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

Khalil I 1 , Colombara DV 1 , Forouzanfar MH 1 , Troeger C 1 , Daoud F 1 , Moradi-Lakeh M 2 Show all authors , Bcheraoui CE 1 , Rao PC 1 , Afshin A 1 , Charara R 1 , Abate KH 3 , Razek MMAE 4 , Abd-Allah F 5 , Abu-Elyazeed R 6 , Kiadaliri AA 7 , Akanda AS 8 , Akseer N 9 , Alam K 10 , Alasfoor D 11 , Ali R 12 , AlMazroa MA 13 , Alomari MA 14 , Al-Raddadi RMS 15 , Alsharif U 16 , Alsowaidi S 17 , Altirkawi KA 18 , Alvis-Guzman N 19 , Ammar W 20 , Antonio CAT 21 , Asayesh H 22 , Asghar RJ 23 , Atique S 24 , Awasthi A 25 , Bacha U 26 , Badawi A 27 , Barac A 28 , Bedi N 29 , Bekele T 30 , Bensenor IM 31 , Betsu BD 32 , Bhutta Z 33 , Abdulhak AAB 34 , Butt ZA 35 , Danawi H 36 , Dubey M 37 , Endries AY 38 , Faghmous IDA 39 , Farid T 40 , Farvid MS 41 , Farzadfar F 42 , Fereshtehnejad SM 43 , Fischer F 44 , Fitchett JRA 45 , Gibney KB 46 , Ginawi IAM 47 , Gishu MD 48 , Gugnani HC 49 , Gupta R 50 , Hailu GB 51 , Hamadeh RR 52 , Hamidi S 53 , Harb HL 20 , Hedayati MT 54 , Hsairi M 55 , Husseini A 56 , Jahanmehr N 57 , Javanbakht M 58 , Jibat T 59 , Jonas JB 60 , Kasaeian A 61 , Khader YS 62 , Khan AR 40 , Khan EA 63 , Khan G 64 , Khoja TAM 65 , Kinfu Y 66 , Kissoon N 67 , Koyanagi A 68 , Lal A 69 , Latif AAA 70 , Lunevicius R 71 , Razek HMAE 72 , Majeed A 73 , Malekzadeh R 74 , Mehari A 75 , Mekonnen AB 76 , Melaku YA 77 , Memish ZA 78 , Mendoza W 79 , Misganaw A 1 , Mohamed LAI 80 , Nachega JB 81 , Nguyen QL 82 , Nisar MI 83 , Peprah EK 84 , Platts-Mills JA 85 , Pourmalek F 67 , Qorbani M 86 , Rafay A 87 , Rahimi-Movaghar V 88 , Rahman SU 89 , Rai RK 90 , Rana SM 87 , Ranabhat CL 91 , Rao SR 92 , Refaat AH 93 , Riddle M 94 , Roshandel G 95 , Ruhago GM 96 , Saleh MM 97 , Sanabria JR 98 , Sawhney M 99 , Sepanlou SG 74 , Setegn T 100 , Sliwa K 101 , Sreeramareddy CT 102 , Sykes BL 103 , Tavakkoli M 104 , Tedla BA 105 , Terkawi AS 106 , Ukwaja K 107 , Uthman OA 108 , Westerman R 109 , Wubshet M 110 , Yenesew MA 100 , Yonemoto N 111 , Younis MZ 112 , Zaidi Z 113 , Zaki MES 114 , Rabeeah AAA 13 , Wang H 1 , Naghavi M 1 , Vos T 1 , Lopez AD 115 , Murray CJL 1 , Mokdad AH 1

