posts: 24149
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| 24149 | More than half a million children die from diarrhea each year. How do we prevent this? | childhood-diarrheal-diseases | post | publish | <!-- wp:html --> <div class="blog-info">Our World in Data presents the empirical evidence on global development in entries dedicated to specific topics.<br>This blog post is part of our <strong><a href="https://ourworldindata.org/introducing-the-child-mortality-series" target="_blank" rel="noopener noreferrer">Child Mortality Series</a></strong> and draws on data and research discussed in our entry on <strong><a href="https://ourworldindata.org/child-mortality" target="_blank" rel="noopener noreferrer">Child & Infant Mortality</a></strong>.</div> <!-- /wp:html --> <!-- wp-block-tombstone 26761 --> <!-- wp:heading {"level":3} --> <h3>Diarrheal diseases are one of the biggest killers of children worldwide</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>In 2017, almost 1.6 million people died from diarrheal diseases globally.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>This is more than all deaths from all 'intentional injuries' combined in the same year: almost 800,000 died from suicide, 405,000 from homicide, 130,000 in conflict, and 26,500 from terrorism – in total 1,355,000.{ref}The data can be seen <a href="https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause">here</a>. The precise numbers are 793,823+405,346+26,445+129,720=1,355,334{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>As the visualization shows, one-third of all who died from diarrheal diseases were children under five years old. For most of the past three decades under-5s have accounted for the majority of deaths from diarrheal diseases – back in 1990 it killed 1.7 million children.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Diarrheal disease was the cause of every tenth child's death in 2017 – more than half a million of the 5.4 million children that died in 2017 died from diarrheal disease.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Diarrheal diseases are the <a href="https://ourworldindata.org/grapher/causes-of-death-in-children?time=2017">third leading </a>cause of child mortality globally, falling just behind pneumonia and preterm birth complications.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/deaths-from-diarrheal-diseases-by-age" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --> <!-- wp-block-tombstone 26765 --> <!-- wp:heading {"level":3} --> <h3>Where are children dying from diarrheal diseases?</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The death rate from diarrheal diseases is highest in the world's poorest countries: this chart shows the relationship between the death rate from diarrheal diseases and the country’s average income. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The death rate from diarrheal diseases in many of the poorest countries is higher than 100 annual deaths per 100,000 children. In those countries with the worst health – including Madagascar, Chad and the Central African Republic – the rate is higher than 300 per 100,000.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In high-income countries the death rate is very low. In many European countries, but also some rich Asian countries the rate is below 1 per 100,000 per year.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>At lower levels of income risk factors for diarrheal diseases such as <a href="https://ourworldindata.org/water-use-sanitation#access-to-improved-water-sources-increases-with-income">lack of access to clean water</a>, <a href="https://ourworldindata.org/grapher/share-of-one-year-olds-who-received-the-rotavirus-vaccine">rotavirus vaccine availability</a>, <a href="https://ourworldindata.org/hunger-and-undernourishment">undernutrition</a>, <a href="https://ourworldindata.org/hunger-and-undernourishment#too-little-height-for-age-stunting">stunting</a> and <a href="https://ourworldindata.org/grapher/deaths-by-risk-under5s">others</a> are the most prevalent.{ref}Troeger, Christopher, et al. <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30362-1/fulltext">"Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016."</a> <em>The Lancet Infectious Diseases</em> 18.11 (2018): 1211-1228.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/diarrheal-death-rates-children-vs-gdp-per-capita" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --> <!-- wp:heading {"level":3} --> <h3>What causes diarrheal diseases in children?</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Understanding the cause of disease is important so that we can set our priorities on the interventions and treatments that would save most lives, e.g. developing vaccines against the main agents for diarrhea and using antibiotic treatments only when they are appropriate.</p> <!-- /wp:paragraph --> <!-- wp-block-tombstone 26768 --> <!-- wp:paragraph --> <p>Diarrheal diseases are caused primarily by viral and bacterial pathogens. The visualization shows the major pathogens responsible for diarrhea in children; the area of each box corresponds to the number of deaths from diarrhea in 2016 that can be attributed to each pathogen. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>While bacterial pathogens (shown in red) are the major group of organisms responsible for diarrheal diseases, rotavirus is the single largest causative agent.{ref}Correction: <em>The previous version of the treemap incorrectly classified Cryptosporidium as a bacterial pathogen. It should in fact be grouped with protist. Thank you to the readers who noticed the</em> mistake.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:image {"id":24352} --> <figure class="wp-block-image"><img src="https://owid.cloud/app/uploads/2019/08/Diarrhea-Cause-treemap-2-726x550.png" alt="" class="wp-image-24352"/></figure> <!-- /wp:image --> <!-- wp-block-tombstone 26771 --> <!-- wp:heading {"level":3} --> <h3>Why are children still dying from diarrhea?