# name
Quantifying risks and interventions that have affected the
                burden of diarrhoea among children younger than 5 years: an
                analysis of the Global Burden of Disease Study 2017

# metadata.dc.contributor.author[].value
GBD 2017 Diarrhoeal Disease Collaborators

# metadata.dc.description.abstract[].value
Background: Many countries have shown marked declines in diarrhoeal disease mortality among children younger
than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger
than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the
study’s comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader
sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017.
Methods: This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital
registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble
modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual
framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the
relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea
mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to
explain differences in the trends of diarrhoea mortality among children younger than 5 years.
Findings: Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162–593145)
among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1–87·1) per 100000 children.
The diarrhoea mortality rate ranged between countries by over 685 deaths per 100000 children. Diarrhoea mortality
per 100000 globally decreased by 69·6% (63·1–74·6) between 1990 and 2017. Among the risk factors considered in
this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to
unsafe sanitation (13·3% decrease, 11·2–15·5), childhood wasting (9·9% decrease, 9·6–10·2), and low use of oral
rehydration solution (6·9% decrease, 4·8–8·4).
Interpretation: Diarrhoea mortality has declined substantially since 1990, although there are variations by country.
Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk
factors—particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution—appear to
be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions
might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting
against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to
this illness.

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Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Quantifying risks and interventions that have affected the
                burden of diarrhoea among children younger than 5 years: an
                analysis of the Global Burden of Disease Study 2017