Systematic review of diarrhea duration and severity in children and adults in low- and middle-income countriesReport as inadecuate

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BMC Public Health

, 12:276

First Online: 06 April 2012Received: 31 October 2011Accepted: 06 April 2012DOI: 10.1186-1471-2458-12-276

Cite this article as: Lamberti, L.M., Fischer Walker, C.L. & Black, R.E. BMC Public Health 2012 12: 276. doi:10.1186-1471-2458-12-276


BackgroundDiarrhea is a leading cause of morbidity and mortality globally; yet the overall burden of diarrhea in terms of duration and severity has not been quantified. As improvements in treatment lead to decreases in diarrhea mortality, it is important to understand the substantial impact of diarrhea morbidity on disability among children and adults worldwide.

MethodsWe conducted a systematic review to generate estimates of duration and severity outcomes for individuals 0-59 mos, 5-15 yrs, and ≥ 16 yrs, and for 3 severity indexes: mild, moderate, and severe.

ResultsWe estimate that among children under-five, 64.8% of diarrheal episodes are mild, 34.7% are moderate, and 0.5% are severe. On average, mild episodes last 4.3 days, and severe episodes last 8.4 days and cause dehydration in 84.6% of cases. We estimate that among older children and adults, 95% of episodes are mild; 4.95% are moderate; and 0.05% are severe. Among individuals ≥ 16 yrs, severe episodes typically last 2.6 days and cause dehydration in 92.8% of cases.

ConclusionsModerate and severe episodes constitute a substantial portion of the total envelope of diarrhea among children under-five 35.2%; about 588 million episodes. Among older children and adults, moderate and severe episodes account for a much smaller proportion of the total envelope of diarrhea 5%, but the absolute number of such episodes is noteworthy about 21.5 million episodes among individuals ≥ 16 yrs. Hence, the global burden of diarrhea consists of significant morbidity, extending beyond episodes progressing to death.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-12-276 contains supplementary material, which is available to authorized users.

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Author: Laura M Lamberti - Christa L Fischer Walker - Robert E Black


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