Estimating the global burden of diarrhea among young children with wasting and stunting and its projection to 2050: evidence from the Global Burden of Disease 2021 study.

BACKGROUND: Diarrheal disease is one of the leading causes of death among children worldwide. Childhood stunting and wasting are independent risk factors for pediatric diarrhea. Using data from the Global Burden of Disease 2021 study (GBD 2021), this study investigated the epidemiological burden, temporal trends and future trajectories of stunting- and wasting-related diarrhea in children under 5 years globally, so as to provide evidence for formulating targeted and differentiated diarrhea prevention and control strategies.

METHODS: This study adopted GBD 2021 data from 1990 to 2021 covering 204 countries and regions worldwide. Four core indicators including deaths, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) were used to compare the burden of the two types of diarrhea. Stratified analyses were performed by sex, age, region and Socio-Demographic Index (SDI). Estimated annual percentage change (EAPC) was calculated to quantify temporal trends, and decomposition analysis was conducted to estimate the contributions of epidemiological changes and population growth to burden fluctuations. The Autoregressive Integrated Moving Average (ARIMA) model was applied to predict and compare long-term burden trends from 2022 to 2050. As a retrospective secondary study, it has limitations due to raw data quality, regional data imbalance and model estimation bias, and the predictions only reflect overall trends.

RESULTS: From 1990 to 2021, all burden indicators of stunting- and wasting-related diarrhea in under-five children declined substantially and continuously, with Western Sub-Saharan Africa bearing the highest burden globally. Projections for 2022-2050 showed sustained reductions in mortality and disability-adjusted life years, with a more remarkable decline among girls. Wasting-related diarrhea experienced a greater and faster burden reduction, and obvious heterogeneity existed in their long-term trends.

DISCUSSION: The steady decline in disease burden is mainly attributed to improved epidemiological conditions. Improving sanitation facilities, ensuring access to safe drinking water, optimizing child nutrition and increasing rotavirus vaccination coverage are core measures for diarrhea control. ARIMA projections revealed that wasting-related diarrhea saw a far larger burden reduction. Early and precise nutritional interventions for wasted children can effectively reduce the burden of acute diarrhea and achieve efficient and sustainable prevention and control.