{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:09:06Z","timestamp":1789711746734,"version":"4.0.1"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Diarrheal diseases remain a major cause of death and disability among children under five, especially in low- and middle-income countries (LMICs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using Global Burden of Disease Study 2021 (GBD 2021) data, we assessed mortality and disability-adjusted life years (DALYs) attributable to 13 diarrheal pathogens across 204 countries from 1990 to 2021. Analyses included age-stratified burden estimation, temporal trend analysis using estimated annual percentage change (EAPC), and frontier analysis with the Socio-demographic Index (SDI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 1990 to 2021, global diarrheal deaths declined from 2.43 million to 0.56 million, and DALYs from 218.14 million (95% UI: 131.58\u2013335.90 million) to 50.63 million (95% UI: 28.77\u201382.70 million).\n                      <jats:italic>Rotavirus and Shigella<\/jats:italic>\n                      remained leading causes of mortality, while Clostridioides difficile was the only pathogen with a positive EAPC, indicating an increasing burden. Considerable regional and national disparities persisted, with the highest mortality in Chad (842.44 per 100,000) and the lowest in Andorra (0.05 per 100,000).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings underscore the need for pathogen-specific, regionally targeted interventions to further reduce child mortality and disability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1846669","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:39:15Z","timestamp":1789709955000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Global burden of diarrheal diseases attributable to 13 pathogens in children under five: a comprehensive analysis from GBD 2021"],"prefix":"10.3389","volume":"14","author":[{"given":"Xue","family":"Li","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The Seventh People\u2019s Hospital of Zhengzhou","place":["Zhengzhou, China"]},{"name":"Institute of Biological Therapy, Henan Academy of Innovations in Medical Science","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Seventh People\u2019s Hospital of Zhengzhou","place":["Zhengzhou, China"]},{"name":"Institute of Biological Therapy, Henan Academy of Innovations in Medical Science","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongyan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Seventh People\u2019s Hospital of Zhengzhou","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanjuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Seventh People\u2019s Hospital of Zhengzhou","place":["Zhengzhou, China"]},{"name":"Institute of Biological Therapy, Henan Academy of Innovations in Medical Science","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"04107","DOI":"10.7189\/jogh.15.04107","article-title":"Incidence of diarrhoeal disease among children aged less than five years in low- and middle-income countries: a systematic review","volume":"15","author":"Fekadu","year":"2025","journal-title":"J Glob Health"},{"key":"B2","year":"2024"},{"key":"B3","year":""},{"key":"B4","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.ijid.2023.10.005","article-title":"Estimating the global impact of rotavirus vaccines on child mortality","volume":"137","author":"Clark","year":"2023","journal-title":"Int J Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"958","DOI":"10.1001\/jamapediatrics.2018.1960","article-title":"Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years","volume":"172","author":"Troeger","year":"2018","journal-title":"JAMA Pediatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"20503121251353356","DOI":"10.1177\/20503121251353356","article-title":"Pathogenic bacteria in raw milk and milk products in Ethiopia: a decade review of prevalence, contributing factors, and antimicrobial resistance. 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