posts_gdocs: 1mDkPiGSy3dHCfnIFc1HAPU2XU3yz9iKWBNWfRUTniCw
Data license: CC-BY
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| id | slug | type | content | published | createdAt | publishedAt | updatedAt | publicationContext | revisionId | breadcrumbs | markdown | title |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1mDkPiGSy3dHCfnIFc1HAPU2XU3yz9iKWBNWfRUTniCw | diarrheal-diseases | topic-page | {
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1 | 2023-12-28 15:18:56 | 2023-07-03 11:06:00 | 2023-12-28 22:34:52 | unlisted | ALBJ4LvqDf5XM-oVZqU00WVTVybSSNSaB2JT9vY-DouM7-6un-3MNXtBFTdKvIVDHSQ8-deQ8y8PnFeVZiI0Og | Diarrheal diseases are among the most common causes of death, especially in children. In 2019 around 1.5 million people died from diarrheal diseases. That was more than all violent deaths combined.1 Around half a million of these deaths were among children. In recent decades, deaths from diarrheal diseases have fallen significantly across the world, as a result of public health interventions. But more progress is possible. Diarrheal deaths are preventable because they are primarily caused by pathogens, whose spread can be easily controlled. By increasing global access to [clean water](https://ourworldindata.org/water-access) and [sanitation](https://ourworldindata.org/sanitation), oral rehydration treatment, and vaccination, this major cause of death can be reduced substantially. This page shows estimates of diarrheal death rates worldwide and the pathogens that cause them. We also offer data on access to public health measures and how they have changed. ## Key Insights on Diarrheal Diseases ### Diarrheal diseases are a leading cause of death among children Diarrheal diseases are one of the most common causes of death among children. It’s estimated that around half a million children died from diarrheal diseases globally in 2019. This is shown in the chart, which details the causes of death in children under five. Deaths from diarrheal diseases have [declined over time](https://ourworldindata.org/grapher/deaths-from-diarrheal-diseases-by-age), but they still carry a substantial death toll today. This is because people in many countries still lack access to [clean water](https://ourworldindata.org/water-access) and [sanitation](https://ourworldindata.org/sanitation), adequate treatment and healthcare, and have low vaccination rates against pathogens that cause diarrheal disease. <Callout /> <Chart url="https://ourworldindata.org/grapher/causes-of-death-in-children-under-5"/> ### Diarrheal death rates vary widely There are significant differences in diarrheal death rates across the world. This is shown in the map, which reports deaths from diarrheal diseases per 100,000 people. Deaths from diarrheal disease are more common in [poorer countries](https://ourworldindata.org/grapher/diarrheal-death-rates-children-vs-gdp-per-capita). Death rates in low-income countries are almost fifty times higher than in high-income countries. Diarrheal deaths remain a large problem in much of the world – even today – but they can be significantly reduced with greater public health efforts. <Callout /> <Chart url="https://ourworldindata.org/grapher/diarrheal-disease-death-rates"/> ### Ten pathogens are responsible for most diarrheal deaths in children Researchers now know that diarrheal disease deaths in children are primarily caused by pathogens, such as viruses, bacteria, and protists.2 The visualization shows the estimated annual number of child deaths globally caused by different viruses, bacteria, and other pathogens. The size of the box is proportional to their share of diarrheal deaths. Rotavirus is responsible for the greatest share – over one-third – of yearly diarrheal disease deaths in children. It kills over 200,000 children. It is followed by shigella, responsible for more than one in ten. In total, ten pathogens are responsible for three-quarters of diarrheal deaths. These pathogens are transmitted between people through different