Abstract
BackgroundDiarrhea is recognized as a leading cause of morbidity and mortality among children under 5 years of age in low- and middle-income countries yet updated estimates of diarrhea incidence by age for these countries are greatly needed. We conducted a systematic literature review to identify cohort studies that sought to quantify diarrhea incidence among any age group of children 0-59 mo of age.MethodsWe used the Expectation-Maximization algorithm as a part of a two-stage regression model to handle diverse age data and overall incidence rate variation by study to generate country specific incidence rates for low- and middle-income countries for 1990 and 2010. We then calculated regional incidence rates and uncertainty ranges using the bootstrap method, and estimated the total number of episodes for children 0-59 mo of age in 1990 and 2010.ResultsWe estimate that incidence has declined from 3.4 episodes/child year in 1990 to 2.9 episodes/child year in 2010. As was the case previously, incidence rates are highest among infants 6-11 mo of age; 4.5 episodes/child year in 2010. Among these 139 countries there were nearly 1.9 billion episodes of childhood diarrhea in 1990 and nearly 1.7 billion episodes in 2010.ConclusionsAlthough our results indicate that diarrhea incidence rates may be declining slightly, the total burden on the health of each child due to multiple episodes per year is tremendous and additional funds are needed to improve both prevention and treatment practices in low- and middle-income countries.
Highlights
Diarrhea is recognized as a leading cause of morbidity and mortality among children under 5 years of age in low- and middle-income countries yet updated estimates of diarrhea incidence by age for these countries are greatly needed
To convert non-standard age group reports into preset age groups we modeled through a two-stage iterative process using the Expectation-Maximization (EM) algorithm
Systematic literature review We screened more than 19,000 possible titles to identify 72 studies that met all inclusion and exclusion criteria (Figure 1)
Summary
Diarrhea is recognized as a leading cause of morbidity and mortality among children under 5 years of age in low- and middle-income countries yet updated estimates of diarrhea incidence by age for these countries are greatly needed. Ten years later Bern et al published an update of this review using similar methodology, including more recent studies, and estimated children to have 2.6 episodes of diarrhea/year [7]. In 2003, Kosek et al provided another updated estimate of diarrhea morbidity concluding that children have 3.2 episodes of diarrhea/year [8] Given it has been nearly 10 years since the last published estimate of diarrhea morbidity, there is a great need for updated estimates of incidence rates for calculating burden of disease and for planning at the country level. Numerous studies have been published since the last review; we sought to include updated data, as well as improve upon past search strategies to expand the contributing of literature
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