{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T09:10:58Z","timestamp":1788945058840,"version":"build-2803163510"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":68,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Epidemiol Glob Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diarrhoeal diseases remain a major cause of under-five mortality in South Asia despite global health progress. This study quantifies the economic losses due to premature under-five deaths from diarrhoeal diseases, analyzing trends, aetiologies, and risk factors across five South Asian countries between 2010 and 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from the datasets published by the Institute for Health Metrics and Evaluation (IHME) and World Bank indicators, the study applied the human capital approach to estimate the present value of lost future labour income associated with diarrhoeal deaths among children under five. Losses were estimated in both purchasing power parity (PPP)-adjusted and nominal U.S. dollars to reflect real productivity losses and fiscal implications, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>While age-standardized mortality and DALY rates declined significantly across South Asia (EAPC\u2009\u2212\u20095.2 for both), the economic burden of premature mortality due to childhood diarrhoeal diseases remained substantial. India accounted for the largest absolute loss in future labour income, estimated at USD 5,581\u00a0million PPP, followed by Pakistan (USD 1,571\u00a0million PPP) and Bangladesh (USD 360\u00a0million PPP). When expressed relative to national GDP using nominal estimates, Pakistan experienced the highest proportional economic loss, equivalent to approximately 0.055% of GDP in 2023, followed by India (0.020%), Bangladesh (0.012%), and Nepal (0.005%). Major etiological agents included rotavirus, Shigella, and Escherichia coli, while unsafe water, poor sanitation, and child undernutrition were the leading attributable risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Policy Implications<\/jats:title>\n                    <jats:p>Despite epidemiological gains, diarrhoeal diseases continue to impose substantial economic and developmental costs in South Asia. Strengthened investments in WASH infrastructure, nutrition, and vaccination programs can yield dual benefits by saving lives and reducing future productivity losses. Integrating child health strategies into national economic planning is imperative for sustainable growth.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s44197-026-00598-9","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T01:34:58Z","timestamp":1783042498000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Economic Losses from Premature Under-Five Mortality due to Diarrhoeal Diseases in South Asia: Trends, Aetiologies, and Key Risk Factors"],"prefix":"10.1007","volume":"16","author":[{"given":"Bijaya Kumar","family":"Padhi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manya","family":"Soni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amogh","family":"Verma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prajnasini","family":"Satapathy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorabh","family":"Lakhanpal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rekha","family":"Arcot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Do-Youn","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakasini","family":"Satapathy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"issue":"5","key":"598_CR1","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1016\/s1473-3099(24)00691-1","volume":"25","author":"HH Kyu","year":"1990","unstructured":"Kyu HH, Vongpradith A, Dominguez R-M, Ma J, Albertson SB, Novotney A, et al. Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990\u20132021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Infect Dis. 1990;25(5):519\u201336. https:\/\/doi.org\/10.1016\/s1473-3099(24)00691-1.","journal-title":"Lancet Infect Dis"},{"key":"598_CR2","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000039578","author":"EU Alum","year":"2024","unstructured":"Alum EU, Obeagu EI, Ugwu O-C. Enhancing quality water, good sanitation, and proper hygiene is the panacea to diarrhea control and the attainment of some related sustainable development goals: a review. Medicine (Baltimore). 2024. https:\/\/doi.org\/10.1097\/md.0000000000039578.","journal-title":"Medicine (Baltimore)"},{"key":"598_CR3","doi-asserted-by":"publisher","DOI":"10.1136\/bmjph-2024-001909","author":"AR Sarker","year":"2025","unstructured":"Sarker AR, Hasan A, Nawar N, Islam R. Childhood diarrhoeal disease in South Asian countries: a population-based analysis. BMJ Public Health. 