routes, including contaminated water and food, respiratory droplets, and close contact.3 <Callout />  ### Public health measures can substantially reduce diarrheal diseases Several pathogens that cause diarrheal diseases are spread by contaminated water or food and unsafe sewage.3 This means clean water treatment, food safety measures, and sanitation can effectively kill them and reduce their disease burden. This can be done through simple measures such as chlorination and water filtration, pasteurization, and safe piped water systems.5 Death rates from diarrheal diseases were previously much higher in countries that are now wealthy before large-scale public health efforts.6 In Stockholm, for example, infant deaths from diarrheal diseases were cut massively – from an annual death rate of 59 per 1,000 to 2 per 1,000 – between 1878 and 1925.7 However, people in many countries today still lack access to [clean water](https://ourworldindata.org/water-access) and [sanitation](https://ourworldindata.org/sanitation), especially during conflicts and natural disasters. On the map, you can see the share of people who lack access to safely-managed sanitation. Improving access to safe drinking water and sanitation would help reduce diarrheal deaths and child mortality rates. <Callout /> <Chart url="https://ourworldindata.org/explorers/water-and-sanitation?facet=none&country=~OWID_WRL&hideControls=true&Resource=Sanitation&Level+of+Access=Safely+managed&Residence=Total&Relative+to+population=Share+of+population"/> ### Many children still don’t receive oral rehydration treatment By understanding the causes of diarrheal diseases, the world has managed to reduce their burden through public health measures. Cholera, for example, used to be far deadlier than it is today. Left untreated, it can cause dehydration and death within hours of the first symptoms.8 During large outbreaks in the 19th century, between 30 and 60% of people diagnosed with cholera then died from it in many major cities, including New York and Berlin.9 This changed when scientists discovered that diarrheal diseases could be treated with a straightforward form of treatment — what patients need is rehydration, using a solution of water, salts, and sugar, which replenish fluids lost, while continuing to feed. In the 1960s, scientists developed a low-cost version, [oral rehydration solution](https://ourworldindata.org/oral-rehydration-therapy), which can be used easily at home.10 With this understanding, diarrhea can be made much less deadly.11 But, in many countries, only a small share of children receive oral rehydration therapy. You can see this in the chart. This is due to various factors, such as a lack of knowledge about its benefits, limited advocacy and messaging, and low treatment supply.12 By providing more children with treatment, the burden of diarrheal diseases can be reduced significantly. <Callout /> <Chart url="https://ourworldindata.org/grapher/children-who-receive-ors"/> ### Rotavirus vaccination can prevent around a hundred thousand deaths each year Rotavirus is the most common cause of diarrheal deaths in children globally. Although [rotavirus vaccines](https://ourworldindata.org/rotavirus-vaccine) were first introduced in the United States in 2006, the [death rate](https://ourworldindata.org/grapher/child-mortality-rate-from-rotavirus) remains high because children in many countries do not receive [vaccinations](https://ourworldindata.org/grapher/rotavirus-number-unvaccinated). In addition, the efficacy of rotavirus vaccines has been lower in countries with higher mortality rates.13 In the chart, you can see the share of one-year-olds who were vaccinated against rotavirus. Vaccination rates were high in some countries, such as Ghana, Kenya, and Tajikistan, with rates above 90% in 2021. But in other countries, they were much lower: for example, fewer than 1-in-5 children in Congo were vaccinated. By increasing vaccination rates, more children can be protected against the virus, and a major