Burden of Diarrhea in the Eastern Mediterranean Region, 1990–2013: Findings from the Global Burden of Disease Study 2013
Authors: Khalil Ibrahim , Colombara Danny V. , Forouzanfar Mohammad Hossein , Troeger Christopher , Daoud Farah , Moradi-Lakeh Maziar , Bcheraoui Charbel El , Rao Puja C. , Afshin Ashkan , Charara Raghid , Abate Kalkidan Hassen , Razek Mohammed Magdy Abd El , Abd-Allah Foad , Abu-Elyazeed Remon , Kiadaliri Aliasghar Ahmad , Akanda Ali Shafqat , Akseer Nadia , Alam Khurshid , Alasfoor Deena , Ali Raghib , AlMazroa Mohammad A. , Alomari Mahmoud A. , Al-Raddadi Rajaa Mohammad Salem , Alsharif Ubai , Alsowaidi Shirina , Altirkawi Khalid A. , Alvis-Guzman Nelson , Ammar Walid , Antonio Carl Abelardo T. , Asayesh Hamid , Asghar Rana Jawad , Atique Suleman , Awasthi Ashish , Bacha Umar , Badawi Alaa , Barac Aleksandra , Bedi Neeraj , Bekele Tolesa , Bensenor Isabela M. , Betsu Balem Demtsu , Bhutta Zulfiqar , Abdulhak Aref A. Bin , Butt Zahid A. , Danawi Hadi , Dubey Manisha , Endries Aman Yesuf , Faghmous Imad D. A. , Farid Talha , Farvid Maryam S. , Farzadfar Farshad , Fereshtehnejad Seyed-Mohammad , Fischer Florian , Fitchett Joseph Robert Anderson , Gibney Katherine B. , Ginawi Ibrahim Abdelmageem Mohamed , Gishu Melkamu Dedefo , Gugnani Harish Chander , Gupta Rahul , Hailu Gessessew Bugssa , Hamadeh Randah Ribhi , Hamidi Samer , Harb Hilda L. , Hedayati Mohammad T. , Hsairi Mohamed , Husseini Abdullatif , Jahanmehr Nader , Javanbakht Mehdi , Jibat Tariku , Jonas Jost B. , Kasaeian Amir , Khader Yousef Saleh , Khan Abdur Rahman , Khan Ejaz Ahmad , Khan Gulfaraz , Khoja Tawfik Ahmed Muthafer , Kinfu Yohannes , Kissoon Niranjan , Koyanagi Ai , Lal Aparna , Latif Asma Abdul Abdul , Lunevicius Raimundas , Razek Hassan Magdy Abd El , Majeed Azeem , Malekzadeh Reza , Mehari Alem , Mekonnen Alemayehu B. , Melaku Yohannes Adama , Memish Ziad A. , Mendoza Walter , Misganaw Awoke , Mohamed Layla Abdalla Ibrahim , Nachega Jean B. , Nguyen Quyen Le , Nisar Muhammad Imran , Peprah Emmanuel Kwame , Platts-Mills James A. , Pourmalek Farshad , Qorbani Mostafa , Rafay Anwar , Rahimi-Movaghar Vafa , Rahman Sajjad Ur , Rai Rajesh Kumar , Rana Saleem M. , Ranabhat Chhabi L. , Rao Sowmya R. , Refaat Amany H. , Riddle Mark , Roshandel Gholamreza , Ruhago George Mugambage , Saleh Muhammad Muhammad , Sanabria Juan R. , Sawhney Monika , Sepanlou Sadaf G. , Setegn Tesfaye , Sliwa Karen , Sreeramareddy Chandrashekhar T. , Sykes Bryan L. , Tavakkoli Mohammad , Tedla Bemnet Amare , Terkawi Abdullah S. , Ukwaja Kingsley , Uthman Olalekan A. , Westerman Ronny , Wubshet Mamo , Yenesew Muluken A. , Yonemoto Naohiro , Younis Mustafa Z. , Zaidi Zoubida , Zaki Maysaa El Sayed , Rabeeah Abdullah A. Al , Wang Haidong , Naghavi Mohsen , Vos Theo , Lopez Alan D. , Murray Christopher J. L. , Mokdad Ali H. 
Published: October 2016

Abstract
Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0–1) in Bahrain and Oman to 471 (95% UI = 245–763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520–989) in Syria to 40,869 (95% UI = 21,540–65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.