2025. https:\/\/doi.org\/10.1136\/bmjph-2024-001909.","journal-title":"BMJ Public Health"},{"key":"598_CR4","doi-asserted-by":"publisher","DOI":"10.1016\/j.cegh.2021.100813","author":"K Ghosh","year":"2021","unstructured":"Ghosh K, Chakraborty AS, Mog M. Prevalence of diarrhoea among under five children in India and its contextual determinants: a geo-spatial analysis. Clin Epidemiol Glob Health. 2021. https:\/\/doi.org\/10.1016\/j.cegh.2021.100813.","journal-title":"Clin Epidemiol Glob Health"},{"key":"598_CR5","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17062140","author":"R Li","year":"2020","unstructured":"Li R, Lai Y, Feng C, Dev R, Wang Y, Hao Y. Diarrhea in under five year-old children in Nepal: a spatiotemporal analysis based on demographic and health survey data. Int J Environ Res Public Health. 2020. https:\/\/doi.org\/10.3390\/ijerph17062140.","journal-title":"Int J Environ Res Public Health"},{"key":"598_CR6","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.1043","author":"ZS Rahmat","year":"2023","unstructured":"Rahmat ZS, Zubair A, Abdi I, Humayun N, Arshad F, Essar MY. The rise of diarrheal illnesses in the children of Pakistan amidst COVID-19: a narrative review. Health Sci Rep. 2023. https:\/\/doi.org\/10.1002\/hsr2.1043.","journal-title":"Health Sci Rep"},{"key":"598_CR7","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2611-6","author":"K Wangdi","year":"2017","unstructured":"Wangdi K, Clements ACA. Spatial and temporal patterns of diarrhoea in Bhutan 2003\u20132013. BMC Infect Dis. 2017. https:\/\/doi.org\/10.1186\/s12879-017-2611-6.","journal-title":"BMC Infect Dis"},{"key":"598_CR8","doi-asserted-by":"publisher","first-page":"F18","DOI":"10.1016\/j.vaccine.2009.08.098","volume":"27","author":"JE Tate","year":"2009","unstructured":"Tate JE, Chitambar S, Esposito DH, Sarkar R, Gladstone B, Ramani S, et al. Disease and economic burden of rotavirus diarrhoea in India. Vaccine. 2009;27:F18\u201324. https:\/\/doi.org\/10.1016\/j.vaccine.2009.08.098.","journal-title":"Vaccine"},{"key":"598_CR9","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.ijid.2021.04.038","volume":"107","author":"MZ Hasan","year":"2021","unstructured":"Hasan MZ, Mehdi GG, De Broucker G, Ahmed S, Ali MW, Martin Del Campo J, et al. The economic burden of diarrhea in children under 5 years in Bangladesh. Int J Infect Dis. 2021;107:37\u201346. https:\/\/doi.org\/10.1016\/j.ijid.2021.04.038.","journal-title":"Int J Infect Dis"},{"key":"598_CR10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjpo-2025-003622","author":"MF Al Fidah","year":"2025","unstructured":"Al Fidah MF, Islam MR, Amin R, Nuzhat S, Ahmed T, Faruque ASG. The cost of diarrhoea: a household perspective from seven countries in the Global Enteric Multicenter Study (GEMS). BMJ Paediatr Open. 2025. https:\/\/doi.org\/10.1136\/bmjpo-2025-003622.","journal-title":"BMJ Paediatr Open"},{"key":"598_CR11","unstructured":"Results IHMEGBD. 2025 [Available from: https:\/\/vizhub.healthdata.org\/gbd-results\/"},{"key":"598_CR12","unstructured":"Bank W. World Development Indicators 2025 [Available from: https:\/\/databank.worldbank.org\/reports.aspx?source=2&series=NY.GDP.PCAP.CD&country=#."},{"key":"598_CR13","unstructured":"Young Eun Kim NVL. Productivity Growth Patterns and Determinants across the World. 2019."},{"key":"598_CR14","unstructured":"The R Project for Statistical Computing. 2025 [Available from: https:\/\/www.r-project.org\/"},{"issue":"9888","key":"598_CR15","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/s0140-6736(13)60844-2","volume":"382","author":"KL Kotloff","year":"2013","unstructured":"Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet. 2013;382(9888):209\u201322. https:\/\/doi.org\/10.1016\/s0140-6736(13)60844-2.","journal-title":"Lancet"},{"issue":"10345","key":"598_CR16","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/s0140-6736(22)00937-0","volume":"400","author":"J Wolf","year":"2022","unstructured":"Wolf J, Hubbard S, Brauer M, Ambelu A, Arnold BF, Bain R, et al. Effectiveness of interventions to improve drinking water, sanitation, and handwashing with soap on risk of diarrhoeal disease in children in low-income and middle-income settings: a systematic review and meta-analysis. Lancet. 2022;400(10345):48\u201359. https:\/\/doi.org\/10.1016\/s0140-6736(22)00937-0.","journal-title":"Lancet"},{"key":"598_CR17","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph21070823","author":"G Geremew","year":"2024","unstructured":"Geremew G, Cumming O, Haddis A, Freeman MC, Ambelu A. Rainfall and temperature influences on childhood diarrhea and the effect modification role of water and sanitation conditions: a systematic review and meta-analysis. Int J Environ Res Public Health. 