Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

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.).

Original publication

DOI

10.1056/NEJMoa1716766

Type

Journal article

Journal

The new england journal of medicine

Publication Date

09/2018

Volume

379

Pages

1128 - 1138

Addresses

From 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.).

Keywords

Humans, Diarrhea, Incidence, Prevalence, Mortality, Bayes Theorem, Child, Preschool, Infant, Africa, Geography, Medical