Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review
Tóm tắt
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. 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.
We 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.
We 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.
Although 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.
Từ khóa
Tài liệu tham khảo
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, et al: Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010, 375: 1969-1987. 10.1016/S0140-6736(10)60549-1.
Lamberti LM, Fischer Walker CL, Noiman A, Victora C, Black RE: Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health. 2011, 11 (Suppl 3): S15-10.1186/1471-2458-11-S3-S15.
Brown KH, Peerson JM, Baker SK, Hess SY: Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food Nutr Bull. 2009, 30: S12-S40.
Beaton GH, Martorell R, L'Abbe : Effectiveness of vitamin A supplementation in the control of young child morbidity and mortality in developing countries. 1993, Toronto: International Nutrition Program
Santosham M, Chandran A, Fitzwater S, Fischer-Walker C, Baqui AH, et al: Progress and barriers for the control of diarrhoeal disease. Lancet. 2010, 376: 63-67. 10.1016/S0140-6736(10)60356-X.
Snyder JD, Merson MH: The magnitude of the global problem of acute diarrhoeal disease: a review of active surveillance data. Bull World Health Organ. 1992, 60: 605-613.
Bern C, Martines J, de Zoysa I, Glass RI: The magnitude of the global problem of diarrhoeal disease: a ten-year update. Bull World Health Organ. 1992, 70: 705-714.
Kosek M, Bern C, Guerrant RL: The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ. 2003, 81: 197-204.
Meng XL: The EM algorithm and medical studies: a historical link. Stat Methods Med Res. 1997, 6: 3-23. 10.1191/096228097675663031.
Hartley HO: Maximum likelihood estimation from incomplete-data. Biometrics. 1958, 14: 174-194. 10.2307/2527783.
Dempster AP, Laird NM, Rubin DB: Maximum likelihood from incomplete data via the EM algorithm. J Royal Stat Soc Series B (Methodological). 1977, 39: 1-38.
Carpenter J, Bithell J: Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med. 2000, 19: 1141-1164. 10.1002/(SICI)1097-0258(20000515)19:9<1141::AID-SIM479>3.0.CO;2-F.
Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, et al: Multi-country analysis of the effects of diarrhoea on childhood stunting. Int J Epidemiol. 2008, 37: 816-830.
Schmidt WP, Cairncross S, Barreto ML, Clasen T, Genser B: Recent diarrhoeal illness and risk of lower respiratory infections in children under the age of 5 years. Int J Epidemiol. 2009, 38: 766-772. 10.1093/ije/dyp159.
Briscoe J: Intervention studies and the definition of dominant transmission routes. Am J Epidemiol. 1984, 120: 449-455.