cause of diarrheal deaths can be prevented.14 <Callout /> <Chart url="https://ourworldindata.org/grapher/share-of-one-year-olds-who-received-the-rotavirus-vaccine"/> ## Related research and writing * https://ourworldindata.org/childhood-diarrheal-diseases ,* https://ourworldindata.org/rotavirus-vaccine ,* https://ourworldindata.org/oral-rehydration-therapy <AllCharts heading="Interactive Charts on Diarrheal Diseases"/> It’s estimated that 1.53 million people died from diarrheal diseases in 2019. Meanwhile, it’s estimated that around 760,000 died from suicide, around 415,000 died from homicide, and around 63,000 died in conflict and terrorism that year; these add up to 1.24 million. These estimates come from the IHME’s Global Burden of Disease study, and you can explore the data [here](https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause). Protists are single-celled organisms that don’t fit into other categories, such as fungi, animals, or plants. Webb, C., & Cabada, M. M. (2018). A Review on Prevention Interventions to Decrease Diarrheal Diseases’ Burden in Children. Current Tropical Medicine Reports, 5(1), 31–40. [https://doi.org/10.1007/s40475-018-0134-x](https://doi.org/10.1007/s40475-018-0134-x) Cohen, A. L., Platts-Mills, J. A., Nakamura, T., Operario, D. J., Antoni, S., Mwenda, J. M., Weldegebriel, G., Rey-Benito, G., De Oliveira, L. H., Ortiz, C., Daniels, D. S., Videbaek, D., Singh, S., Njambe, E., Sharifuzzaman, M., Grabovac, V., Nyambat, B., Logronio, J., Armah, G., … Serhan, F. (2022). Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: Findings from the Global Pediatric Diarrhea Surveillance network. BMJ Global Health, 7(9), e009548. [https://doi.org/10.1136/bmjgh-2022-009548](https://doi.org/10.1136/bmjgh-2022-009548) Deaths from cholera were primarily found in South Asia in this study. Kremer, M., Luby, S. P., Maertens, R., Tan, B., & Więcek, W. (2023). Water Treatment And Child Mortality: A Meta-Analysis And Cost-effectiveness Analysis (No. w30835). National Bureau of Economic Research. Available [here](https://bfi.uchicago.edu/wp-content/uploads/2022/03/BFI_WP_2022-26.pdf). Santosham, M., Duggan, C. P., & Glass, R. (2019). Elimination of diarrheal mortality in children – the last half million. Journal of Global Health, 9(2), 020102. [https://doi.org/10.7189/jogh.09.020102](https://doi.org/10.7189/jogh.09.020102) Alsan, M., & Goldin, C. (2019). Watersheds in child mortality: The role of effective water and sewerage infrastructure, 1880–1920. Journal of Political Economy, 127(2), 586-638 Guerrant, R. L., Carneiro-Filho, B. A., & Dillingham, R. A. (2003). Cholera, Diarrhea, and Oral Rehydration Therapy: Triumph and Indictment. Clinical Infectious Diseases, 37(3), 398–405. [https://doi.org/10.1086/376619](https://doi.org/10.1086/376619) Cutler, D., & Miller, G. (2005). The role of public health improvements in health advances: The twentieth-century United States. Demography, 42(1), 1–22. [https://doi.org/10.1353/dem.2005.0002](https://doi.org/10.1353/dem.2005.0002) Van Poppel, F., & Van der Heijden, C. (1997). The effects of water supply on infant and childhood mortality: A review of historical evidence. Health Transition Review, 113–148. [https://ocw.tudelft.nl/wp-content/uploads/Childhood-Mortality.pdf](https://ocw.tudelft.nl/wp-content/uploads/Childhood-Mortality.pdf) Shulman, S. T. (2004). The History of Pediatric Infectious Diseases. Pediatric Research, 55(1), 163–176. [https://doi.org/10.1203/01.PDR.0000101756.93542.09](https://doi.org/10.1203/01.PDR.0000101756.93542.09) These figures are the death rates among children under 2 years old. Burström, B., Macassa, G., Öberg, L., Bernhardt, E., & Smedman, L. (2005). Equitable child health interventions: The impact of improved water and sanitation on inequalities in child mortality in Stockholm, 1878 to 1925. American Journal of Public Health, 95(2), 208–216. