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India has achieved a remarkable reduction in mortality rates among children under the age of five from diarrhoeal diseases, according to a new study published in The Lancet Infectious Diseases journal. The findings, based on data from the Global Burden of Disease (GBD) study covering 204 countries, highlight significant progress between 1990 and 2021.
Major Findings
The study, conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, revealed that India’s under-five diarrhoeal mortality rate declined from 147 deaths per 100,000 population in 1990 to just over 35 deaths per 100,000 in 2021. This reduction underscores significant advancements in health interventions over the past three decades.
In terms of gender, the death rate due to diarrhoeal diseases in 2021 ranged between 25 and 50 per 100,000 population in males and between 50 and 100 per 100,000 in females.
Disability-Adjusted Life Years (DALYs)
India, Nigeria, and Pakistan demonstrated the most significant improvements in reducing disability-adjusted life-years (DALYs) lost to diarrhoeal diseases. India’s DALYs dropped from 16.8 million in 1990 to 2.11 million in 2021, reflecting substantial progress. Similar trends were observed in Nigeria, which reduced its DALYs from 10.1 million to 164,000, and Pakistan, which saw a reduction from 2.47 million to 152,000.
Pathogens and Global Context
The report identified key pathogens causing diarrhoeal mortality and morbidity in India, including adenovirus, aeromonas, campylobacter, cholera, clostridium difficile, cryptosporidium, norovirus, rotavirus, salmonella, and shigella. Despite global advancements, diarrhoeal diseases remain a significant challenge, with 1.2 million deaths worldwide in 2021, compared to 2.9 million in 1990.
Children under five experienced the largest decrease in mortality rates globally, with a 79% reduction over the past three decades. However, they continue to bear the highest mortality burden, followed by individuals aged 70 years and older. South Asia, including India, recorded the highest mortality rates among the elderly, with 476 deaths per 100,000 in 2021.
Risk Factors and Interventions
The study identified several risk factors contributing to diarrhoeal disease burden, such as low birthweight, preterm birth, child growth failure, unsafe water, and poor sanitation. These findings highlight the importance of comprehensive public health strategies to address underlying causes.
The decline in diarrhoeal mortality is attributed to key health interventions, including:
- Widespread adoption of oral rehydration therapy (ORT).
- Improved water, sanitation, and hygiene (WASH) infrastructure.
- Global immunisation campaigns targeting rotavirus.
Future Recommendations
To sustain and accelerate this progress, the study emphasizes the need for:
- Greater adoption of World Health Organization (WHO)-recommended rotavirus vaccines.
- Expanding vaccine development to target specific pathogens.
- Strengthening preventive measures to reduce the burden on healthcare systems.
Dr. Hmwe Hmwe Kyu, the study’s author and associate professor at IHME, noted, “In spite of the encouraging progress made combating diarrhoeal mortality, a multipronged approach is required to simultaneously tackle life-saving solutions while also prioritising preventive interventions to alleviate burdens on health systems.”
Conclusion
India’s substantial progress in reducing diarrhoeal disease mortality among children under five reflects the success of targeted health policies and interventions. However, continued focus on prevention, vaccination, and addressing root causes will be essential to further minimize the impact of diarrhoeal diseases and achieve long-term health improvements.