</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>There are two main reasons why the number of children dying from diarrhea is still so large – the prevalence of diarrhea-associated risk factors and the lack of access to essential treatment.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The figure shows the number of deaths associated with the major risks factors for diarrheal diseases: unsafe drinking water, poor sanitation and malnutrition are responsible for the largest portion of deaths. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Since 1990 we have made a lot of progress in reducing these major risks; you can read more in our research entries on <a href="https://ourworldindata.org/hunger-and-undernourishment">Hunger and Undernourishment</a>, <a href="https://owid.cloud/extreme-poverty">Extreme Poverty</a> and <a href="https://ourworldindata.org/water-use-sanitation">Water Use and Sanitation</a>. But continued progress is still needed.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In addition to reducing exposure to risks factors, increasing access to oral rehydration therapy (ORT), therapeutic zinc use and the coverage of rotavirus vaccines were all shown to be essential for reducing the burden of diarrheal diseases in children.{ref}Troeger, C., Blacker, B. F., Khalil, I. A., Rao, P. C., Cao, S., Zimsen, S. R., … & Alvis-Guzman, N. (2018). <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30362-1/fulltext">Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016</a>. <em>The Lancet Infectious Diseases</em>, <em>18</em>(11), 1211-1228.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/number-of-deaths-from-diarrheal-diseases-by-risk-factor-for-under-5s" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --> <!-- wp-block-tombstone 26662 --> <!-- wp:heading {"level":3} --> <h3>How can we stop child deaths from diarrhea?</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p><span style="font-weight: 400;">Diarrheal diseases are both 'preventable and treatable', as the WHO says, because we already know how to deal with many of the risk factors that may lead to diarrhea and, if diarrhea cannot be avoided, we know how to treat it. </span></p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The table below lists the range of interventions available for the treatment of diarrhea we have today.{ref}Das, J. K., Salam, R. A., & Bhutta, Z. A. (2014). <a href="https://insights.ovid.com/pubmed?pmid=25101554">Global burden of childhood diarrhea and interventions.</a> <em>Current Opinion in Infectious Diseases</em>, <em>27</em>(5), 451-458.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p> Some of these interventions, such as ORS, breastfeeding and improvements in sanitation broadly target all-causes of diarrhea, whereas, <a href="https://owid.cloud/vaccination">vaccination</a> and antibiotic use are specifically directed against the causative agents of the disease.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Water, sanitation and hygiene (WASH) interventions are the best way to prevent diarrheal diseases. Hand washing with soap, better water quality and better sanitation have been shown to reduce the risk of diarrheal infections by 47%, 17% and 36%, respectively.{ref}Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I. C., & Schmidt, W. P. (2010). <a href="https://www.ncbi.nlm.nih.gov/pubmed/20348121">Water, sanitation and hygiene for the prevention of diarrhoea</a>. <em>International Journal of Epidemiology</em>, <em>39</em>(suppl_1), i193-i205.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Educating mothers about the importance of breastfeeding is also important. Breastfeeding allows for the transfer of maternal immunity to the child – in developing countries infants that are not breastfed are six times more likely to die from infectious diseases, such as those causing to diarrhea, in the first 2 months of their lives.{ref}Victoria, C. G. (2000). <a href="https://www.sciencedirect.com/science/article/pii/S0140673600820115">Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis</a>. <em>Lancet (British edition)</em>, <em>355</em>(9202), 451-455.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Another way to prevent diarrheal diseases is vaccination. Until relatively recently, there were few vaccines available to prevent diarrheal diseases. Cholera vaccine has been licensed since 1991 but it is primarily given to travelers and used as an outbreak control measure. This is because targeted immunization combined with other sanitary measures is more cost-effective than immunizing every individual with a vaccine that only provides a few years of protection.{ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Apps.who.int. (2019). <em>Weekly Epidemiological Record</em>. [online] Available at: <a href="https://apps.who.int/iris/bitstream/handle/10665/258763/WER9234.pdf?sequence=1">https://apps.who.int/iris/bitstream/handle/10665/258763/WER9234.pdf?sequence=1</a> [Accessed 12 Aug. 2019].</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Sinclair, David, et al. <a href="https://www.cochrane.org/CD008603/INFECTN_oral-vaccines-preventing-cholera">"Oral vaccines for preventing cholera."</a> <em>Cochrane Database of Systematic Reviews</em> 3 (2011).</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p> In 2006, however, new vaccines against rotavirus – the leading cause of childhood diarrhea as the treemap above shows – have been introduced. The most recent studies show that, while the effectiveness of the new rotavirus vaccines vary across different countries, it works well in protecting children against rotavirus disease.{ref}Jonesteller, Christine L., et al. <a href="https://academic.oup.com/cid/article/65/5/840/3746914">"Effectiveness of rotavirus vaccination: a systematic review of the first decade of global postlicensure data, 2006–2016."</a><em>Clinical Infectious Diseases </em>65.5 (2017): 840-850.