The overlapping burden of the three leading causes of disability and death in sub-Saharan African children
Authors: Reiner Robert C. ,   LBD Triple Burden Collaborators, Welgan Catherine A. , Troeger Christopher E. , Baumann Mathew M. , Weiss Daniel J. , Deshpande Aniruddha , Blacker Brigette F. , Miller-Petrie Molly K. , Earl Lucas , Bhatt Samir , Abolhassani Hassan , Abosetugn Akine Eshete , Abu-Gharbieh Eman , Adekanmbi Victor , Adetokunboh Olatunji O. , Aghaali Mohammad , Aji Budi , Alahdab Fares , Al-Aly Ziyad , Alhassan Robert Kaba , Ali Saqib , Alizade Hesam , Aljunid Syed Mohamed , Almasi-Hashiani Amir , Al-Mekhlafi Hesham M. , Altirkawi Khalid A. , Alvis-Guzman Nelson , Amare Azmeraw T. , Amini Saeed , Amugsi Dickson A. , Ancuceanu Robert , Andrei Catalina Liliana , Ansari Fereshteh , Anvari Davood , Appiah Seth Christopher Yaw , Arabloo Jalal , Aremu Olatunde , Atout Maha Moh’d Wahbi , Ausloos Marcel , Ausloos Floriane , Ayanore Martin Amogre , Aynalem Yared Asmare , Azene Zelalem Nigussie , Badawi Alaa , Baig Atif Amin , Banach Maciej , Bedi Neeraj , Bhagavathula Akshaya Srikanth , Bhandari Dinesh , Bhardwaj Nikha , Bhardwaj Pankaj , Bhattacharyya Krittika , Bhutta Zulfiqar A. , Bijani Ali , Birhanu Tesega Tesega Mengistu , Bitew Zebenay Workneh , Boloor Archith , Brady Oliver J. , Butt Zahid A. , Car Josip , Carvalho Felix , Casey Daniel C. , Chattu Vijay Kumar , Chowdhury Mohiuddin Ahsanul Kabir , Chu Dinh-Toi , Coelho Camila H. , Cook Aubrey J. , Damiani Giovanni , Daoud Farah , Gela Jiregna Darega , Darwish Amira Hamed , Daryani Ahmad , Das Jai K. , Davis Weaver Nicole , Deribe Kebede , Desalew Assefa , Dharmaratne Samath Dhamminda , Dianatinasab Mostafa , Diaz Daniel , Djalalinia Shirin , Dorostkar Fariba , Dubljanin Eleonora , Duko Bereket , Dwyer-Lindgren Laura , Effiong Andem , El Sayed Zaki Maysaa , El Tantawi Maha , Enany Shymaa , Fattahi Nazir , Feigin Valery L. , Fernandes Eduarda , Ferrara Pietro , Fischer Florian , Foigt Nataliya A. , Folayan Morenike Oluwatoyin , Foroutan Masoud , Frostad Joseph Jon , Fukumoto Takeshi , Gaidhane Abhay Motiramji , Gebrekrstos Hailemikael Gebrekidan G. K. , Gebremeskel Leake , Gebreslassie Assefa Ayalew , Gething Peter W. , Gezae Kebede Embaye , Ghadiri Keyghobad , Ghashghaee Ahmad , Golechha Mahaveer , Gubari Mohammed Ibrahim Mohialdeen , Hadgu Fikaden Berhe , Hamidi Samer , Handiso Demelash Woldeyohannes , Hashi Abdiwahab , Hassan Shoaib , Hayat Khezar , Herteliu Claudiu , Ho Hung Chak , Holla Ramesh , Hosseinzadeh Mehdi , Househ Mowafa , Hussain Rabia , Hwang Bing-Fang , Ibitoye Segun Emmanuel , Ilesanmi Olayinka Stephen , Ilic Irena M. , Ilic Milena D. , Irvani Seyed Sina Naghibi , Jaafari Jalil , Javaheri Tahereh , Jha Ravi Prakash , Johnson Kimberly B. , Jonas Jost B. , Jozwiak Jacek Jerzy , Kabir Ali , Kalhor Rohollah , Kanchan Tanuj , Karch André , Kayode Gbenga A. , Keiyoro Peter Njenga , Khader Yousef Saleh , Khalil Ibrahim A. , Khan Md Nuruzzaman , Khan Maseer , Khan Gulfaraz , Khatab Khaled , Khater Mona M. , Khatib Mahalaqua Nazli , Kianipour Neda , Kim Yun Jin , Kimokoti Ruth W. , Kisa Sezer , Kisa Adnan , Kissoon Niranjan , Kochhar Sonali , Koolivand Ali , Kopec Jacek A. , Koyanagi Ai , Krishan Kewal , Kumar Pushpendra , Kurmi Om P. , Kusuma Dian , Lal Dharmesh Kumar , Lami Faris Hasan , Landires Iván , Lansingh Van Charles , Lasrado Savita , La Vecchia Carlo , Lazzar-Atwood Alice , Lee Paul H. , LeGrand Kate E. , Lewycka Sonia , Li Bingyu , Lim Stephen S. , Lindstedt Paulina A. , Liu Xuefeng , Longbottom Joshua , Lopez Alan D. , Magdy Abd El Razek Hassan , Mahasha Phetole Walter , Maleki Afshin , Mamun Abdullah A. , Mansournia Mohammad Ali , Marczak Laurie B. , Martins-Melo Francisco Rogerlândio , Mayala Benjamin K. , Meharie Birhanu Geta , Melese