10 research outputs found
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
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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
Rotavirus Vaccination and the Global Burden of Rotavirus Diarrhea Among Children Younger Than 5 Years
Rotavirus genotype trends from 2013 to 2018 and vaccine effectiveness in southern Vietnam
Apparent overuse of antibiotics in the management of watery diarrhoea in children in Abakaliki, Nigeria
Effect of Bismuth Subsalicylate vs Placebo on Use of Antibiotics Among Adult Outpatients With Diarrhea in Pakistan
Potential of avian and mammalian species A rotaviruses to reassort as explored by plasmid only-based reverse genetics
Enteric dysfunction and other factors associated with attained size at 5 years: MAL-ED birth cohort study findings
Funding Information: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH, and the NIH/Fogarty International Center. This work was also supported by the Fogarty International Center, NIH (D43-TW009359 to ETR).Peer reviewe