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Aliabadi, Negar, et al. <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30207-4/fulltext">"Global impact of rotavirus vaccine introduction on rotavirus hospitalisations among children under 5 years of age, 2008–16: findings from the Global Rotavirus Surveillance Network."</a> <em>The Lancet Global Health </em>7.7 (2019): e893-e903.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p> We will explore the success, potential and limitations of rotavirus vaccines in an upcoming post.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>When preventative measures fail, several options for the treatment of diarrheal diseases are available, including nutritional interventions and antibiotic use when necessary. But the single best treatment for diarrheal diseases is a surprisingly simple mixture of water, salt and sugar: otherwise known as the oral rehydration solution.{ref}Fontaine, Olivier, Paul Garner, and M. K. Bhan. <a href="https://www.bmj.com/content/334/suppl_1/s14">"Oral rehydration therapy: the simple solution for saving lives."</a> <em>BMJ,</em>334.suppl 1 (2007): s14-s14.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p> The estimates of ORS effectiveness vary by source, with some suggesting that the current use of ORS helps to prevent 69% of diarrheal deaths and, if its coverage would be increased close to 100%, 93% of diarrheal deaths could be prevented.{ref}Munos, M. K., Walker, C. L. F., & Black, R. E. (2010). <a href="https://academic.oup.com/ije/article/39/suppl_1/i75/700641">The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality</a>. <em>International Journal of Epidemiology</em>, <em>39</em>(suppl_1), i75-i87.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":6} --> <h6>Potential of interventions to prevent the burden of diarrheal diseases in childhood{ref}Adapted from: Das, J. K., Salam, R. A., & Bhutta, Z. A. (2014). Global burden of childhood diarrhea and interventions. Current Opinion in Infectious Diseases, 27(5), 451-458.{/ref}</h6> <!-- /wp:heading --> <!-- wp:shortcode --> <table><thead><tr><th scope="col" colSpan="1">Intervention</th><th scope="col" colSpan="1">Estimate of the effect size</th></tr></thead><tbody><tr><td colSpan="1" rowspan="1">Handwashing with soap</td><td colSpan="1" rowspan="1">48% risk reduction</td></tr><tr><td colSpan="1" rowspan="1">Improved water quality</td><td colSpan="1" rowspan="1">17% risk reduction</td></tr><tr><td colSpan="1" rowspan="1">Excreta disposal (improved sanitation)</td><td colSpan="1" rowspan="1">36% risk reduction</td></tr><tr><td colSpan="1" rowspan="1">Breastfeeding education</td><td colSpan="1" rowspan="1">43% increase in exclusive breastfeeding rates at day 1, 30% increase until 1 month, and 90% increase from 1-6 months</td></tr><tr><td colSpan="1" rowspan="1">Preventive zinc supplementation</td><td colSpan="1" rowspan="1">13% reduction in diarrhea incidence, but no effect on mortality</td></tr><tr><td colSpan="1" rowspan="1">Therapeutic zinc supplementation</td><td colSpan="1" rowspan="1">46% reduction in all-cause mortality and 23% reduction in hospitalization due to diarrhea</td></tr><tr><td colSpan="1" rowspan="1">Rotavirus vaccines</td><td colSpan="1" rowspan="1">74% effectiveness against very severe rotavirus infection; 61% against severe; 47% reduction in hospitalization</td></tr><tr><td colSpan="1" rowspan="1">Cholera vaccines</td><td colSpan="1" rowspan="1">52% effective against cholera infection</td></tr><tr><td colSpan="1" rowspan="1">Oral rehydration solution (ORS)</td><td colSpan="1" rowspan="1">69% reduction in diarrhea-specific mortality</td></tr><tr><td colSpan="1" rowspan="1">Dietary management for diarrhea </td><td colSpan="1" rowspan="1">47% reduction in diarrhea treatment failure and 47% reduction in treatment failure </td></tr><tr><td colSpan="1" rowspan="1">Antibiotics for cholera</td><td colSpan="1" rowspan="1">63% reduction in clinical failure rates</td></tr><tr><td colSpan="1" rowspan="1">Antibiotics for Shigella</td><td colSpan="1" rowspan="1">82% reduction in clinical failure rates</td></tr><tr><td colSpan="1" rowspan="1">Antibiotics for cryptosporidiosis </td><td colSpan="1" rowspan="1">52% reduction in clinical failure rates</td></tr><tr><td colSpan="1" rowspan="1">Community-based interventions (home visits and healthcare promotion)</td><td colSpan="1" rowspan="1">160% increase in ORS use and 80% increase in zinc use. 9% increase in seeking care for diarrhea and 75% reduction in inappropriate antibiotic use</td></tr></tbody></table> <!-- /wp:shortcode --> <!-- wp:paragraph --> <p>We will look in more detail at the specific prevention and treatment measures against diarrheal diseases in upcoming posts. This should help to make clear what is possible and effective in preventing and treating one of the leading causes of death in children.</p> <!-- /wp:paragraph --> | {
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2019-08-16 14:00:26 | 2024-02-16 14:22:48 | 17qaWKnVg7YF4QEnEBm0TZkK7EHm5_KBBchBi_ujmkl0 | [
"Bernadeta Dadonaite"
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Despite being treatable and preventable, 1.6 million people died from diarrheal diseases in 2017; one-third were children under five years old. This makes it one of the largest killers of children. Here we look at where and why children are dying from diarrrheal diseases, and what we can do stop this. | 2019-08-12 11:42:19 | 2020-04-30 14:00:14 | https://ourworldindata.org/wp-content/uploads/2019/08/deaths-from-diarrheal-diseases-by-age.png | {} |
