A recent global study has highlighted a remarkable 60% decrease in mortality from diarrheal diseases, though children and the elderly remain the most vulnerable. The study, conducted by the Institute for Health Metrics and Evaluation (IHME) and published in The Lancet Infectious Diseases journal, underscores both progress and ongoing challenges in combating diarrheal diseases worldwide.
In 2021, diarrheal diseases were responsible for 1.2 million deaths globally, a substantial decline from the 2.9 million deaths reported in 1990. The most significant reduction occurred among children under 5 years, where mortality rates dropped by 79%. Despite this improvement, children under 5 continue to experience the highest mortality rate from diarrheal diseases across all age groups. The second-highest mortality rate was observed in individuals aged 70 and older.
Regional Disparities Persist
While global mortality has decreased, significant regional disparities persist. In high-income countries, the mortality rate for children under 5 is below one death per 100,000 population. In contrast, sub-Saharan Africa records more than 150 deaths per 100,000 in the same age group, the highest rate for children worldwide. In South Asia, the elderly population (aged 70 and older) faces the highest mortality rate, with 476 deaths per 100,000 people.
Although mortality rates have decreased globally, particularly in most super-regions, the disparity between high- and low-income regions remains a pressing issue. These findings point to the need for more targeted health interventions in areas with the highest death rates.
Decline in Disability-Adjusted Life Years (DALYs)
The study also measured the burden of diarrheal diseases through disability-adjusted life years (DALYs), which account for both years of life lost and years lived with disability. DALYs related to diarrheal diseases have dropped significantly from 186 million in 1990 to 59 million in 2021. However, 31 million of these DALYs were in children younger than 5, highlighting the ongoing vulnerability of this age group.
Researchers identified several key risk factors contributing to the burden of diarrheal diseases, including poor neonatal conditions, low birthweight, preterm birth, inadequate water, and poor sanitation. Addressing these risk factors, particularly in vulnerable populations, could further reduce the global burden.
Impact of Health Interventions
The decline in diarrheal disease mortality and morbidity is a testament to the effectiveness of health interventions. Oral rehydration therapy, improved water, sanitation, and hygiene infrastructure, and global immunization efforts, particularly against rotavirus, have all played a crucial role in reducing deaths and disabilities. These interventions are expected to continue to make a significant impact in the coming years.
“Preventive measures against key risk factors and pathogens could further reduce the global burden. If leading risk factors were eliminated, DALYs could potentially be reduced to less than 5 million in 2021,” said Dr. Hmwe Hmwe Kyu, a study author and associate professor at IHME.
Vaccine Development and Expansion
Vaccination efforts, particularly the WHO-recommended rotavirus vaccines, have significantly reduced hospitalizations and deaths from diarrheal diseases. The rotavirus vaccine is now administered in over 100 countries, and its widespread use has been a key factor in improving global health outcomes. WHO’s expanded immunization program aims to continue this progress, with the possibility of combining vaccines to reduce manufacturing costs and simplify scheduling.
Dr. Heidi Soeters, an epidemiologist with WHO’s Department of Immunization, Vaccines and Biologicals, emphasized the importance of both increasing immunization coverage and expanding vaccine development to target specific pathogens that cause diarrheal diseases. “Expanding vaccine development to target specific pathogens and considering combination vaccines could provide broader protection, especially in regions most affected by diarrheal diseases,” she said.
A Call for Continued Action
This study, for the first time, incorporates pathogen-specific data from WHO’s Global Pediatric Diarrhea Surveillance network, providing a more detailed view of the global burden of diarrheal diseases, particularly in high-burden countries. While progress is evident, the need for a multipronged approach remains. Targeted interventions, preventive measures, and continued investment in vaccine development are crucial to further reducing diarrheal mortality and ensuring long-term improvements in global health.
Despite the progress made, experts stress that there is still work to be done. “A combination of life-saving solutions and preventive interventions will be necessary to address the health systems burden and further reduce the global impact of diarrheal diseases,” Dr. Kyu concluded.
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