Match!

Global disability-adjusted life-year estimates of long-term health burden and undernutrition attributable to diarrhoeal diseases in children younger than 5 years.

Published on Mar 1, 2018in The Lancet Global Health
· DOI :10.1016/S2214-109X(18)30045-7
Christopher Troeger25
Estimated H-index: 25
(UW: University of Washington),
Danny V. Colombara16
Estimated H-index: 16
(UW: University of Washington)
+ 15 AuthorsAli A. Mokdad100
Estimated H-index: 100
(UW: University of Washington)
Sources
Abstract
Summary Background Diarrhoea is a leading cause of death and illness globally among children younger than 5 years. Mortality and short-term morbidity cause substantial burden of disease but probably underestimate the true effect of diarrhoea on population health. This underestimation is because diarrhoeal diseases can negatively affect early childhood growth, probably through enteric dysfunction and impaired uptake of macronutrients and micronutrients. We attempt to quantify the long-term sequelae associated with childhood growth impairment due to diarrhoea. Methods We used the Global Burden of Diseases, Injuries, and Risk Factors Study framework and leveraged existing estimates of diarrhoea incidence, childhood undernutrition, and infectious disease burden to estimate the effect of diarrhoeal diseases on physical growth, including weight and height, and subsequent disease among children younger than 5 years. The burden of diarrhoea was measured in disability-adjusted life-years (DALYs), a composite metric of mortality and morbidity. We hypothesised that diarrhoea is negatively associated with three common markers of growth: weight-for-age, weight-for-height, and height-for-age Z -scores. On the basis of these undernutrition exposures, we applied a counterfactual approach to quantify the relative risk of infectious disease (subsequent diarrhoea, lower respiratory infection, and measles) and protein energy malnutrition morbidity and mortality per day of diarrhoea and quantified the burden of diarrhoeal disease due to these outcomes caused by undernutrition. Findings Diarrhoea episodes are significantly associated with childhood growth faltering. We found that each day of diarrhoea was associated with height-for-age Z -score (–0·0033 [95% CI −0·0024 to −0·0041]; p=4·43 × 10 −14 ), weight-for-age Z -score (–0·0077 [–0·0058 to −0·0097]; p=3·19 × 10 −15 ), and weight-for-height Z -score (–0·0096 [–0·0067 to −0·0125]; p=7·78 × 10 −11 ). After addition of the DALYs due to the long-term sequelae as a consequence of undernutrition, the burden of diarrhoeal diseases increased by 39·0% (95% uncertainty interval [UI] 33·0–46·6) and was responsible for 55 778 000 DALYs (95% UI 49 125 400–62 396 200) among children younger than 5 years in 2016. Among the 15 652 300 DALYs (95% UI 12 951 300–18 806 100) associated with undernutrition due to diarrhoeal episodes, more than 84·7% are due to increased risk of infectious disease, whereas the remaining 15·3% of long-term DALYs are due to increased prevalence of protein energy malnutrition. The burden of diarrhoea has decreased substantially since 1990, but progress has been greater in long-term (78·7% reduction [95% UI 69·3–85·5]) than in acute (70·4% reduction [95% UI 61·7–76·5]) DALYs. Interpretation Diarrhoea represents an even larger burden of disease than was estimated in the Global Burden of Disease Study. In order to adequately address the burden of its long-term sequelae, a renewed emphasis on controlling the risk of diarrhoea incidence may be required. This renewed effort can help further prevent the potential lifelong cost on child health, growth, and overall potential. Funding Bill & Melinda Gates Foundation.
Figures & Tables
  • References (36)
  • Citations (29)
📖 Papers frequently viewed together
201359.10The Lancet
1,444 Citations
201659.10The Lancet
50 Authors (Jie Liu, ..., Eric R. Houpt)
211 Citations
198 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
References36
Newest
#1E. Theo Vos (UW: University of Washington)H-Index: 117
Last. Christopher MargonoH-Index: 175
view all 727 authors...
Summary Background As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. Methods We estimated prevalence and incidence fo...
865 CitationsSource
#1Christopher TroegerH-Index: 25
Last. Ali A. MokdadH-Index: 100
view all 68 authors...