Our World in Data presents the empirical evidence on global development in entries dedicated to specific topics. This blog post is part of our **[Child Mortality Series](https://ourworldindata.org/introducing-the-child-mortality-series)** and draws on data and research discussed in our entry on **[Child & Infant Mortality](https://ourworldindata.org/child-mortality)** . ## Diarrheal diseases are one of the biggest killers of children worldwide In 2017, almost 1.6 million people died from diarrheal diseases globally. This is more than all deaths from all 'intentional injuries' combined in the same year: almost 800,000 died from suicide, 405,000 from homicide, 130,000 in conflict, and 26,500 from terrorism – in total 1,355,000.{ref}The data can be seen [here](https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause). The precise numbers are 793,823+405,346+26,445+129,720=1,355,334{/ref} As the visualization shows, one-third of all who died from diarrheal diseases were children under five years old. For most of the past three decades under-5s have accounted for the majority of deaths from diarrheal diseases – back in 1990 it killed 1.7 million children. Diarrheal disease was the cause of every tenth child's death in 2017 – more than half a million of the 5.4 million children that died in 2017 died from diarrheal disease. Diarrheal diseases are the [third leading ](https://ourworldindata.org/grapher/causes-of-death-in-children?time=2017)cause of child mortality globally, falling just behind pneumonia and preterm birth complications. <Chart url="https://ourworldindata.org/grapher/deaths-from-diarrheal-diseases-by-age"/> ## Where are children dying from diarrheal diseases? The death rate from diarrheal diseases is highest in the world's poorest countries: this chart shows the relationship between the death rate from diarrheal diseases and the country’s average income. The death rate from diarrheal diseases in many of the poorest countries is higher than 100 annual deaths per 100,000 children. In those countries with the worst health – including Madagascar, Chad and the Central African Republic – the rate is higher than 300 per 100,000. In high-income countries the death rate is very low. In many European countries, but also some rich Asian countries the rate is below 1 per 100,000 per year. At lower levels of income risk factors for diarrheal diseases such as [lack of access to clean water](https://ourworldindata.org/water-use-sanitation#access-to-improved-water-sources-increases-with-income), [rotavirus vaccine availability](https://ourworldindata.org/grapher/share-of-one-year-olds-who-received-the-rotavirus-vaccine), [undernutrition](https://ourworldindata.org/hunger-and-undernourishment), [stunting](https://ourworldindata.org/hunger-and-undernourishment#too-little-height-for-age-stunting) and [others](https://ourworldindata.org/grapher/deaths-by-risk-under5s) are the most prevalent.{ref}Troeger, Christopher, et al. ["Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016."](https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30362-1/fulltext)_The Lancet Infectious Diseases_ 18.11 (2018): 1211-1228.{/ref} <Chart url="https://ourworldindata.org/grapher/diarrheal-death-rates-children-vs-gdp-per-capita"/> ## What causes diarrheal diseases in children? Understanding the cause of disease is important so that we can set our priorities on the interventions and treatments that would save most lives, e.g. developing vaccines against the main agents for diarrhea and using antibiotic treatments only when they are appropriate. Diarrheal diseases are caused primarily by viral and bacterial pathogens. The visualization shows the major pathogens responsible for diarrhea in children; the area of each box corresponds to the number of deaths from diarrhea in 2016 that can be attributed to each pathogen. While bacterial pathogens (shown in red) are the major group of organisms responsible for diarrheal diseases, rotavirus is the single largest causative agent.{ref}Correction: _The previous version of the treemap incorrectly classified Cryptosporidium as a bacterial pathogen. It should in fact be grouped with protist. Thank you to the readers who noticed the_ mistake.{/ref} <Image filename="Diarrhea-Cause-treemap-2.png" alt=""/> ## Why are children still dying from diarrhea? There are two main reasons why the number of children dying from diarrhea is still so large – the prevalence of diarrhea-associated risk factors and the lack of access to essential treatment. The figure shows the number of deaths associated with the major risks factors for diarrheal diseases: unsafe drinking water, poor sanitation and malnutrition are responsible for the largest portion of deaths. Since 1990 we have made a lot of progress in reducing these major risks; you can read more in our research entries on [Hunger and Undernourishment](https://ourworldindata.org/hunger-and-undernourishment), [Extreme Poverty](https://owid.cloud/extreme-poverty) and [Water Use and Sanitation](https://ourworldindata.org/water-use-sanitation). But continued progress is still needed. In addition to reducing exposure to risks factors, increasing access to oral rehydration therapy (ORT), therapeutic zinc use and the coverage of rotavirus vaccines were all shown to be essential for reducing the burden of diarrheal diseases in children.{ref}Troeger, C., Blacker, B. F., Khalil, I. A., Rao, P. C., Cao, S., Zimsen, S. R., … & Alvis-Guzman, N. (2018). [Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016](https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30362-1/fulltext). _The Lancet Infectious Diseases_, _18_(11), 1211-1228.{/ref} <Chart url="https://ourworldindata.org/grapher/number-of-deaths-from-diarrheal-diseases-by-risk-factor-for-under-5s"/> ## How can we stop child deaths from diarrhea? Diarrheal diseases are both 'preventable and treatable', as the WHO says, because we already know how to deal with many of the risk factors that may lead to diarrhea and, if diarrhea cannot be avoided, we know how to treat it. The table below lists the range of interventions available for the treatment of diarrhea we have today.{ref}Das, J. K., Salam, R. A., & Bhutta, Z. A. (2014). [Global burden of childhood diarrhea and interventions.](https://insights.ovid.com/pubmed?pmid=25101554)_Current Opinion in Infectious Diseases_, _27_(5), 451-458.