2024. https:\/\/doi.org\/10.3390\/ijerph21070823.","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"598_CR18","doi-asserted-by":"publisher","first-page":"1556","DOI":"10.1038\/s41467-024-45624-1","volume":"15","author":"PA Ante-Testard","year":"2024","unstructured":"Ante-Testard PA, Rerolle F, Nguyen AT, Ashraf S, Parvez SM, Naser AM, et al. WASH interventions and child diarrhea at the interface of climate and socioeconomic position in Bangladesh. Nat Commun. 2024;15(1):1556. https:\/\/doi.org\/10.1038\/s41467-024-45624-1.","journal-title":"Nat Commun"},{"key":"598_CR19","volume-title":"Investment Framework for Nutrition 2024","author":"Bank W.","year":"2024","unstructured":"Bank W. Investment Framework for Nutrition 2024. Washington, DC: World Bank; 2024."},{"issue":"5","key":"598_CR20","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1016\/j.jiph.2023.03.021","volume":"16","author":"AR Sarker","year":"2023","unstructured":"Sarker AR. Economic assessment of childhood rotavirus vaccination in Bangladesh. J Infect Public Health. 2023;16(5):816\u201322. https:\/\/doi.org\/10.1016\/j.jiph.2023.03.021.","journal-title":"J Infect Public Health"},{"key":"598_CR21","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a041202","author":"A Scott","year":"2023","unstructured":"Scott A, Ashwin J, Ellison M, Sinclair D. International gains to achieving healthy longevity. Cold Spring Harb Perspect Med. 2023. https:\/\/doi.org\/10.1101\/cshperspect.a041202.","journal-title":"Cold Spring Harb Perspect Med"},{"issue":"7","key":"598_CR22","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1007\/s40273-013-0056-3","volume":"31","author":"M Krol","year":"2013","unstructured":"Krol M, Brouwer W, Rutten F. Productivity costs in economic evaluations: past, present, future. Pharmacoeconomics. 2013;31(7):537\u201349. https:\/\/doi.org\/10.1007\/s40273-013-0056-3.","journal-title":"Pharmacoeconomics"},{"key":"598_CR23","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-015-2465-z","author":"JM Kirigia","year":"2015","unstructured":"Kirigia JM, Muthuri RDK, Nabyonga-Orem J, Kirigia DG. Counting the cost of child mortality in the World Health Organization African region. BMC Public Health. 2015. https:\/\/doi.org\/10.1186\/s12889-015-2465-z.","journal-title":"BMC Public Health"},{"issue":"3","key":"598_CR24","doi-asserted-by":"publisher","first-page":"226","DOI":"10.7326\/m20-1565","volume":"173","author":"NP Jewell","year":"2020","unstructured":"Jewell NP, Lewnard JA, Jewell BL. Caution warranted: using the Institute for Health Metrics and Evaluation model for predicting the course of the COVID-19 pandemic. Ann Intern Med. 2020;173(3):226\u20137. https:\/\/doi.org\/10.7326\/m20-1565.","journal-title":"Ann Intern Med"},{"issue":"6","key":"598_CR25","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1007\/s40258-018-0416-4","volume":"16","author":"J Pike","year":"2018","unstructured":"Pike J, Grosse SD. Friction cost estimates of productivity costs in cost-of-illness studies in comparison with human capital estimates: a review. Appl Health Econ Health Policy. 2018;16(6):765\u201378. https:\/\/doi.org\/10.1007\/s40258-018-0416-4.","journal-title":"Appl Health Econ Health Policy"},{"issue":"3","key":"598_CR26","doi-asserted-by":"publisher","first-page":"e683","DOI":"10.1093\/cid\/ciaa1938","volume":"73","author":"JR Donowitz","year":"2021","unstructured":"Donowitz JR, Drew J, Taniuchi M, Platts-Mills JA, Alam M, Ferdous T, et al. Diarrheal pathogens associated with growth and neurodevelopment. Clin Infect Dis. 2021;73(3):e683\u201391. https:\/\/doi.org\/10.1093\/cid\/ciaa1938.","journal-title":"Clin Infect Dis"}],"container-title":["Journal of Epidemiology and Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s44197-026-00598-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44197-026-00598-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44197-026-00598-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T09:05:39Z","timestamp":1788944739000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s44197-026-00598-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["598"],"URL":"https:\/\/doi.org\/10.1007\/s44197-026-00598-9","relation":{},"ISSN":["2210-6014"],"issn-type":[{"value":"2210-6014","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]},"assertion":[{"value":"27 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable, as this study used publicly available secondary data and did not involve human participants.","order":1,"name":"Ethics","label":"Ethics Approval and Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors have reviewed and approved the final manuscript and agree to its publication. The manuscript does not contain any individual person\u2019s identifiable data requiring additional consent.","order":2,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"109"}}