Estimating diarrhea mortality among young children in low and middle income countries

Abstract

Background: Diarrhea remains one of the leading causes of morbidity and mortality among children under 5 years of age, but in many low and middle-income countries where vital registration data are lacking, updated estimates with regard to the proportion of deaths attributable to diarrhea are needed.

Methods: We conducted a systematic literature review to identify studies reporting diarrhea proportionate mortality for children 1-59 mo of age published between 1980 and 2009. Using the published proportionate mortality estimates and country level covariates we constructed a logistic regression model to estimate country and regional level proportionate mortality and estimated uncertainty bounds using Monte-Carlo simulations.

Findings: We identified more than 90 verbal autopsy studies from around the world to contribute data to a single-cause model. We estimated diarrhea proportionate mortality for 84 countries in 6 regions and found diarrhea to account for between 10.0% of deaths in the Americas to 31.3% of deaths in the South-east Asian region.

Discussion: Diarrhea remains a leading cause of death for children 1-59 mo of age. Published literature can be used to create a single-cause mortality disease model to estimate mortality for countries lacking vital registration data.

Figure 1. Systematic review and data abstraction flow chart.

Figure 2. Geographic distribution of model input data and countries for which the model predicts proportionate mortality.

Figure 3. Distribution of study level diarrhea proportionate mortality by WHO region.

Figure 4. Comparison of country specific diarrhea-proportionate mortality estimates by country for the single cause-model vs. Lancet estimates .