Diarrhoeal disease and subsequent risk of death in infants and children residing in low-income and middle-income countries: analysis of the GEMS case-control study and 12-month GEMS-1A follow-on study

• Type of Material: Article
• Authors: Myron M. Levine, University of Maryland; Dilruba Nasrin, University of Maryland; Sozinho Acacio, Instituto Nacional de Saúde; Quique Bassat, Instituto Nacional de Saúde; Helen Powell, University of Maryland; Sharon M. Tennant, University of Maryland; Samba O. Sow, Centre pour le Développement des Vaccins; Robert Breiman, Emory University; Eric Mintz, Emory University; Ciara O'Reilly, Emory University
• Language: English
• Date: 2020-02-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Author(s). Published by Elsevier Ltd.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/S2214-109X(19)30541-8
• Title of Journal or Parent Work: Lancet Global Health
• Volume: 8
• Issue: 2
• Start Page: 204
• End Page: 214
• Grant/Funding Information: This study was supported by grants 38874 and OPP1033572 from the Bill & Melinda Gates Foundation (MML, Principal lnvestigator). MML is supported in part by the Simon and Bessie Grollman Distinguished Professorship. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
• Keywords: diarrhoeal disease; diarrhoeal-associated death; mortality; pathogen
• Research Categories: Health Sciences, Public Health; Health Sciences, Pathology

Abstract

Although diarrhoeal-associated deaths have steadily decreased during the past two decades, diarrhoeal diseases remain responsible for an estimated 9% of all mortality in children younger than 5 years, accounting for about 499 000 to 525 000 annual deaths. Accurate descriptions of the major causative pathogens, determinants, and risk factors for these deaths are necessary to design improved preventive and therapeutic strategies that will have maximal impact on diarrhoeal disease, and thus, on young child survival. We searched PubMed for articles published in English, Spanish, French, or Portuguese between Jan 1, 2000, and Sept 30, 2019, using the terms “low and middle-income countries” or “developing countries” AND “diarrheal deaths” OR “diarrhea AND mortality”. We included earlier reports, and articles identified in reference lists, as appropriate. Previous aetiological studies have put the focus on specific pathogens in particular high-risk populations, including, among others, rotavirus, diarrhoeagenic Escherichia coli, or Shigella spp. However, few studies have included comprehensive investigation of a representative sample of diarrhoea cases in children in different low-income regions of the world where diarrhoeal illness remains a major public health problem.