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449154/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449154/) Macassa, G., Ponce de Leon, A., & Burström, B. (2006). The impact of water supply and sanitation on area differentials in the decline of diarrhoeal disease mortality among infants in Stockholm 1878—1925. Scandinavian Journal of Public Health, 34(5), 526–533. [https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2003.034900](https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2003.034900) Helgertz, J., & Önnerfors, M. (2019). Public water and sewerage investments and the urban mortality decline in Sweden 1875–1930. The History of the Family, 24(2), 307–338. [https://doi.org/10.1080/1081602X.2018.1558411](https://doi.org/10.1080/1081602X.2018.1558411) Harris, J. B., LaRocque, R. C., Qadri, F., Ryan, E. T., & Calderwood, S. B. (2012). Cholera. The Lancet, 379(9835), 2466–2476. [https://doi.org/10.1016/S0140-6736(12)60436-X](https://doi.org/10.1016/S0140-6736(12)60436-X) Chan, C. H., Tuite, A. R., & Fisman, D. N. (2013). Historical Epidemiology of the Second Cholera Pandemic: Relevance to Present Day Disease Dynamics. PLoS ONE, 8(8), e72498. [https://doi.org/10.1371/journal.pone.0072498](https://doi.org/10.1371/journal.pone.0072498) Oral rehydration solution effectively replaces fluid loss in many diarrheal diseases, not just cholera. Zinc supplementation also reduces diarrheal diseases and can be provided with oral rehydration solution. Additional medications, such as antibiotics and antiparasitic treatments, may also be needed to treat some diarrheal diseases. Zinc Supplementation in Acute Diarrhea is Acceptable, Does Not Interfere with Oral Rehydration, and Reduces the Use of Other Medications: A Randomized Trial in Five Countries. (2006). Journal of Pediatric Gastroenterology & Nutrition, 42(3), 300–305. [https://doi.org/10.1097/01.mpg.0000189340.00516.30](https://doi.org/10.1097/01.mpg.0000189340.00516.30) Santosham, M., Chandran, A., Fitzwater, S., Fischer-Walker, C., Baqui, A. H., & Black, R. (2010). Progress and barriers for the control of diarrhoeal disease. The Lancet, 376(9734), 63–67. [https://doi.org/10.1016/S0140-6736(10)60356-X](https://doi.org/10.1016/S0140-6736(10)60356-X) Black, R. E. (2019). Progress in the use of ORS and zinc for the treatment of childhood diarrhea. Journal of Global Health, 9(1), 010101. [https://doi.org/10.7189/jogh.09.010101](https://doi.org/10.7189/jogh.09.010101) Patel, A., Mamtani, M., Dibley, M. J., Badhoniya, N., & Kulkarni, H. (2010). Therapeutic Value of Zinc Supplementation in Acute and Persistent Diarrhea: A Systematic Review. PLoS ONE, 5(4), e10386. [https://doi.org/10.1371/journal.pone.0010386](https://doi.org/10.1371/journal.pone.0010386) Kanungo, S., Azman, A. S., Ramamurthy, T., Deen, J., & Dutta, S. (2022). Cholera. The Lancet, 399(10333), 1429–1440. [https://doi.org/10.1016/S0140-6736(22)00330-0](https://doi.org/10.1016/S0140-6736(22)00330-0) Deen, J., Mengel, M. A., & Clemens, J. D. (2020). Epidemiology of cholera. Vaccine, 38, A31–A40. [https://doi.org/10.1016/j.vaccine.2019.07.078](https://doi.org/10.1016/j.vaccine.2019.07.078) Santosham, M., Duggan, C. P., & Glass, R. (2019). Elimination of diarrheal mortality in children – the last half million. Journal of Global Health, 9(2), 020102. [https://doi.org/10.7189/jogh.09.020102](https://doi.org/10.7189/jogh.09.020102) Bhattacharya, S. K. (1994). History of development of oral rehydration therapy. Indian Journal of Public Health, 38(2), 39–43. [https://pubmed.ncbi.nlm.nih.gov/7530695/](https://pubmed.ncbi.nlm.nih.gov/7530695/) Binder, H. J., Brown, I., Ramakrishna, B. S., & Young, G. P. (2014). Oral Rehydration Therapy in the Second Decade of the Twenty-first Century. Current Gastroenterology Reports, 16(3), 376. [https://doi.org/10.1007/s11894-014-0376-2](https://doi.org/10.1007/s11894-014-0376-2) The case-fatality rate of cholera now ranges between 0 to 10% globally. However, this figure has limitations: many countries lack surveillance and reporting of cholera cases. Furthermore, some countries use different definitions of cases due