Affiliations 

  • 1 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
  • 2 Department of Community Medicine, Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran
  • 3 Jimma University, Jimma, Ethiopia
  • 4 Aswan Faculty of Medicine, Aswan, Egypt
  • 5 Department of Neurology, Cairo University, Cairo, Egypt
  • 6 GlaxoSmithKline, Philadelphia, Pennsylvania
  • 7 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
  • 8 University of Rhode Island, Kingston, Rhode Island
  • 9 University of Toronto, Toronto, Canada
  • 10 University of Sydney, Sydney, Australia
  • 11 Ministry of Health, Al Khuwair, Oman
  • 12 University of Oxford, Oxford, United Kingdom
  • 13 Kingdom of Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
  • 14 Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
  • 15 Ministry of Health, Jeddah, Saudi Arabia
  • 16 Charité Universitätsmedizin, Berlin, Germany
  • 17 Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
  • 18 King Saud University, Riyadh, Saudi Arabia
  • 19 Universidad de Cartagena, Cartagena de Indias, Colombia
  • 20 Ministry of Public Health, Beirut, Lebanon
  • 21 Department of Health Policy and Administration, College of Public Health, University of the Philippines, Manila, Philippines
  • 22 Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran
  • 23 South Asian Public Health Forum, Islamabad, Pakistan
  • 24 Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
  • 25 Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  • 26 School of Health Sciences, University of Management and Technology, Lahore, Pakistan
  • 27 Public Health Agency of Canada, Toronto, Canada
  • 28 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • 29 College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
  • 30 Madawalabu University, Bale Goba, Ethiopia
  • 31 University of São Paulo, São Paulo, Brazil
  • 32 Mekelle University, Mekelle, Ethiopia
  • 33 Medical Center, Aga Khan University, Karachi, Pakistan
  • 34 University of Iowa Hospitals and Clinics, Iowa City, Iowa
  • 35 Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
  • 36 Walden University, Minneapolis, Minnesota
  • 37 International Institute for Population Sciences, Mumbai, India
  • 38 Arba Minch University, Arba Minch, Ethiopia
  • 39 London School of Hygiene and Tropical Medicine, London, United Kingdom
  • 40 University of Louisville, Louisville, Kentucky
  • 41 Institute for Health Policy, Boston, Massachusetts
  • 42 Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  • 43 Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
  • 44 Bielefeld University, Bielefeld, Germany
  • 45 Harvard University, Boston, Massachusetts
  • 46 Melbourne Health, Parkville, Australia
  • 47 College of Medicine, University of Hail, Hail, Saudi Arabia
  • 48 Kersa Health and Demographic Surveillance System, Harar, Ethiopia
  • 49 Department of Epidemiology and Biostatistics, Saint James School of Medicine, Anguilla, British West Indies
  • 50 West Virginia Bureau for Public Health, Charleston, West Virginia
  • 51 Kilte Awlaelo Health and Demographic Surveillance System, Ethiopia
  • 52 Arabian Gulf University, Manama, Bahrain
  • 53 Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
  • 54 Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
  • 55 Department of Epidemiology, Salah Azaiz Institute, Tunis, Tunisia
  • 56 Qatar University, Doha, Qatar
  • 57 Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • 58 University of Aberdeen, Aberdeen, United Kingdom
  • 59 Wageningen University, Wageningen, Netherlands
  • 60 Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
  • 61 Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • 62 Jordan University of Science and Technology, Irbid, Jordan
  • 63 Health Services Academy, Islamabad, Pakistan
  • 64 Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
  • 65 Executive Board of the Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia
  • 66 Centre for Research and Action in Public Health, Faculty of Health, University of Canberra, Canberra, Australia
  • 67 University of British Columbia, Vancouver, Canada
  • 68 Research and Development Unit, Parc Sanitari Sant Joan de Deu (CIBERSAM), Barcelona, Spain
  • 69 Australian National University, Canberra, Australia
  • 70 Department of Zoology, Lahore College for Women University, Lahore, Pakistan
  • 71 School of Medicine, University of Liverpool, Liverpool, United Kingdom
  • 72 Mansoura Faculty of Medicine, Mansoura, Egypt
  • 73 Imperial College London, London, United Kingdom
  • 74 Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  • 75 Howard University College of Medicine, Washington, District of Columbia
  • 76 University of Gondar, Gondar, Ethiopia
  • 77 School of Medicine, University of Adelaide, Adelaide, Australia
  • 78 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
  • 79 United Nations Population Fund, Lima, Peru
  • 80 Federal Ministry of Health, Khartoum, Sudan
  • 81 Stellenbosch University, Cape Town, Western Cape, South Africa
  • 82 Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
  • 83 Aga Khan University, Karachi, Pakistan
  • 84 National Heart, Lung, and Blood Institute, Bethesda, Maryland
  • 85 University of Virginia, Charlottesville, Virginia
  • 86 Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
  • 87 Contech School of Public Health, Lahore, Pakistan
  • 88 Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • 89 Hamad Medical Corporation, Doha, Qatar
  • 90 Society for Health and Demographic Surveillance, Suri, India
  • 91 Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
  • 92 Department of Surgery, School of Medicine, Boston University, Boston, Massachusetts
  • 93 Suez Canal University, Ismailia, Egypt
  • 94 Naval Medical Research Center, Silver Spring, Maryland
  • 95 Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
  • 96 Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  • 97 Development Research and Projects Center, Abuja, Nigeria
  • 98 Case Western Reserve University, Cleveland, Ohio
  • 99 Marshall University, Huntington, West Virginia
  • 100 Bahir Dar University, Bahir Dar, Ethiopia
  • 101 Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
  • 102 Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia
  • 103 Departments of Criminology, Law and Society, Sociology, and Public Health, University of California-Irvine, Irvine, California
  • 104 Westchester Medical Center, Valhalla, New York
  • 105 James Cook University, Cairns, Australia
  • 106 Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia
  • 107 Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
  • 108 Warwick Medical School, University of Warwick, Coventry, United Kingdom
  • 109 German National Cohort Consortium, Heidelberg, Germany
  • 110 Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
  • 111 Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
  • 112 Jackson State University, Jackson, Mississippi
  • 113 University Hospital, Setif, Algeria
  • 114 Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • 115 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
Am J Trop Med Hyg, 2016 Dec 07;95(6):1319-1329.
PMID: 27928080 DOI: 10.4269/ajtmh.16-0339

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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