Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013.
Khalil I., Colombara DV., Forouzanfar MH., Troeger C., Daoud F., Moradi-Lakeh M., Bcheraoui CE., Rao PC., Afshin A., Charara R., Abate KH., Razek MMAE., Abd-Allah F., Abu-Elyazeed R., Kiadaliri AA., Akanda AS., Akseer N., Alam K., Alasfoor D., Ali R., AlMazroa MA., Alomari MA., Al-Raddadi RMS., Alsharif U., Alsowaidi S., Altirkawi KA., Alvis-Guzman N., Ammar W., Antonio CAT., Asayesh H., Asghar RJ., Atique S., Awasthi A., Bacha U., Badawi A., Barac A., Bedi N., Bekele T., Bensenor IM., Betsu BD., Bhutta Z., Abdulhak AAB., Butt ZA., Danawi H., Dubey M., Endries AY., Faghmous IDA., Farid T., Farvid MS., Farzadfar F., Fereshtehnejad S-M., Fischer F., Fitchett JRA., Gibney KB., Ginawi IAM., Gishu MD., Gugnani HC., Gupta R., Hailu GB., Hamadeh RR., Hamidi S., Harb HL., Hedayati MT., Hsairi M., Husseini A., Jahanmehr N., Javanbakht M., Jibat T., Jonas JB., Kasaeian A., Khader YS., Khan AR., Khan EA., Khan G., Khoja TAM., Kinfu Y., Kissoon N., Koyanagi A., Lal A., Latif AAA., Lunevicius R., Razek HMAE., Majeed A., Malekzadeh R., Mehari A., Mekonnen AB., Melaku YA., Memish ZA., Mendoza W., Misganaw A., Mohamed LAI., Nachega JB., Nguyen QL., Nisar MI., Peprah EK., Platts-Mills JA., Pourmalek F., Qorbani M., Rafay A., Rahimi-Movaghar V., Rahman SU., Rai RK., Rana SM., Ranabhat CL., Rao SR., Refaat AH., Riddle M., Roshandel G., Ruhago GM., Saleh MM., Sanabria JR., Sawhney M., Sepanlou SG., Setegn T., Sliwa K., Sreeramareddy CT., Sykes BL., Tavakkoli M., Tedla BA., Terkawi AS., Ukwaja K., Uthman OA., Westerman R., Wubshet M., Yenesew MA., Yonemoto N., Younis MZ., Zaidi Z., Zaki MES., Rabeeah AAA., Wang H., Naghavi M., Vos T., Lopez AD., Murray CJL., Mokdad AH.
Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.