Global burden and socioeconomic disparities of enteric infections in children under five: a comprehensive analysis from 1990 to 2021.

BACKGROUND

Enteric infections are a leading cause of preventable mortality in children under five, primarily driven by diarrheal diseases and invasive non-typhoidal Salmonella (iNTS). Despite global progress, substantial disparities persist in low- and middle-income countries, fueled by inadequate water, sanitation, hygiene (WASH), and malnutrition.

METHODS

This study utilized data from the Global Burden of Disease (GBD) 2021 to analyze the spatiotemporal patterns of enteric infections in children under five across 204 countries from 1990 to 2021. The analysis included incidence, mortality, and disability-adjusted life years (DALYs), stratified by age, sex, and socio-demographic index (SDI). Bayesian meta-regression tools, such as DisMod-MR, were employed for data harmonization. Descriptive statistics, Joinpoint regression, and Spearman's correlation were used to assess trends and associations between SDI and disease burden.

RESULTS

In 2021, enteric infections caused 60,157.3 cases and 63.4 deaths per 100,000 children under five globally, reflecting a 68.6% and 77.7% decline since 1990, respectively. Low-SDI regions bore the highest burden, with mortality rates 166-fold higher than high-SDI regions. Diarrheal diseases accounted for 81.6% of deaths, while iNTS incidence increased in certain areas. Geographically, sub-Saharan Africa and South Asia were hotspots. Neonates had the highest incidence, with male mortality consistently exceeding females. Unsafe water, poor sanitation, and malnutrition contributed to 82.3% of attributable DALYs.

CONCLUSION

Enteric infections remain a critical threat to child survival. Achieving global health goals requires decisive, multisectoral interventions to address the root causes of these persistent and glaring inequities.