{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T20:15:21Z","timestamp":1793218521965,"version":"4.5.0"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T00:00:00Z","timestamp":1720742400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T00:00:00Z","timestamp":1720742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Bill and Melinda Gates Foundation,United States","award":["OPP1195617"],"award-info":[{"award-number":["OPP1195617"]}]},{"DOI":"10.13039\/501100000617","name":"Foreign and Commonwealth Office","doi-asserted-by":"publisher","award":["OPP1195617"],"award-info":[{"award-number":["OPP1195617"]}],"id":[{"id":"10.13039\/501100000617","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Diarrheal diseases substantially affect public health impact in low- and middle-income countries (LMIC), particularly in Africa, where previous studies have indicated a lack of comprehensive data. With a growing number of primary studies on enteric infections in Africa, this study aimed to estimate the incidence and mortality of diarrheal pathogens across all ages in Africa in the year 2020. We also explored different methodological assumptions to allow comparison with other approaches.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Through a systematic review and meta-analysis of data from African LMICs, we estimated the etiology proportions for diarrheal diseases and deaths. We combined the etiology proportions with incidence data collected from a population survey in Africa from 2020 and mortality data from the Global Health Observatory of WHO.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We estimated 1,008\u00a0billion diarrhea cases (95% UI 447\u00a0million-1,4\u00a0billion) and 515,031 diarrhea deaths (95% UI 248,983-1,007,641) in the African region in 2020. In children under five, enteroaggregative <jats:italic>E. coli<\/jats:italic> (EAEC) (44,073 cases per 100,000 people, 95% UI 18,818\u2009\u2212\u200960,922) and <jats:italic>G. lamblia<\/jats:italic> (36,116 cases per 100,000 people, 95% UI 15,245\u2009\u2212\u200949,961) were the leading causes of illness. Enteroinvasive <jats:italic>E. coli<\/jats:italic> (EIEC) (155 deaths per 100,000 people, 95% UI 106.5-252.9) and rotavirus (61.5 deaths per 100,000 people, 95% UI 42.3-100.3) were the primary causes of deaths. For children over five and adults, <jats:italic>Salmonella<\/jats:italic> spp. caused the largest number of diarrheal cases in the population of children\u2009\u2265\u20095 and adults (122,090 cases per 100,000 people, 95% UI 51,833\u2009\u2212\u2009168,822), while rotavirus (16.4 deaths per 100,000 people, 95% UI 4.2\u201336.7) and enteroaggregative <jats:italic>E. coli<\/jats:italic> (EAEC) (14.6 deaths per 100,000 people, 95% UI 3.9\u201332.9) causing the most deaths. Geographically, the highest incidence of diarrhea was in Eastern Africa for children under five (114,389 cases per 100,000 people, 95% UI 34,771\u2009\u2212\u2009172,884) and Central Africa for children over five and adults (117,820 cases per 100,000 people, 95% UI 75,111\u2013157,584). Diarrheal mortality was highest in Western Africa for both children below five and above (children\u2009&lt;\u20095: 194.5 deaths per 100,000 people, 95% UI 120-325.4; children\u2009\u2265\u20095 and above: 33.5 deaths per 100,000 people, 95% UI 12.9\u201375.1).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>These findings provide new information on the incidence and mortality of sixteen pathogens and highlight the need for surveillance and control of diarrheal infectious diseases in Africa. The cause-specific estimates are crucial for prioritizing diarrheal disease prevention in the region.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12889-024-19334-8","type":"journal-article","created":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T07:02:09Z","timestamp":1720767729000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":57,"title":["Etiology-specific incidence and mortality of diarrheal diseases in the African region: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"24","author":[{"given":"Cecilie","family":"Thystrup","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon E.","family":"Majowicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinaol B.","family":"Kitila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binyam N.","family":"Desta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olanrewaju E.","family":"Fayemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christianah I.","family":"Ayolabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ephrasia","family":"Hugho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elna M.","family":"Buys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel B.","family":"Akanni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norgia E.","family":"Machava","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celso","family":"Monjane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tine","family":"Hald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara M.","family":"Pires","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,12]]},"reference":[{"key":"19334_CR1","unstructured":"World Health Organization. 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All the authors complied with the ethics and policy of the journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Sara M. Pires and Shannon Majowicz are members of the World Health Organization\u2019s Foodborne Disease Burden Epidemiology Reference Group (FERG).Shannon Majowicz is an expert on the Joint FAO\/WHO Expert Meetings on Microbiological Risk Assessment (JEMRA) Roster of Experts. All other authors have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Shannon Majowicz is an expert on the Joint FAO\/WHO Expert Meetings on Microbiological Risk Assessment (JEMRA) Roster of Experts.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"All other authors had no competing interests.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1864"}}