216 CitationsSource
#1Simon I. HayH-Index: 121
#2Amanuel Alemu Abajobir (UQ: University of Queensland)H-Index: 27
Last. Christopher MargonoH-Index: 175
view all 798 authors...
Summary Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and he...
568 CitationsSource
#1Mohsen Naghavi (UW: University of Washington)H-Index: 98
#2Amanuel Alemu Abajobir (UQ: University of Queensland)H-Index: 27
Last. Christopher MargonoH-Index: 175
view all 600 authors...
Summary Background Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. Methods We estim...
780 CitationsSource
#1Li Liu (Johns Hopkins University)H-Index: 19
#2Shefali Oza (Lond: University of London)H-Index: 15
Last. Robert E Black (Johns Hopkins University)H-Index: 118
view all 10 authors...
Summary Background Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. In this paper, we updated our annual estimates of child mortality by cause to 2000–15 to reflect on progress toward the MDG 4 and consider implications for the Sustainable Development Goals (SDG) target for child survival. Methods We increased the estimation i...
465 CitationsSource
#1Relana Pinkerton (UVA: University of Virginia)H-Index: 21
#2Reinaldo B. Oriá (UVA: University of Virginia)H-Index: 26
Last. Richard L. Guerrant (UVA: University of Virginia)H-Index: 73
view all 10 authors...
Abstract Understanding the complex relationship between early childhood infectious diseases, nutritional status, poverty, and cognitive development is significantly hindered by the lack of studies that adequately address confounding between these variables. This study assesses the independent contributions of early childhood diarrhea (ECD) and malnutrition on cognitive impairment in later childhood. A cohort of 131 children from a shantytown community in northeast Brazil was monitored from birth...
14 CitationsSource
#1Chad K. PorterH-Index: 25
#2Barbara KowalcykH-Index: 9
Last. Mark S. RiddleH-Index: 37
view all 3 authors...
16 CitationsSource
#1E. Theo Vos (UW: University of Washington)H-Index: 117
#2Christine Allen (UW: University of Washington)H-Index: 16
Last. Christopher Margono (UW: University of Washington)H-Index: 175
view all 637 authors...
Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the...
1,210 CitationsSource
#1Haidong Wang (UW: University of Washington)H-Index: 39
#2Mohsen Naghavi (UW: University of Washington)H-Index: 98
Last. Christopher Margono (UW: University of Washington)H-Index: 175
view all 772 authors...
Summary Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We...
1,708 CitationsSource
#1Nicholas J. Kassebaum (UW: University of Washington)H-Index: 45
#2Megha Arora (UW: University of Washington)H-Index: 13
Last. Christopher Margono (UW: University of Washington)H-Index: 175
view all 615 authors...
Summary Background Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. ...
644 CitationsSource
Cited By29
Newest
Background Diarrheagenic Escherichia coli (DEC) is a significant cause of gastroenteritis and a major public health problem. This study investigates the prevalence and the antibiotic resistance patterns of DEC that were isolated from infectious diarrhea samples of pediatric patients from central Iran. Patients and Methods Pediatric diarrhea samples were collected from 230 pediatric patients visiting the hospital. E. coli pathotypes were diagnosed by using conventional culture methods and PCR. An...
Source
#1Sophie Budge (Cranfield University)H-Index: 2
#2Megan J. Barnett (BGS: British Geological Survey)H-Index: 2
Last. Mohammedyasin Jemal (People in Need)
view all 10 authors...
Early infection from enteropathogens is recognised as both a cause and effect of infant malnutrition. Specifically, evidence demonstrates associations between growth shortfalls and Campylobacter infection, endemic across low-income settings, with poultry a major source. Whilst improvements in water, sanitation and hygiene (WASH) should reduce pathogen transmission, interventions show inconsistent effects on infant health. This cross-sectional, formative study aimed to understand relationships be...
Source
#1Anna Manko-Prykhoda (U of C: University of Calgary)
#2Thibault Allain (U of C: University of Calgary)H-Index: 6
Last. Paul L. Beck (U of C: University of Calgary)H-Index: 50
view all 11 authors...
