Diarrheal Disease Incidence and Associated Mortality in Ethiopia: A Systematic Subnational Analysis in Global Burden of Disease Study, 1990-2019

Abstract

Abstract
Background: A diarrheal disease prevalent in low and middle-income countries, it majorly affects children and elders. In Ethiopia, where there is a disparity in health service access, sanitation, and safe water across regions, there is a lack of evidence on diarrheal disease incidence and mortality rate and trends at national and regional levels for Ethiopia. This study aims to provide national and regional diarrheal disease incidence and associated mortality trends from 1990-2019 to inform policy and practice in Ethiopia.
Methods: The stated analysis is a component of the GBD-2019 study, a collaborative effort between the Ethiopian Public Health Institute (EPHI) and the Institute for Health Metrics and Evaluation (IHME). It aims to evaluate the extent of diarrheal disease burden in Ethiopia, along with its regional states and chartered cities, by examining specific locations and age groups. This study provides comprehensive data on the incidence and mortality trends of diarrheal diseases at national and regional levels, standardized for age, from 1990 to 2019. The results are presented along with 95% uncertainty intervals (UI) to account for the inherent uncertainty in the findings.
Results: The national age-standardized diarrheal disease incidence rate was 122,781.8 [95% Uncertainly Interval (UI): 113,245.4-132,880.6] per 100,000 populations in 2019. It declined by an annual rate of 16.43% [95% UI;12.26%-20.58%] from 1990 to 2019. It was higher among under-5 children (186,732.2 [95% UI: 153,251.4–226,075.6]) and older than 70-year adults 244.2 [95% UI: 289,749.3 –324,673.4]). The national age-standardized diarrheal disease-associated mortality was 76.4 [95% UI:45.1-112.2] per 100,000 populations in 2019. Nationally, it was declined by an annual rate of 74.99% between 1990 and 2019. The findings indicate that the national age-standardized life years lost due to diarrheal disease declined by 76.30 % [95% UI: 53.90%, 85.29%] between 1990 and 2019.
Conclusion: Diarrheal disease has remained a public health problem by affecting a large number of the population in Ethiopia. The youngest and elder populations were disproportionately affected by diarrheal disease incidence and associated mortality. This result may call the attention of Primary Public Health Services to revisit universal health coverage in Ethiopia. Moreover, prevention and management modalities need the community's and other stakeholders' engagement and participation. Equal attention needs to be given to older adults as of under-five children. [Ethiop. J. Health Dev. 2023;37 (SI-2)]
Keywords: diarrheal disease, incidence, morbidity, mortality, Ethiopia