to a lack of testing capacity. For example, some countries describe all cases of watery diarrhea as cholera cases during outbreaks due to limited laboratory capacity. The case-fatality rate has also risen during large outbreaks from conflict and natural disasters, when people may lack access to clean water, sanitation, and treatments. Ganesan, D., Gupta, S. S., & Legros, D. (2020). Cholera surveillance and estimation of burden of cholera. Vaccine, 38, A13–A17. [https://doi.org/10.1016/j.vaccine.2019.07.036](https://doi.org/10.1016/j.vaccine.2019.07.036) Wiens, K. E., Xu, H., Zou, K., Mwaba, J., Lessler, J., Malembaka, E. B., Demby, M. N., Bwire, G., Qadri, F., Lee, E. C., & Azman, A. S. (2022). Towards estimating true cholera burden: A systematic review and meta-analysis of Vibrio cholerae positivity [Preprint]. MedRxiv. [https://doi.org/10.1101/2022.10.05.22280736](https://doi.org/10.1101/2022.10.05.22280736) Ezezika, O., Ragunathan, A., El-Bakri, Y., & Barrett, K. (2021). Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review. PLOS ONE, 16(4), e0249638. [https://doi.org/10.1371/journal.pone.0249638](https://doi.org/10.1371/journal.pone.0249638) Santosham, M., Chandran, A., Fitzwater, S., Fischer-Walker, C., Baqui, A. H., & Black, R. (2010). Progress and barriers for the control of diarrhoeal disease. The Lancet, 376(9734), 63–67. [https://doi.org/10.1016/S0140-6736(10)60356-X](https://doi.org/10.1016/S0140-6736(10)60356-X) The effectiveness of rotavirus vaccines has been around 86% among children under 12 months in countries with low rotavirus mortality, and 63 or 66% in countries with high rotavirus mortality. Burnett, E., Parashar, U. D., & Tate, J. E. (2020). Real-world effectiveness of rotavirus vaccines, 2006–19: A literature review and meta-analysis. The Lancet Global Health, 8(9), e1195–e1202. [https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30262-X/fulltext](https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30262-X/fulltext) The reasons for a lower efficacy in poorer countries are unknown but may result from many factors. For example, other oral vaccines, including vaccines against polio and cholera, have also shown lower efficacies in poorer countries. This may be because children have co-infections with other enteric viruses, which reduce their gut immune response to the vaccines. Other potential factors include higher exposure to the virus and variations in gut microbiomes, blood groups, and immune antigens. Burke, R. M., Tate, J. E., Kirkwood, C. D., Steele, A. D., & Parashar, U. D. (2019). Current and new rotavirus vaccines: Current Opinion in Infectious Diseases, 32(5), 435–444. [https://doi.org/10.1097/QCO.0000000000000572](https://doi.org/10.1097/QCO.0000000000000572) Burnett, E., Parashar, U., & Tate, J. (2018). Rotavirus Vaccines: Effectiveness, Safety, and Future Directions. Pediatric Drugs, 20(3), 223–233. [https://doi.org/10.1007/s40272-018-0283-3](https://doi.org/10.1007/s40272-018-0283-3) Kirkwood, C. D., Ma, L.-F., Carey, M. E., & Steele, A. D. (2019). The rotavirus vaccine development pipeline. Vaccine, 37(50), 7328–7335. [https://doi.org/10.1016/j.vaccine.2017.03.076](https://doi.org/10.1016/j.vaccine.2017.03.076) Troeger, C., Khalil, I. A., Rao, P. C., Cao, S., Blacker, B. F., Ahmed, T., Armah, G., Bines, J. E., Brewer, T. G., Colombara, D. V., Kang, G., Kirkpatrick, B. D., Kirkwood, C. D., Mwenda, J. M., Parashar, U. D., Petri, W. A., Riddle, M. S., Steele, A. D., Thompson, R. L., … Reiner, R. C. (2018). Rotavirus Vaccination and the Global Burden of Rotavirus Diarrhea Among Children Younger Than 5 Years. JAMA Pediatrics, 172(10), 958. [https://doi.org/10.1001/jamapediatrics.2018.1960](https://doi.org/10.1001/jamapediatrics.2018.1960) The authors estimate that the rotavirus averted around 28,000 deaths in children under five in 2016. They also estimate that an additional 83,200 deaths in this age group could have been averted if full vaccine coverage had been achieved that year. | Diarrheal Diseases |