Abstract Polymicrobial infections of the gastro-intestinal tract are common in areas with poor sanitation. Disease outcome is the result of complex interactions between the host and pathogens. Such interactions lie at the core of future management strategies of enteric diseases. In developed countries of the world, Giardia duodenalis is a common cause of diarrheal disease. In contrast, giardiasis appears to protect children against diarrhea in countries with poor sanitation, via obscure mechanis...
Source
#1Zobia Noreen (CUI: COMSATS Institute of Information Technology)H-Index: 6
#2Fariha Siddiqui (CUI: COMSATS Institute of Information Technology)H-Index: 4
Last. Habib Bokhari (CUI: COMSATS Institute of Information Technology)H-Index: 14
view all 5 authors...
Abstract Objectives Campylobacter jejuni has been classified as a member of priority pathogens group due to the rapid emergence of multidrug resistant isolates. In the present study we planned to determine the prevalence, antibiotic resistance patterns and source tracking of clinical C. jejuni isolates from pediatric diarrheal patients in Pakistan. Methods A total of 150 stool samples from children were processed for the presence of Campylobacter jejuni using culture, biochemical tests and by sp...
Source
#1Bezuayehu Alemayehu (JU: Jimma University)H-Index: 1
#2Birhanu Teshome Ayele (Stellenbosch University)H-Index: 2
Last. Argaw Ambelu (JU: Jimma University)H-Index: 11
view all 4 authors...
Abstract Under-five children diarrhea remains a major public health problem in resource-limited areas, including Ethiopia, due to multiple risk factors. This study aimed to identify individual and community-level risk factors affecting under-five children diarrhea (UFCD) in five districts of the Bench Maji Zone, southwestern Ethiopia. A community-based cross-sectional study was conducted from February to April 2018. A total of 826 households were recruited from five randomly selected districts u...
1 CitationsSource
Diarrhoea contributes significantly to the under-five childhood morbidity and mortality worldwide. This cross-sectional study was carried out in a tertiary care hospital in Ujjain, India from July 2015 to June 2016. Consecutive children aged 1 month to 12 years having “some dehydration” and “dehydration” according to World Health Organization classification were eligible to be included in the study. Other signs and symptoms used to assess severe dehydration were capillary refill time, urine outp...
Source
PurposeTo assess the association between changes in gut flora and serum inflammatory factors in children with noninfectious diarrhea.Basic ProcedureNinety-three children diagnosed with and treated ...
Source
#1Esther Ndungo (UMB: University of Maryland, Baltimore)H-Index: 1
#2Marcela F. Pasetti (UMB: University of Maryland, Baltimore)H-Index: 38
ABSTRACTThe development, clinical advancement and licensure of vaccines, and monitoring of vaccine effectiveness could be expedited and simplified by the ability to measure immunological endpoints ...
2 CitationsSource
#1Yue Hu (KU: University of Kansas)H-Index: 4
#2Ozan S. Kumru (KU: University of Kansas)H-Index: 13
Last. David B. Volkin (KU: University of Kansas)H-Index: 35
view all 10 authors...
Abstract Enterotoxigenic Escherichia coli (ETEC) is a major cause of diarrheal disease in children in developing countries, and there are no licensed vaccines to protect against ETEC. Passive immunization by oral delivery of ETEC-specific secretory IgAs (sIgAs) could potentially provide an alternative approach for protection in targeted populations. In this study, a series of physiochemical techniques and an in vitro gastric digestion model were used to characterize and compare key structural at...
4 CitationsSource
#1Karoun H. Bagamian (UF: University of Florida)H-Index: 8
#2John Anderson (ASU: Appalachian State University)H-Index: 9
Last. Richard Rheingans (ASU: Appalachian State University)H-Index: 32
view all 7 authors...
Summary Background Diarrhoea, a global cause of child mortality and morbidity, is linked to adverse consequences including childhood stunting and death from other diseases. Few studies explore how diarrhoeal mortality varies subnationally, especially by cause, which is important for targeting investments. Even fewer examine indirect effects of diarrhoeal morbidity on child mortality. We estimated the subnational distribution of mortality, morbidity, and childhood stunting attributable to enterot...
1 CitationsSource