Local Burden of Disease Diarrhoea Collaborators (2020) Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17: analysis for the Global Burden of Disease Study 2017. The Lancet, 395. 10239. pp. 1779-1801.

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Abstract

Across low-income and middle-income countries (LMICs), diarrhoea causes more than half a million childhood deaths annually. In addition to this staggering loss of life, more than 910 million childhood cases of diarrhoea per year2 are distributed unequally across the population, causing not only acute morbidity but also long-term disability in children who suffer repeatedly with enteric infections. National-level analyses of the burden of childhood diarrhoea, measured by both death rates and incidence, have exposed substantial variation. In LMICs in 2017, the incidence of diarrhoea ranged from less than one episode per child per year to more than four episodes per child per year. In the same population, the case-fatality rate of diarrhoea can vary from one per 10 000 infections to more than 20 per 10 000 infections.

WHO's integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD) identified three approaches to reduce the burden of diarrhoea: protect, prevent, and treat. Healthy children are less likely to have severe diarrhoea episodes, so diarrhoeal burden can be reduced by prioritising good health practices from birth. As such, reducing general health risk factors, such as child growth failure (CGF) indicators of stunting, wasting, and underweight, can protect a child from diarrhoea. Preventing illness by promoting vaccination and improved water, sanitation, and hygiene (WASH) can similarly reduce diarrhoeal burden. Finally, appropriate treatment, such as oral rehydration solution (ORS), the efficacy of which exceeds 90%,10 can substantially reduce death resulting from disease-associated dehydration.

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