LAUSR

The Global Burden of Disease study examined changes in mortality rate per 100 000 children <5 years old between 1990 and 2017. The good news is that the global diarrhoea mortality rate decreased by 69.6% (95% confidence interval 63.1–74.6%). The bad news is that in 2017, diarrhoea still resulted in an estimated 533 768 deaths of children <5 years globally. The global mortality rate for children <5 years with diarrhoea in 2017 was 78.4 per 100 000 children, but ranged from 0.1 in Singapore to 685.8 deaths per 100 000 children in the Central African Republic, and was highest in sub-Saharan Africa. Saudi Arabia had the greatest relative decline in mortality (98.1% decrease from 77.1 to 1.5 deaths per 100 000 children). Niger had the greatest absolute decline in mortality rate (from 1731.2 to 387.8 deaths or 1344.2 fewer deaths per 100 000 children). Nine countries (Armenia, China, Iran, Jamaica, Kazakhstan, Macedonia, Saudi Arabia, Turkey and Uzbekistan) had mortality rates above the global median rate in 1990 and below the median in 2017, all associated with steep improvements in socio-demographic status. The largest declines in diarrhoea mortality rate were due to reduction in unsafe sanitation (13.3% decrease), in childhood wasting (9.9%) and in under-use of oral rehydration solution (6.9%). Full use of rotavirus vaccine could have prevented an estimated 22% of diarrhoeal deaths, while providing safe water, sanitation and hygiene could have prevented 94% globally.