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. 2016 Dec 7;95(6):1319-1329.
doi: 10.4269/ajtmh.16-0339. Epub 2016 Oct 10.

Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013

Ibrahim Khalil  1 , Danny V Colombara  1 , Mohammad Hossein Forouzanfar  1 , Christopher Troeger  1 , Farah Daoud  1 , Maziar Moradi-Lakeh  2   1 , Charbel El Bcheraoui  1 , Puja C Rao  1 , Ashkan Afshin  1 , Raghid Charara  1 , Kalkidan Hassen Abate  3 , Mohammed Magdy Abd El Razek  4 , Foad Abd-Allah  5 , Remon Abu-Elyazeed  6 , Aliasghar Ahmad Kiadaliri  7   8 , Ali Shafqat Akanda  9 , Nadia Akseer  10   11 , Khurshid Alam  12   13   14 , Deena Alasfoor  15 , Raghib Ali  16 , Mohammad A AlMazroa  17 , Mahmoud A Alomari  18 , Rajaa Mohammad Salem Al-Raddadi  19 , Ubai Alsharif  20 , Shirina Alsowaidi  21 , Khalid A Altirkawi  22 , Nelson Alvis-Guzman  23 , Walid Ammar  24 , Carl Abelardo T Antonio  25 , Hamid Asayesh  26 , Rana Jawad Asghar  27 , Suleman Atique  28 , Ashish Awasthi  29 , Umar Bacha  30 , Alaa Badawi  31 , Aleksandra Barac  32 , Neeraj Bedi  33 , Tolesa Bekele  34 , Isabela M Bensenor  35 , Balem Demtsu Betsu  36 , Zulfiqar Bhutta  37   11 , Aref A Bin Abdulhak  38 , Zahid A Butt  39 , Hadi Danawi  40 , Manisha Dubey  41 , Aman Yesuf Endries  42 , Imad D A Faghmous  43 , Talha Farid  44 , Maryam S Farvid  45   44 , Farshad Farzadfar  46 , Seyed-Mohammad Fereshtehnejad  47 , Florian Fischer  48 , Joseph Robert Anderson Fitchett  49 , Katherine B Gibney  50   51 , Ibrahim Abdelmageem Mohamed Ginawi  52 , Melkamu Dedefo Gishu  53   54 , Harish Chander Gugnani  55   56 , Rahul Gupta  57 , Gessessew Bugssa Hailu  58   36 , Randah Ribhi Hamadeh  59 , Samer Hamidi  60 , Hilda L Harb  24 , Mohammad T Hedayati  61 , Mohamed Hsairi  62 , Abdullatif Husseini  63 , Nader Jahanmehr  64 , Mehdi Javanbakht  65 , Tariku Jibat  66   67 , Jost B Jonas  68 , Amir Kasaeian  69   46 , Yousef Saleh Khader  70 , Abdur Rahman Khan  44 , Ejaz Ahmad Khan  71 , Gulfaraz Khan  72 , Tawfik Ahmed Muthafer Khoja  73 , Yohannes Kinfu  74 , Niranjan Kissoon  75 , Ai Koyanagi  76 , Aparna Lal  77 , Asma Abdul Abdul Latif  78 , Raimundas Lunevicius  79   80 , Hassan Magdy Abd El Razek  81 , Azeem Majeed  82 , Reza Malekzadeh  83 , Alem Mehari  84 , Alemayehu B Mekonnen  85   12 , Yohannes Adama Melaku  86   87 , Ziad A Memish  88   89 , Walter Mendoza  90 , Awoke Misganaw  1 , Layla Abdalla Ibrahim Mohamed  91 , Jean B Nachega  92   93 , Quyen Le Nguyen  94 , Muhammad Imran Nisar  95 , Emmanuel Kwame Peprah  96 , James A Platts-Mills  97 , Farshad Pourmalek  75 , Mostafa Qorbani  98 , Anwar Rafay  99   100 , Vafa Rahimi-Movaghar  101 , Sajjad Ur Rahman  102 , Rajesh Kumar Rai  103 , Saleem M Rana  99   100 , Chhabi L Ranabhat  104   105 , Sowmya R Rao  106 , Amany H Refaat  107   40 , Mark Riddle  108 , Gholamreza Roshandel  109   83 , George Mugambage Ruhago  110 , Muhammad Muhammad Saleh  111 , Juan R Sanabria  112   113 , Monika Sawhney  114 , Sadaf G Sepanlou  83 , Tesfaye Setegn  115 , Karen Sliwa  116 , Chandrashekhar T Sreeramareddy  117 , Bryan L Sykes  118 , Mohammad Tavakkoli  119 , Bemnet Amare Tedla  120   85 , Abdullah S Terkawi  121   122   123 , Kingsley Ukwaja  124 , Olalekan A Uthman  125 , Ronny Westerman  126   127 , Mamo Wubshet  128   85 , Muluken A Yenesew  115 , Naohiro Yonemoto  129 , Mustafa Z Younis  130 , Zoubida Zaidi  131 , Maysaa El Sayed Zaki  132 , Abdullah A Al Rabeeah  17 , Haidong Wang  1 , Mohsen Naghavi  1 , Theo Vos  1 , Alan D Lopez  133   1 , Christopher J L Murray  1 , Ali H Mokdad  1
Affiliations

Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013

Ibrahim Khalil et al. Am J Trop Med Hyg. .

Abstract

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.

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Figures

Figure 1.
Figure 1.
Diarrheal disease-associated deaths in the Eastern Mediterranean Region, 1990–2013.
Figure 2.
Figure 2.
Diarrheal disease-associated death rates among children under 5 years of age in the Eastern Mediterranean Region, sorted by low, middle, and high income per capita gross national income, 2013.
Figure 3.
Figure 3.
The proportion of diarrheal deaths due to known pathogens,* among children under 5 years of age in the Eastern Mediterranean Region, 2013 (*excluding cholera and Clostridium difficile).
See this image and copyright information in PMC

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