and Technology of the Republic of Serbia (project III45005). AK is supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the national research, development, and innovation, and funded by Instituto de Salud Carlos III—General Branch Evaluation and Promotion of Health Research—and the European Regional Development Fund (ERDF-FEDER). SMR acknowledges support from Contech School of Public Health, Lahore. RS reports research funding from the Cystic Fibrosis Foundation, Cystic Fibrosis Canada, Alberta Innovates, and the Canadian Institutes of Health Research.Múltipla - ver em NotasThe Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provides an up-to-date analysis of the burden of diarrhoea in 195 countries. This study assesses cases, deaths, and aetiologies in 1990-2016 and assesses how the burden of diarrhoea has changed in people of all ages. Methods We modelled diarrhoea mortality with a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We modelled diarrhoea incidence with a compartmental meta-regression tool that enforces an association between incidence and prevalence, and relies on scientific literature, population representative surveys, and health-care data. Diarrhoea deaths and episodes were attributed to 13 pathogens by use of a counterfactual population attributable fraction approach. Diarrhoea risk factors are also based on counterfactual estimates of risk exposure and the association between the risk and diarrhoea. Each modelled estimate accounted for uncertainty

Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provides an up-to-date analysis of the burden of diarrhoea in 195 countries. This study assesses cases, deaths, and aetiologies in 1990–2016 and assesses how the burden of diarrhoea has changed in people of all ages. Methods: We modelled diarrhoea mortality with a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We modelled diarrhoea incidence with a compartmental meta-regression tool that enforces an association between incidence and prevalence, and relies on scientific literature, population representative surveys, and health-care data. Diarrhoea deaths and episodes were attributed to 13 pathogens by use of a counterfactual population attributable fraction approach. Diarrhoea risk factors are also based on counterfactual estimates of risk exposure and the association between the risk and diarrhoea. Each modelled estimate accounted for uncertainty. Findings: In 2016, diarrhoea was the eighth leading cause of death among all ages (1 655944 deaths, 95% uncertainty interval [UI] 1244 073–2366 552) and the fifth leading cause of death among children younger than 5 years (446 000 deaths, 390 894–504 613). Rotavirus was the leading aetiology for diarrhoea mortality among children younger than 5 years (128 515 deaths, 105138–155 133) and among all ages (228 047 deaths, 183 526–292737). Childhood wasting (low weight-for-height score), unsafe water, and unsafe sanitation were the leading risk factors for diarrhoea, responsible for 80·4% (95% UI 68·2–85·0), 72·1% (34·0–91·4), and 56·4% (49·3–62·7) of diarrhoea deaths in children younger than 5 years, respectively. Prevention of wasting in 1762 children (95% UI 1521–2170) could avert one death from diarrhoea. Interpretation: Substantial progress has been made globally in reducing the burden of diarrhoeal diseases, driven by decreases in several primary risk factors. However, this reduction has not been equal across locations, and burden among adults older than 70 years requires attention