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. 2022 Dec 6;13(1):7457.
doi: 10.1038/s41467-022-34240-6.

The overlapping burden of the three leading causes of disability and death in sub-Saharan African children

Robert C Reiner Jr  1   2 ; LBD Triple Burden Collaborators; Simon I Hay  3   4
Collaborators, Affiliations

The overlapping burden of the three leading causes of disability and death in sub-Saharan African children

Robert C Reiner Jr et al. Nat Commun. .

Abstract

Despite substantial declines since 2000, lower respiratory infections (LRIs), diarrhoeal diseases, and malaria remain among the leading causes of nonfatal and fatal disease burden for children under 5 years of age (under 5), primarily in sub-Saharan Africa (SSA). The spatial burden of each of these diseases has been estimated subnationally across SSA, yet no prior analyses have examined the pattern of their combined burden. Here we synthesise subnational estimates of the burden of LRIs, diarrhoea, and malaria in children under-5 from 2000 to 2017 for 43 sub-Saharan countries. Some units faced a relatively equal burden from each of the three diseases, while others had one or two dominant sources of unit-level burden, with no consistent pattern geographically across the entire subcontinent. Using a subnational counterfactual analysis, we show that nearly 300 million DALYs could have been averted since 2000 by raising all units to their national average. Our findings are directly relevant for decision-makers in determining which and targeting where the most appropriate interventions are for increasing child survival.

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Conflict of interest statement

This study was funded by the Bill & Melinda Gates Foundation. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The non-consortium authors have no competing interests. Competing interests for consortium authors is as follows: Robert Ancuceanu reports receiving consultancy or speaker feeds from UCB, Sandoz, Abbvie, Zentiva, Teva, Laropharm, CEGEDIM, Angelini, Biessen Pharma, Hofigal, AstraZeneca, and Stada. Jacek Jerzy Jozwiak reports personal fees from Amgen, ALAB Laboratories, Teva, Synexus, Boehringer Ingelheim, and Zentiva, all outside the submitted work. Kewal Krishan reports non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. Walter Mendoza is a Program Analyst in Population and Development at the United Nations Population Fund-UNFPA Country Office in Peru, which does not necessarily endorse or support these findings. Maarten J Postma reports grants and personal fees from MSD, GSK, Pfizer, Boehringer Ingelheim, Novavax, BMS, Seqirus, Astra Zeneca, Sanofi, IQVIA, grants from Bayer, BioMerieux, WHO, EU, FIND, Antilope, DIKTI, LPDP, Budi, personal fees from Novartis, Quintiles, Pharmerit, owning stock options in Health-Ecore and PAG Ltd, and being advisor to Asc Academics, all outside the submitted work. Jasviner A Singh reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, Practice Point communications, the National Institutes of Health, the American College of Rheumatology, and Simply Speaking, owning stock options in Amarin, Viking, Moderna, Vaxart pharmaceuticals and Charlotte’s Web Holdings, being a member of FDA Arthritis Advisory Committee, the steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arm’s length funding from 12 pharmaceutical companies, and the Veterans Affairs Rheumatology Field Advisory Committee, and acting as Editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, all outside the submitted work. Era Upadhyay has a patent A system and method of reusable filters for anti-pollution mask pending, and a patent A system and method for electricity generation through crop stubble by using microbial fuel cells pending.

Figures

Fig. 1
Fig. 1. Global and continental trends in under-5 mortality and DALYs.
a Global under-5 mortality from 2000 to 2017. Fuchsia indicates the fraction of those deaths that occur in sub-Saharan Africa. b Total under-5 DALYs in sub-Saharan Africa from 2000 to 2017. Orange indicates the fraction of those DALYs attributable to the combined burden of lower respiratory infections (LRIs), diarrhoea, and malaria; Total DALYs per child: estimates of burden attributable to malaria (c, purple), diarrhoea (d, green), LRIs (e, blue), and all other causes (grey) are summed to give total DALY rates for 2017. In all panels, white dashes indicate 25th % and 75th percentiles, and white lines indicate 50%. Maps were produced using ArcGIS Desktop 10.6.
Fig. 2
Fig. 2. Combined disability-adjusted life years (DALYs) in 2017 and decomposition.
a Second administrative level estimates of combined DALYs. b For second administrative units where the combined DALYs per child per year exceeded 0.5 in 2017, the primary component of the local composition of burden is plotted. Units where the combined DALYs were less than 0.5 are plotted as white. Units with dark purple have greater than 60% of their combined burden attributable to malaria (e.g., areas of Burkina Faso). Units with dark blue have greater than 60% of their combined burden attributable to LRIs (e.g., areas of Nigeria). Units with dark green have greater than 60% of their combined burden attributable to diarrhoea (e.g., areas of Chad). Units coloured light purple, blue, or green have between 50% and 60% of their combined burden attributable to malaria, LRIs, or diarrhoea, respectively. Units coloured yellow have no dominant cause (no cause’s contribution exceeds 50%). Units which are shaded dark brown have all causes represented in their combined burden with percentages between 20% and 40%. Three examples from Western sub-Saharan Africa are highlighted. For each region, the composition of the relative contribution of each cause translates to a point in the ternary plot legend. The closer a point is to each corner, the higher the relative contribution of that cause. Maps were produced using ArcGIS Desktop 10.6.
Fig. 3
Fig. 3. Counterfactual analysis in 2017.
a Second administrative level reductions in combined DALY rates b Map of second administrative units in Nigeria whose averted combined DALYs exceeded 10,000, the primary component of the local composition of burden is plotted. Units where the combined DALYs averted were less than 10,000 are plotted as white. Units with dark purple have greater than 60% of their averted combined burden attributable to malaria. Units coloured light purple or blue have between 50% and 60% of their averted combined burden attributable to malaria or LRIs, respectively. Units coloured yellow have no dominant cause (no cause’s contribution exceeds 50%). Units which are shaded dark brown have all causes represented in their averted combined burden with percentages between 20% and 40%. Maps were produced using ArcGIS Desktop 10.6.
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