{/ref} Some of these interventions, such as ORS, breastfeeding and improvements in sanitation broadly target all-causes of diarrhea, whereas, [vaccination](https://owid.cloud/vaccination) and antibiotic use are specifically directed against the causative agents of the disease. Water, sanitation and hygiene (WASH) interventions are the best way to prevent diarrheal diseases. Hand washing with soap, better water quality and better sanitation have been shown to reduce the risk of diarrheal infections by 47%, 17% and 36%, respectively.{ref}Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I. C., & Schmidt, W. P. (2010). [Water, sanitation and hygiene for the prevention of diarrhoea](https://www.ncbi.nlm.nih.gov/pubmed/20348121). _International Journal of Epidemiology_, _39_(suppl_1), i193-i205.{/ref} Educating mothers about the importance of breastfeeding is also important. Breastfeeding allows for the transfer of maternal immunity to the child – in developing countries infants that are not breastfed are six times more likely to die from infectious diseases, such as those causing to diarrhea, in the first 2 months of their lives.{ref}Victoria, C. G. (2000). [Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis](https://www.sciencedirect.com/science/article/pii/S0140673600820115). _Lancet (British edition)_, _355_(9202), 451-455.{/ref} Another way to prevent diarrheal diseases is vaccination. Until relatively recently, there were few vaccines available to prevent diarrheal diseases. Cholera vaccine has been licensed since 1991 but it is primarily given to travelers and used as an outbreak control measure. This is because targeted immunization combined with other sanitary measures is more cost-effective than immunizing every individual with a vaccine that only provides a few years of protection.{ref} Apps.who.int. (2019). _Weekly Epidemiological Record_. [online] Available at: [https://apps.who.int/iris/bitstream/handle/10665/258763/WER9234.pdf?sequence=1](https://apps.who.int/iris/bitstream/handle/10665/258763/WER9234.pdf?sequence=1) [Accessed 12 Aug. 2019]. Sinclair, David, et al. ["Oral vaccines for preventing cholera."](https://www.cochrane.org/CD008603/INFECTN_oral-vaccines-preventing-cholera)_Cochrane Database of Systematic Reviews_ 3 (2011). {/ref} In 2006, however, new vaccines against rotavirus – the leading cause of childhood diarrhea as the treemap above shows – have been introduced. The most recent studies show that, while the effectiveness of the new rotavirus vaccines vary across different countries, it works well in protecting children against rotavirus disease.{ref}Jonesteller, Christine L., et al. ["Effectiveness of rotavirus vaccination: a systematic review of the first decade of global postlicensure data, 2006–2016."](https://academic.oup.com/cid/article/65/5/840/3746914)_Clinical Infectious Diseases _65.5 (2017): 840-850. Aliabadi, Negar, et al. ["Global impact of rotavirus vaccine introduction on rotavirus hospitalisations among children under 5 years of age, 2008–16: findings from the Global Rotavirus Surveillance Network."](https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30207-4/fulltext)_The Lancet Global Health _7.7 (2019): e893-e903.{/ref} We will explore the success, potential and limitations of rotavirus vaccines in an upcoming post. When preventative measures fail, several options for the treatment of diarrheal diseases are available, including nutritional interventions and antibiotic use when necessary. But the single best treatment for diarrheal diseases is a surprisingly simple mixture of water, salt and sugar: otherwise known as the oral rehydration solution.{ref}Fontaine, Olivier, Paul Garner, and M. K. Bhan. ["Oral rehydration therapy: the simple solution for saving lives."](https://www.bmj.com/content/334/suppl_1/s14)_BMJ,_334.suppl 1 (2007): s14-s14.{/ref} The estimates of ORS effectiveness vary by source, with some suggesting that the current use of ORS helps to prevent 69% of diarrheal deaths and, if its coverage would be increased close to 100%, 93% of diarrheal deaths could be prevented.{ref}Munos, M. K., Walker, C. L. F., & Black, R. E. (2010). [The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality](https://academic.oup.com/ije/article/39/suppl_1/i75/700641). _International Journal of Epidemiology_, _39_(suppl_1), i75-i87.{/ref} ##### Potential of interventions to prevent the burden of diarrheal diseases in childhood{ref}Adapted from: Das, J. K., Salam, R. A., & Bhutta, Z. A. (2014). Global burden of childhood diarrhea and interventions. Current Opinion in Infectious Diseases, 27(5), 451-458.{/ref} <div class="raw-html-table__container"><table><thead><tr><th scope="col" colspan="1">Intervention</th><th scope="col" colspan="1">Estimate of the effect size</th></tr></thead><tbody><tr><td colspan="1" rowspan="1">Handwashing with soap</td><td colspan="1" rowspan="1">48% risk reduction</td></tr><tr><td colspan="1" rowspan="1">Improved water quality</td><td colspan="1" rowspan="1">17% risk reduction</td></tr><tr><td colspan="1" rowspan="1">Excreta disposal (improved sanitation)</td><td colspan="1" rowspan="1">36% risk reduction</td></tr><tr><td colspan="1" rowspan="1">Breastfeeding education</td><td colspan="1" rowspan="1">43% increase in exclusive breastfeeding rates at day 1, 30% increase until 1 month, and 90% increase from 1-6 months</td></tr><tr><td colspan="1" rowspan="1">Preventive zinc supplementation</td><td colspan="1" rowspan="1">13% reduction in diarrhea incidence, but no effect on mortality</td></tr><tr><td colspan="1" rowspan="1">Therapeutic zinc supplementation</td><td colspan="1" rowspan="1">46% reduction in all-cause mortality and 23% reduction in hospitalization due to diarrhea</td></tr><tr><td colspan="1" rowspan="1">Rotavirus vaccines</td><td colspan="1" rowspan="1">74% effectiveness against very severe rotavirus infection; 61% against severe; 47% reduction in hospitalization</td></tr><tr><td colspan="1" rowspan="1">Cholera vaccines</td><td colspan="1" rowspan="1">52% effective against cholera infection</td></tr><tr><td colspan="1" rowspan="1">Oral rehydration solution (ORS)</td><td colspan="1" rowspan="1">69% reduction in