Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting
Summary: Background: Diarrhoea, a global cause of child mortality and morbidity, is linked to adverse consequences including childhood stunting and death from other diseases. Few studies explore how diarrhoeal mortality varies subnationally, especially by cause, which is important for targeting inv...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-01-01
|
| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X19304565 |
| _version_ | 1818291026146623488 |
|---|---|
| author | Karoun H Bagamian, PhD John D Anderson, IV, PhD Farzana Muhib, MPH Oliver Cumming, MSc Lindsey A Laytner, PhD Thomas F Wierzba, ProfPhD Richard Rheingans, ProfPhD |
| author_facet | Karoun H Bagamian, PhD John D Anderson, IV, PhD Farzana Muhib, MPH Oliver Cumming, MSc Lindsey A Laytner, PhD Thomas F Wierzba, ProfPhD Richard Rheingans, ProfPhD |
| author_sort | Karoun H Bagamian, PhD |
| collection | DOAJ |
| description | Summary: Background: Diarrhoea, a global cause of child mortality and morbidity, is linked to adverse consequences including childhood stunting and death from other diseases. Few studies explore how diarrhoeal mortality varies subnationally, especially by cause, which is important for targeting investments. Even fewer examine indirect effects of diarrhoeal morbidity on child mortality. We estimated the subnational distribution of mortality, morbidity, and childhood stunting attributable to enterotoxigenic Escherichia coli (ETEC) and shigella infection in children younger than 5 years from 11 eastern and central African countries. These pathogens are leading causes of diarrhoea in young children and have been linked to increased childhood stunting. Methods: We combined proxy indicators of morbidity and mortality risk from the most recent Demographic and Health Surveys with published relative risks to estimate the potential distribution of diarrhoeal disease risk. To estimate subnational burden, we used country-specific or WHO region-specific morbidity and mortality estimates and distributed them subnationally by three indices that integrate relevant individual characteristics (ie, underweight, probability of receiving oral rehydration treatment of diarrhoea, and receiving vitamin A supplementation) and household characteristics (ie, type of drinking water and sanitation facilities). Findings: Characterising ETEC and shigella subnational estimates of indirect morbidity (infection-attributable stunting) and indirect mortality (stunting-related deaths from other infectious diseases) identified high-risk areas that could be missed by traditional metrics. Burundi and Democratic Republic of the Congo had the highest ETEC-associated and shigella-associated mortality and stunting rates. Mozambique, Democratic Republic of the Congo, and Zimbabwe had the greatest subnational heterogeneity in most ETEC and shigella mortality measures. Inclusion of indirect ETEC and shigella mortality in burden estimates resulted in a 20–30% increase in total ETEC and shigella mortality rates in some subnational areas. Interpretation: Understanding the indirect mortality and morbidity of diarrhoeal pathogens on a subnational level will strengthen disease control strategies and could have important implications for the relative impact and cost-effectiveness of new enteric vaccines. Because our methods rely on publicly available data, they could be employed for national planning. Funding: Bill & Melinda Gates Foundation. |
| first_indexed | 2024-12-13T02:37:31Z |
| format | Article |
| id | doaj.art-f72cd5d187394f0a83050b0efe013c53 |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-13T02:37:31Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-f72cd5d187394f0a83050b0efe013c532022-12-22T00:02:23ZengElsevierThe Lancet Global Health2214-109X2020-01-0181e101e112Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stuntingKaroun H Bagamian, PhD0John D Anderson, IV, PhD1Farzana Muhib, MPH2Oliver Cumming, MSc3Lindsey A Laytner, PhD4Thomas F Wierzba, ProfPhD5Richard Rheingans, ProfPhD6Department of Environmental & Global Health, University of Florida, FL, USA; Bagamian Scientific Consulting, Gainesville, FL, USA; Correspondence to: Karoun H Bagamian, Bagamian Scientific Consulting, Gainesville, FL 32601, USADepartment of Environmental & Global Health, University of Florida, FL, USA; Goodnight Family Department of Sustainable Development, Appalachian State University, Boone, NC, USAPATH, Washington, DC, USADepartment of Disease Control, London School of Hygiene & Tropical Medicine, London, UKDepartment of Environmental & Global Health, University of Florida, FL, USAPATH, Washington, DC, USA; Department of Internal Medicine, Section on Infectious Diseases, Wake Forest School of Medicine, Winston Salem, NC, USAGoodnight Family Department of Sustainable Development, Appalachian State University, Boone, NC, USASummary: Background: Diarrhoea, a global cause of child mortality and morbidity, is linked to adverse consequences including childhood stunting and death from other diseases. Few studies explore how diarrhoeal mortality varies subnationally, especially by cause, which is important for targeting investments. Even fewer examine indirect effects of diarrhoeal morbidity on child mortality. We estimated the subnational distribution of mortality, morbidity, and childhood stunting attributable to enterotoxigenic Escherichia coli (ETEC) and shigella infection in children younger than 5 years from 11 eastern and central African countries. These pathogens are leading causes of diarrhoea in young children and have been linked to increased childhood stunting. Methods: We combined proxy indicators of morbidity and mortality risk from the most recent Demographic and Health Surveys with published relative risks to estimate the potential distribution of diarrhoeal disease risk. To estimate subnational burden, we used country-specific or WHO region-specific morbidity and mortality estimates and distributed them subnationally by three indices that integrate relevant individual characteristics (ie, underweight, probability of receiving oral rehydration treatment of diarrhoea, and receiving vitamin A supplementation) and household characteristics (ie, type of drinking water and sanitation facilities). Findings: Characterising ETEC and shigella subnational estimates of indirect morbidity (infection-attributable stunting) and indirect mortality (stunting-related deaths from other infectious diseases) identified high-risk areas that could be missed by traditional metrics. Burundi and Democratic Republic of the Congo had the highest ETEC-associated and shigella-associated mortality and stunting rates. Mozambique, Democratic Republic of the Congo, and Zimbabwe had the greatest subnational heterogeneity in most ETEC and shigella mortality measures. Inclusion of indirect ETEC and shigella mortality in burden estimates resulted in a 20–30% increase in total ETEC and shigella mortality rates in some subnational areas. Interpretation: Understanding the indirect mortality and morbidity of diarrhoeal pathogens on a subnational level will strengthen disease control strategies and could have important implications for the relative impact and cost-effectiveness of new enteric vaccines. Because our methods rely on publicly available data, they could be employed for national planning. Funding: Bill & Melinda Gates Foundation.http://www.sciencedirect.com/science/article/pii/S2214109X19304565 |
| spellingShingle | Karoun H Bagamian, PhD John D Anderson, IV, PhD Farzana Muhib, MPH Oliver Cumming, MSc Lindsey A Laytner, PhD Thomas F Wierzba, ProfPhD Richard Rheingans, ProfPhD Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting The Lancet Global Health |
| title | Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting |
| title_full | Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting |
| title_fullStr | Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting |
| title_full_unstemmed | Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting |
| title_short | Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting |
| title_sort | heterogeneity in enterotoxigenic escherichia coli and shigella infections in children under 5 years of age from 11 african countries a subnational approach quantifying risk mortality morbidity and stunting |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X19304565 |
| work_keys_str_mv | AT karounhbagamianphd heterogeneityinenterotoxigenicescherichiacoliandshigellainfectionsinchildrenunder5yearsofagefrom11africancountriesasubnationalapproachquantifyingriskmortalitymorbidityandstunting AT johndandersonivphd heterogeneityinenterotoxigenicescherichiacoliandshigellainfectionsinchildrenunder5yearsofagefrom11africancountriesasubnationalapproachquantifyingriskmortalitymorbidityandstunting AT farzanamuhibmph heterogeneityinenterotoxigenicescherichiacoliandshigellainfectionsinchildrenunder5yearsofagefrom11africancountriesasubnationalapproachquantifyingriskmortalitymorbidityandstunting AT olivercummingmsc heterogeneityinenterotoxigenicescherichiacoliandshigellainfectionsinchildrenunder5yearsofagefrom11africancountriesasubnationalapproachquantifyingriskmortalitymorbidityandstunting AT lindseyalaytnerphd heterogeneityinenterotoxigenicescherichiacoliandshigellainfectionsinchildrenunder5yearsofagefrom11africancountriesasubnationalapproachquantifyingriskmortalitymorbidityandstunting AT thomasfwierzbaprofphd heterogeneityinenterotoxigenicescherichiacoliandshigellainfectionsinchildrenunder5yearsofagefrom11africancountriesasubnationalapproachquantifyingriskmortalitymorbidityandstunting AT richardrheingansprofphd heterogeneityinenterotoxigenicescherichiacoliandshigellainfectionsinchildrenunder5yearsofagefrom11africancountriesasubnationalapproachquantifyingriskmortalitymorbidityandstunting |