Addisu , Mendoza Walter , Menezes Ritesh G. , Mengesha Endalkachew Worku , Mensah George A. , Meretoja Tuomo J. , Mestrovic Tomislav , Miller Ted R. , Mirrakhimov Erkin M. , Moazen Babak , Mohammad Gholi Mezerji Naser , Mohammadi Shadieh , Mohammed Shafiu , Mokdad Ali H. , Moradi Masoud , Moradzadeh Rahmatollah , Moraga Paula , Mosser Jonathan F. , Murray Chrisopher J. L. , Naderi Mehdi , Nagarajan Ahamarshan Jayaraman , Nazari Javad , Ndejjo Rawlance , Negoi Ionut , Ngunjiri Josephine W. , Nguyen QuynhAnh P. , Nguyen Huong Lan Thi , Nnaji Chukwudi A. , Noubiap Jean Jacques , Nuñez-Samudio Virginia , Olagunju Andrew T. , Olusanya Jacob Olusegun , Olusanya Bolajoko Olubukunola , Omer Muktar Omer , Onwujekwe Obinna E. , Otstavnov Nikita , Otstavnov Stanislav S. , Owolabi Mayowa O. , P A Mahesh , Padubidri Jagadish Rao , Pana Adrian , Peprah Emmanuel K. , Pham Hai Quang , Pigott David M. , Pirestani Majid , Postma Maarten J. , Pottoo Faheem Hyder , Pourjafar Hadi , Quazi Syed Zahiruddin , Rahim Fakher , Rahimi-Movaghar Vafa , Rahman Mohammad Hifz Ur , Rao Sowmya J. , Rao Puja C. , Rathi Priya , Rawaf Salman , Rawaf David Laith , Rawal Lal , Rawassizadeh Reza , Regassa Lemma Demissie , Renzaho Andre M. N. , Rezaei Nima , Rezai Mohammad Sadegh , Ribeiro Ana Isabel , Rickard Jennifer , Rios-González Carlos Miguel , Rumisha Susan Fred , Sabour Siamak , Sajadi S. Mohammad , Salomon Joshua A. , Samadi Kafil Hossein , Samy Abdallah M. , Sanabria Juan , Sartorius Benn , Saxena Deepak , Schaeffer Lauren E. , Senthilkumaran Subramanian , Sha Feng , Shaheen Amira A. , Shaikh Masood Ali , Sharma Rajesh , Sheikh Aziz , Shibuya Kenji , Shigematsu Mika , Il Shin Jae , Simonetti Biagio , Singh Jasvinder A. , Smith David L. , Soheili Amin , Sokhan Anton , Spurlock Emma Elizabeth , Sreeramareddy Chandrashekhar T. , Sufiyan Mu’awiyyah Babale , Swartz Scott J. , Tadesse Degena Bahrey , Tamiru Animut Tagele , Tefera Yonas Getaye , Temsah Mohamad-Hani , Tessema Zemenu Tadesse , Titova Mariya Vladimirovna , Tran Bach Xuan , Truong Phuong N. , Unnikrishnan Bhaskaran , Upadhyay Era , Vasankari Tommi Juhani , Vasseghian Yasser , Violante Francesco S. , Vu Giang Thu , Waheed Yasir , Wamai Richard G. , Wassie Emebet Gashaw , Welay Fissaha Tekulu , Wickramasinghe Nuwan Darshana , Wiens Kirsten E. , Wijeratne Tissa , Wiysonge Charles Shey , Wondmeneh Temesgen Gebeyehu , Yamada Tomohide , Yaya Sanni , Yeshitila Yordanos Gizachew , Yip Paul , Yonemoto Naohiro , Yu Chuanhua , Yuce Deniz , Yusefzadeh Hasan , Zaidi Zoubida , Zamanian Maryam , Zangeneh Alireza , Zhang Zhi-Jiang , Zhang Yunquan , Ziapour Arash , Hay Simon I. 
Published: December 2022

Despite substantial declines since 2000, lower respiratory infections (LRIs), diarrhoeal diseases, and malaria remain among the leading causes of nonfatal and fatal disease burden for children under 5 years of age (under 5), primarily in sub-Saharan Africa (SSA). The spatial burden of each of these diseases has been estimated subnationally across SSA, yet no prior analyses have examined the pattern of their combined burden. Here we synthesise subnational estimates of the burden of LRIs, diarrhoea, and malaria in children under-5 from 2000 to 2017 for 43 sub-Saharan countries. Some units faced a relatively equal burden from each of the three diseases, while others had one or two dominant sources of unit-level burden, with no consistent pattern geographically across the entire subcontinent. Using a subnational counterfactual analysis, we show that nearly 300 million DALYs could have been averted since 2000 by raising all units to their national average. Our findings are directly relevant for decision-makers in determining which and targeting where the most appropriate interventions are for increasing child survival.