diarrhea-specific mortality</td></tr><tr><td colspan="1" rowspan="1">Dietary management for diarrhea </td><td colspan="1" rowspan="1">47% reduction in diarrhea treatment failure and 47% reduction in treatment failure </td></tr><tr><td colspan="1" rowspan="1">Antibiotics for cholera</td><td colspan="1" rowspan="1">63% reduction in clinical failure rates</td></tr><tr><td colspan="1" rowspan="1">Antibiotics for Shigella</td><td colspan="1" rowspan="1">82% reduction in clinical failure rates</td></tr><tr><td colspan="1" rowspan="1">Antibiotics for cryptosporidiosis </td><td colspan="1" rowspan="1">52% reduction in clinical failure rates</td></tr><tr><td colspan="1" rowspan="1">Community-based interventions (home visits and healthcare promotion)</td><td colspan="1" rowspan="1">160% increase in ORS use and 80% increase in zinc use. 9% increase in seeking care for diarrhea and 75% reduction in inappropriate antibiotic use</td></tr></tbody></table></div> We will look in more detail at the specific prevention and treatment measures against diarrheal diseases in upcoming posts. This should help to make clear what is possible and effective in preventing and treating one of the leading causes of death in children. | {
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"rendered": "\n<div class=\"blog-info\">Our World in Data presents the empirical evidence on global development in entries dedicated to specific topics.<br>This blog post is part of our <strong><a href=\"https://ourworldindata.org/introducing-the-child-mortality-series\" target=\"_blank\" rel=\"noopener noreferrer\">Child Mortality Series</a></strong> and draws on data and research discussed in our entry on <strong><a href=\"https://ourworldindata.org/child-mortality\" target=\"_blank\" rel=\"noopener noreferrer\">Child & Infant Mortality</a></strong>.</div>\n\n\n\n<h3>Diarrheal diseases are one of the biggest killers of children worldwide</h3>\n\n\n\n<p>In 2017, almost 1.6 million people died from diarrheal diseases globally.</p>\n\n\n\n<p>This is more than all deaths from all ‘intentional injuries’ combined in the same year: almost 800,000 died from suicide, 405,000 from homicide, 130,000 in conflict, and 26,500 from terrorism \u2013 in total 1,355,000.{ref}The data can be seen <a href=\"https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause\">here</a>. The precise numbers are 793,823+405,346+26,445+129,720=1,355,334{/ref}</p>\n\n\n\n<p>As the visualization shows, one-third of all who died from diarrheal diseases were children under five years old. For most of the past three decades under-5s have accounted for the majority of deaths from diarrheal diseases \u2013 back in 1990 it killed 1.7 million children.</p>\n\n\n\n<p>Diarrheal disease was the cause of every tenth child’s death in 2017 \u2013 more than half a million of the 5.4 million children that died in 2017 died from diarrheal disease.</p>\n\n\n\n<p>Diarrheal diseases are the <a href=\"https://ourworldindata.org/grapher/causes-of-death-in-children?time=2017\">third leading </a>cause of child mortality globally, falling just behind pneumonia and preterm birth complications.</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/deaths-from-diarrheal-diseases-by-age\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n\n\n\n<h3>Where are children dying from diarrheal diseases?</h3>\n\n\n\n<p>The death rate from diarrheal diseases is highest in the world’s poorest countries: this chart shows the relationship between the death rate from diarrheal diseases and the country\u2019s average income. </p>\n\n\n\n<p>The death rate from diarrheal diseases in many of the poorest countries is higher than 100 annual deaths per 100,000 children. In those countries with the worst health \u2013 including Madagascar, Chad and the Central African Republic \u2013 the rate is higher than 300 per 100,000.</p>\n\n\n\n<p>In high-income countries the death rate is very low. In many European countries, but also some rich Asian countries the rate is below 1 per 100,000 per year.</p>\n\n\n\n<p>At lower levels of income risk factors for diarrheal diseases such as <a href=\"https://ourworldindata.org/water-use-sanitation#access-to-improved-water-sources-increases-with-income\">lack of access to clean water</a>, <a href=\"https://ourworldindata.org/grapher/share-of-one-year-olds-who-received-the-rotavirus-vaccine\">rotavirus vaccine availability</a>, <a href=\"https://ourworldindata.org/hunger-and-undernourishment\">undernutrition</a>, <a href=\"https://ourworldindata.org/hunger-and-undernourishment#too-little-height-for-age-stunting\">stunting</a> and <a href=\"https://ourworldindata.org/grapher/deaths-by-risk-under5s\">others</a> are the most prevalent.{ref}Troeger, Christopher, et al. <a href=\"https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30362-1/fulltext\">“Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016.”</a> <em>The Lancet Infectious Diseases</em> 18.11 (2018): 1211-1228.{/ref}</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/diarrheal-death-rates-children-vs-gdp-per-capita\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n\n\n\n<h3>What causes diarrheal diseases in children?</h3>\n\n\n\n<p>Understanding the cause of disease is important so that we can set our priorities on the interventions and treatments that would save most lives, e.g. developing vaccines against the main agents for diarrhea and using antibiotic treatments only when they are appropriate.</p>\n\n\n\n<p>Diarrheal diseases are caused primarily by viral and bacterial pathogens. The visualization shows the major pathogens responsible for diarrhea in children; the area of each box corresponds to the number of deaths from diarrhea in 2016 that can be attributed to each pathogen. </p>\n\n\n\n<p>While bacterial pathogens (shown in red) are the major group of organisms responsible for diarrheal diseases, rotavirus is the single largest causative agent.