Health & Medical Public Health

Diarrhea Incidence in Low- and Middle-income Countries

´╗┐Diarrhea Incidence in Low- and Middle-income Countries


Diarrhea remains a leading cause of mortality among children under 5 years of age around the world. The burden of Diarrheal disease disproportionately affects young children in low- and middle-income countries who have higher incidence rates due to inadequate water and sanitation and nutritional risk factors, such as suboptimal breastfeeding and zinc and vitamin A deficiency. Children living in impoverished areas also have higher case-fatality rates compared to children living in high-income countries due to lack of access to quality health care and timely and effective treatment with oral rehydration solution (ORS) and zinc.

There is currently no widely available source for diarrhea incidence estimates. While cross-sectional surveys such as Demographic and Health Surveys routinely gather 2-week point prevalence rates for low- and middle-income countries around the world, these data cannot be used to generate incidence rates because they can be highly affected by seasonal variation in incidence. Age-specific incidence rates acquired from cohort studies including at least 1 year of surveillance are the best source of data, but these are not available for every country. Therefore, we rely on modeling to generate estimates by country and region, and for the world.

Snyder and Merson first estimated diarrhea incidence for young children to be 2.2 episodes/year in 1980 using available data published between 1954 and 1979. Ten years later Bern et al. published an update of this review using similar methodology, including more recent studies, and estimated children to have 2.6 episodes of diarrhea/year. In 2003, Kosek et al. provided another updated estimate of diarrhea morbidity concluding that children have 3.2 episodes of diarrhea/year. Given it has been nearly 10 years since the last published estimate of diarrhea morbidity, there is a great need for updated estimates of incidence rates for calculating burden of disease and for planning at the country level. In addition, numerous studies have been published since the last review; thus, we sought to include updated data, as well as improve upon past search strategies to expand the contributing of literature.

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