Background
Methods
Search strategy and selection criteria
Data abstraction
Data analysis
Envelope of Diarrhea | Severity | Algorithm (Data Source)1
| Source of Duration & Severity Outcomes |
---|---|---|---|
Childhood Diarrhea | Mild | Proportion not seeking care (DHS) | Community-based studies |
Moderate | Proportion seeking care (DHS) Proportion outpatients without severe dehydration (MA) | Hospital outpatient studies | |
Severe | Proportion seeking care (DHS) Proportion outpatients with severe dehydration (MA) | Hospital inpatient studies | |
Adult Diarrhea | Mild | Proportion community-based cases without dehydration (MA) | Community-based studies |
Moderate | Proportion community-based cases with any dehydration (MA) | Hospital outpatient studies | |
Severe | Proportion community-based cases with any dehydration Proportion outpatients with severe dehydration (MA) | Hospital inpatient studies |
Results
Systematic literature review
Duration of diarrheal episodes
Duration Outcome | Study Design | Study Sites1
N | Combined Estimate % (95% CI) |
---|---|---|---|
Low- and middle-income countries
| |||
0-59 mos
| |||
Weighted Mean
2
| Community | 29 | 4.3 (4.3-4.4) |
Hospital - Inpatient | 2 | 8.4 (8.1-8.8) | |
Weighted Median
2
| Community | 8 | 3.1 (3.0-3.2) |
Hospital - Inpatient | 1 | 2.0 (-) | |
Weighted Proportion Persistent
3
| Community | 12 | 4.9 (4.6-5.2) |
Hospital - Inpatient | 4 | 11.1 (9.3-12.9) | |
Hospital - Outpatient | 1 | 15.4 (-) | |
5-15 yrs
| |||
Mean
| Community | 1 | 2.7 (-) |
≥ 16 yrs
| |||
Mean
| Community | 1 | 3.0 (-) |
Hospital - Inpatient | 1 | 2.6 (-) | |
High-income countries
| |||
0-59 mos
| |||
Mean
| Community | 1 | 2.2 (-) |
Median
| Community | 1 | 1.0 (-) |
≥ 16 yrs
| |||
Mean
| Community | 1 | 2.6 (-) |
Hospital - Outpatient | 1 | 4.6 (3.6-5.2) |
Severity of diarrheal illness
Study Sites1
N | Weighted Mean2
% (95% CI) | ||
---|---|---|---|
Community
| |||
Dehydration
| Any | 6 | 7.3 (6.6-8.0) |
Severe | 1 | 10.9 (-) | |
Vomiting
| 10 | 18.1 (17.4-18.7) | |
Bloody Stool
| 9 | 8.7 (8.2-9.2) | |
Stool Frequency
3
| Frequency > 5 stools/day | 3 | 13.4 (12.5-14.2) |
Frequency > 3 stools/day | 2 | 57.5 (54.4-60.5) | |
Mean Stool Frequency (stools/day) | 3 | 4.99 (4.80-5.18) | |
Hospital Outpatient
| |||
Dehydration
| Any | 3 | 51.4 (49.1-53.8) |
Mild | 1 | 32.8 (-) | |
Moderate | 4 | 45.1 (43.5-46.7) | |
Severe | 2 | 1.4 (0.7-2.1) | |
Vomiting
| 2 | 55.7 (52.8-58.5) | |
Stool Frequency
3
| Low | 1 | 63.4 (-) |
Medium | 1 | 22.7 (-) | |
High | 1 | 14.0 (-) | |
Frequency > 5 stools/day | 1 | 55.1 (-) | |
Frequency > 3 stools/day | 3 | 84.4 (83.0-85.7) | |
Hospital Inpatient
| |||
Dehydration
| Any | 7 | 84.6 (83.1-86.1) |
Mild | 5 | 66.7 (63.4-70.0) | |
Moderate | 6 | 18.6 (16.2-20.9) | |
Severe | 10 | 8.1 (7.6-8.6) | |
Vomiting
| 2 | 58.3 (54.3-62.2) | |
Bloody Stool
| 1 | 16.2 (-) | |
Stool Frequency
3
| High | 1 | 53.6 (-) |
Frequency > 5 stools/day | 1 | 90.0 (-) | |
Stool Volume
| Mean Stool Volume (kg/g/day) | 1 | 52.6 (-) |
Study Sites1
N | Weighted Mean2
% (95% CI) | ||
---|---|---|---|
Low- and middle-income countries
| |||
Community
| |||
Dehydration
| Any | 1 | 5.0 (-) |
Vomiting
| 1 | 24.9 (-) | |
Hospital Outpatient
| |||
Dehydration
| Any | 1 | 30.1 (-) |
Vomiting
| 1 | 43.3 (-) | |
Bloody Stool
| 1 | 10.0 (-) | |
Stool Frequency
| Mean Stool Frequency (stools/day) | 1 | 8.1 (-) |
Hospital Inpatient
| |||
Dehydration
| Any | 2 | 92.8 (90.1-95.5) |
Mild | 1 | 0 (-) | |
Moderate | 1 | 72.7 (-) | |
Severe | 2 | 40.3 (35.2-45.5) | |
Vomiting
| 1 | 83.0 (-) | |
High-income countries
| |||
Community
| |||
Vomiting
| 1 | 75.0 (-) | |
Hospital Outpatient
| |||
Vomiting
| 1 | 25.9 (-) |
Diarrhea care-seeking practices
Region | Diarrhea Care-seeking (%) |
---|---|
West/Middle Africa* | 26.9 |
South/East Africa** | 39.1 |
North Africa/West Asia/Europe^
| 41.0 |
Central Asia^^
| 35.6 |
South/Southeast Asia†
| 31.0 |
Latin America/Caribbean††
| 34.8 |
Global Median
|
35.2
|
Estimating the total envelope of diarrhea
Discussion
GBD Region | Total # Diarrhea Episodes 0-59 mos[71]* | Total # Mild Episodes | Total # Moderate Episodes | Total # Severe Episodes |
---|---|---|---|---|
African | 448,755,780 | 290,793,745 | 155,718,256 | 2,243,779 |
Americas | 220,278,200 | 142,740,274 | 76,436,535 | 1,101,391 |
Eastern Mediterranean | 199,376,910 | 129,196,238 | 69,183,788 | 996,885 |
Europe | 111,344,240 | 72,151,068 | 38,636,451 | 556,721 |
South East Asian | 436,836,240 | 283,069,884 | 151,582,175 | 2,184,181 |
Western Pacific | 254,965,120 | 165,217,398 | 88,472,897 | 1,274,826 |
Total
|
1,671,556,490
|
1,083,168,606
|
580,030,102
|
8,357,782
|
Study Period | Outcome | Africa | Asia |
---|---|---|---|
1987-1991 | Mean Duration1
| 4.4 (4.3-4.5)* | 2.9 (2.8-3.0)* |
1990-1994 | Mild Dehydration2
| 69.8 (-) | 65.6 (61.7-69.5)** |
Severe Dehydration2
| 30.2 (-) | 7.2 (5.4-9.0)** | |
1992-1998 | Any Dehydration1
| 77.4 (-) | 1.9 (1.4-2.4)** |
Vomiting1
| 20.3 (19.0-21.6)** | 19.4 (18.0-20.9)** | |
2000-2005 | Mean Duration1
| 4.8 (4.6-5.1)* | 3.4 (3.2-3.5)* |
Median Duration1
| 5.0 (-) | 2.2 (2.1-2.3)* |