{ref}Correction: <em>The previous version of the treemap incorrectly classified Cryptosporidium as a bacterial pathogen. It should in fact be grouped with protist. Thank you to the readers who noticed the</em> mistake.{/ref}</p>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" width=\"726\" height=\"550\" src=\"https://owid.cloud/app/uploads/2019/08/Diarrhea-Cause-treemap-2-726x550.png\" alt=\"\" class=\"wp-image-24352\" srcset=\"https://owid.cloud/app/uploads/2019/08/Diarrhea-Cause-treemap-2-726x550.png 726w, https://owid.cloud/app/uploads/2019/08/Diarrhea-Cause-treemap-2-150x114.png 150w, https://owid.cloud/app/uploads/2019/08/Diarrhea-Cause-treemap-2-400x303.png 400w, https://owid.cloud/app/uploads/2019/08/Diarrhea-Cause-treemap-2-768x582.png 768w\" sizes=\"(max-width: 726px) 100vw, 726px\" /></figure>\n\n\n\n<h3>Why are children still dying from diarrhea?</h3>\n\n\n\n<p>There are two main reasons why the number of children dying from diarrhea is still so large \u2013 the prevalence of diarrhea-associated risk factors and the lack of access to essential treatment.</p>\n\n\n\n<p>The figure shows the number of deaths associated with the major risks factors for diarrheal diseases: unsafe drinking water, poor sanitation and malnutrition are responsible for the largest portion of deaths. </p>\n\n\n\n<p>Since 1990 we have made a lot of progress in reducing these major risks; you can read more in our research entries on <a href=\"https://ourworldindata.org/hunger-and-undernourishment\">Hunger and Undernourishment</a>, <a href=\"https://owid.cloud/extreme-poverty\">Extreme Poverty</a> and <a href=\"https://ourworldindata.org/water-use-sanitation\">Water Use and Sanitation</a>. But continued progress is still needed.</p>\n\n\n\n<p>In addition to reducing exposure to risks factors, increasing access to oral rehydration therapy (ORT), therapeutic zinc use and the coverage of rotavirus vaccines were all shown to be essential for reducing the burden of diarrheal diseases in children.{ref}Troeger, C., Blacker, B. F., Khalil, I. A., Rao, P. C., Cao, S., Zimsen, S. R., \u2026 & Alvis-Guzman, N. (2018). <a href=\"https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30362-1/fulltext\">Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016</a>.\u00a0<em>The Lancet Infectious Diseases</em>,\u00a0<em>18</em>(11), 1211-1228.{/ref}</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/number-of-deaths-from-diarrheal-diseases-by-risk-factor-for-under-5s\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n\n\n\n<h3>How can we stop child deaths from diarrhea?</h3>\n\n\n\n<p><span style=\"font-weight: 400;\">Diarrheal diseases are both ‘preventable and treatable’, as the WHO says, because we already know how to deal with many of the risk factors that may lead to diarrhea and, if diarrhea cannot be avoided, we know how to treat it. </span></p>\n\n\n\n<p>The table below lists the range of interventions available for the treatment of diarrhea we have today.{ref}Das, J. K., Salam, R. A., & Bhutta, Z. A. (2014). <a href=\"https://insights.ovid.com/pubmed?pmid=25101554\">Global burden of childhood diarrhea and interventions.</a> <em>Current Opinion in Infectious Diseases</em>, <em>27</em>(5), 451-458.{/ref}</p>\n\n\n\n<p> Some of these interventions, such as ORS, breastfeeding and improvements in sanitation broadly target all-causes of diarrhea, whereas, <a href=\"https://owid.cloud/vaccination\">vaccination</a> and antibiotic use are specifically directed against the causative agents of the disease.</p>\n\n\n\n<p>Water, sanitation and hygiene (WASH) interventions are the best way to prevent diarrheal diseases. Hand washing with soap, better water quality and better sanitation have been shown to reduce the risk of diarrheal infections by 47%, 17% and 36%, respectively.{ref}Cairncross, S., Hunt, C., Boisson, S., Bostoen, K., Curtis, V., Fung, I. C., & Schmidt, W. P. (2010). <a href=\"https://www.ncbi.nlm.nih.gov/pubmed/20348121\">Water, sanitation and hygiene for the prevention of diarrhoea</a>. <em>International Journal of Epidemiology</em>, <em>39</em>(suppl_1), i193-i205.{/ref}</p>\n\n\n\n<p>Educating mothers about the importance of breastfeeding is also important. Breastfeeding allows for the transfer of maternal immunity to the child \u2013 in developing countries infants that are not breastfed are six times more likely to die from infectious diseases, such as those causing to diarrhea, in the first 2 months of their lives.{ref}Victoria, C. G. (2000). <a href=\"https://www.sciencedirect.com/science/article/pii/S0140673600820115\">Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis</a>. <em>Lancet (British edition)</em>, <em>355</em>(9202), 451-455.{/ref}</p>\n\n\n\n<p>Another way to prevent diarrheal diseases is vaccination. Until relatively recently, there were few vaccines available to prevent diarrheal diseases. Cholera vaccine has been licensed since 1991 but it is primarily given to travelers and used as an outbreak control measure. This is because targeted immunization combined with other sanitary measures is more cost-effective than immunizing every individual with a vaccine that only provides a few years of protection.{ref}</p>\n\n\n\n<p>Apps.who.int. (2019). <em>Weekly Epidemiological Record</em>. [online] Available at: <a href=\"https://apps.who.int/iris/bitstream/handle/10665/258763/WER9234.pdf?sequence=1\">https://apps.who.int/iris/bitstream/handle/10665/258763/WER9234.pdf?sequence=1</a> [Accessed 12 Aug. 2019].</p>\n\n\n\n<p>Sinclair, David, et al. <a href=\"https://www.cochrane.org/CD008603/INFECTN_oral-vaccines-preventing-cholera\">“Oral vaccines for preventing cholera.”</a> <em>Cochrane Database of Systematic Reviews</em> 3 (2011).</p>\n\n\n\n<p>{/ref}</p>\n\n\n\n<p> In 2006, however, new vaccines against rotavirus \u2013 the leading cause of childhood diarrhea as the treemap above shows \u2013 have been introduced. The most recent studies show that, while the effectiveness of the new rotavirus vaccines vary across different countries, it works well in protecting children against rotavirus disease.{ref}Jonesteller, Christine L., et al. <a href=\"https://academic.oup.com/cid/article/65/5/840/3746914\">“Effectiveness of rotavirus vaccination: a systematic review of the first decade of global postlicensure data, 2006\u20132016.”</a><em>Clinical Infectious Diseases </em>65.5 (2017): 840-850.</p>\n\n\n\n<p>Aliabadi, Negar, et al. <a href=\"https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30207-4/fulltext\">“Global impact of rotavirus vaccine introduction on rotavirus hospitalisations among children under 5 years of age, 2008\u201316: findings from the Global Rotavirus Surveillance Network.”</a> <em>The Lancet Global Health </em>7.7 (2019): e893-e903.{/ref}</p>\n\n\n\n<p> We will explore the success, potential and limitations of rotavirus vaccines in an upcoming post.</p>\n\n\n\n<p>When preventative measures fail, several options for the treatment of diarrheal diseases are available, including nutritional interventions and antibiotic use when necessary. But the single best treatment for diarrheal diseases is a surprisingly simple mixture of water, salt and sugar: otherwise known as the oral rehydration solution.{ref}Fontaine, Olivier, Paul Garner, and M. K. Bhan. <a href=\"https://www.bmj.com/content/334/suppl_1/s14\">“Oral rehydration therapy: the simple solution for saving lives.”</a> <em>BMJ,</em>334.suppl 1 (2007): s14-s14.{/ref}</p>\n\n\n\n<p> The estimates of ORS effectiveness vary by source, with some suggesting that the current use of ORS helps to prevent 69% of diarrheal deaths and, if its coverage would be increased close to 100%, 93% of diarrheal deaths could be prevented.{ref}Munos, M. K., Walker, C. L. F., & Black, R. E. (2010). <a href=\"https://academic.oup.com/ije/article/39/suppl_1/i75/700641\">The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality</a>. <em>International Journal of Epidemiology</em>, <em>39</em>(suppl_1), i75-i87.{/ref}</p>\n\n\n\n<h6>Potential of interventions to prevent the burden of diarrheal diseases in childhood{ref}Adapted from: Das, J. K., Salam, R. A., & Bhutta, Z. A. (2014). Global burden of childhood diarrhea and interventions. Current Opinion in Infectious Diseases, 27(5), 451-458.{/ref}</h6>\n\n\n\n<table id=\"tablepress-113\" class=\"tablepress tablepress-id-113\">\n<thead>\n<tr class=\"row-1 odd\">\n\t<th class=\"column-1\">Intervention</th><th class=\"column-2\">Estimate of the effect size</th>\n</tr>\n</thead>\n<tbody class=\"row-hover\">\n<tr class=\"row-2 even\">\n\t<td class=\"column-1\">Handwashing with soap</td><td class=\"column-2\">48% risk reduction</td>\n</tr>\n<tr class=\"row-3 odd\">\n\t<td class=\"column-1\">Improved water quality</td><td class=\"column-2\">17% risk reduction</td>\n</tr>\n<tr class=\"row-4 even\">\n\t<td class=\"column-1\">Excreta disposal (improved sanitation)</td><td class=\"column-2\">36% risk reduction</td>\n</tr>\n<tr class=\"row-5 odd\">\n\t<td class=\"column-1\">Breastfeeding education</td><td class=\"column-2\">43% increase in exclusive breastfeeding rates at day 1, 30% increase until 1 month, and 90% increase from 1-6 months</td>\n</tr>\n<tr class=\"row-6 even\">\n\t<td class=\"column-1\">Preventive zinc supplementation</td><td class=\"column-2\">13% reduction in diarrhea incidence, but no effect on mortality</td>\n</tr>\n<tr class=\"row-7 odd\">\n\t<td class=\"column-1\">Therapeutic zinc supplementation</td><td class=\"column-2\">46% reduction in all-cause mortality and 23% reduction in hospitalization due to diarrhea</td>\n</tr>\n<tr class=\"row-8 even\">\n\t<td class=\"column-1\">Rotavirus vaccines</td><td class=\"column-2\">74% effectiveness against very severe rotavirus infection; 61% against severe; 47% reduction in hospitalization</td>\n</tr>\n<tr class=\"row-9 odd\">\n\t<td class=\"column-1\">Cholera vaccines</td><td class=\"column-2\">52% effective against cholera infection</td>\n</tr>\n<tr class=\"row-10 even\">\n\t<td class=\"column-1\">Oral rehydration solution (ORS)</td><td class=\"column-2\">69% reduction in diarrhea-specific mortality</td>\n</tr>\n<tr class=\"row-11 odd\">\n\t<td class=\"column-1\">Dietary management for diarrhea </td><td class=\"column-2\">47% reduction in diarrhea treatment failure and 47% reduction in treatment failure </td>\n</tr>\n<tr class=\"row-12 even\">\n\t<td class=\"column-1\">Antibiotics for cholera</td><td class=\"column-2\">63% reduction in clinical failure rates</td>\n</tr>\n<tr class=\"row-13 odd\">\n\t<td class=\"column-1\">Antibiotics for Shigella</td><td class=\"column-2\">82% reduction in clinical failure rates</td>\n</tr>\n<tr class=\"row-14 even\">\n\t<td class=\"column-1\">Antibiotics for cryptosporidiosis </td><td class=\"column-2\">52% reduction in clinical failure rates</td>\n</tr>\n<tr class=\"row-15 odd\">\n\t<td class=\"column-1\">Community-based interventions (home visits and healthcare promotion)</td><td class=\"column-2\">160% increase in ORS use and 80% increase in zinc use. 9% increase in seeking care for diarrhea and 75% reduction in inappropriate antibiotic use</td>\n</tr>\n</tbody>\n</table>\n\n\n\n\n<p>We will look in more detail at the specific prevention and treatment measures against diarrheal diseases in upcoming posts. This should help to make clear what is possible and effective in preventing and treating one of the leading causes of death in children.</p>\n",
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"rendered": "Despite being treatable and preventable, 1.6 million people died from diarrheal diseases in 2017; one-third were children under five years old. This makes it one of the largest killers of children. Here we look at where and why children are dying from diarrrheal diseases, and what we can do stop this.",
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"date_gmt": "2019-08-16T14:00:26",
"modified": "2020-04-30T15:00:14",
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"authors_name": [
"Bernadeta Dadonaite"
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"modified_gmt": "2020-04-30T14:00:14",
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