Evidence map›Paper›PMID 29433665›Full record

ArticleThe Lancet. Global health2018

Global disability-adjusted life-year estimates of long-term health burden and undernutrition attributable to diarrhoeal diseases in children younger than 5 years.

Christopher Troeger, Danny V Colombara, Puja C Rao, Ibrahim A Khalil, Alexandria Brown, Thomas G Brewer, Richard L Guerrant, Eric R Houpt, Karen L Kotloff, Kavita Misra and 8 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 121 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
121citing papers in PubMed, 2 pooled it
13.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

121 citing papers in PubMed, 2 syntheses or guidelines pooled it, 194 citations in OpenAlex.

  1. Pooled it
  2. Breastfeeding and the Risk of Infant Illness in Asia: A Review.International journal of environmental research and public health · 2019
    Pooled it
  3. Trial
  4. Trial
  5. Trial
  6. Human vaccines & immunotherapeutics · 2026
    Review
  7. Article
  8. Article
  9. Effects ofmedRxiv : the preprint server for health sciences · 2026
    Article
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  11. Article
  12. Article
  13. Nutrients · 2026
    Article
  14. Review
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  16. Article
  17. Article
  18. TheeLife · 2025
    Article
  19. Article
  20. Article

61 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors at 6 institutions in 2 countries.

Christopher TroegerInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Danny V ColombaraInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Puja C RaoInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Ibrahim A KhalilInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Alexandria BrownInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Thomas G BrewerGlobal Enterics, LLC, Seattle, WA, USA.
Richard L GuerrantCenter for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
Eric R HouptDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
Karen L KotloffDepartments of Pediatrics and Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA.
Kavita MisraBureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY, USA.
William A PetriDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
James Platts-MillsDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
Mark S RiddleUniformed Services University of the Health Sciences, Bethesda, MD, USA.
Scott J SwartzInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Mohammad H ForouzanfarInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Robert C ReinerInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Simon I HayInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
Ali H MokdadInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: mokdaa@uw.edu.
Institute for Health Metrics and Evaluation · USUniversity of Washington · USUniversity of Virginia · USNew York City Department of Health and Mental Hygiene · USUniformed Services University of the Health Sciences · USUniversity of Maryland, Baltimore · US

Funding

FIELD STUDIES OF IMMUNITY TO AMEBIASIS IN BANGLADESHR01AI043596 · NIAID · UNIVERSITY OF VIRGINIA CHARLOTTESVILLE · PI CAROL A GILCHRIST, William A Petri · 1998 to 2026
$7.7M
NIAID NIH HHS R01 AI043596
6 · The paper itself

Abstract

backgroundDiarrhoea is a leading cause of death and illness globally among children younger than 5 years. Mortality and short-term morbidity cause substantial burden of disease but probably underestimate the true effect of diarrhoea on population health. This underestimation is because diarrhoeal diseases can negatively affect early childhood growth, probably through enteric dysfunction and impaired uptake of macronutrients and micronutrients. We attempt to quantify the long-term sequelae associated with childhood growth impairment due to diarrhoea.

methodsWe used the Global Burden of Diseases, Injuries, and Risk Factors Study framework and leveraged existing estimates of diarrhoea incidence, childhood undernutrition, and infectious disease burden to estimate the effect of diarrhoeal diseases on physical growth, including weight and height, and subsequent disease among children younger than 5 years. The burden of diarrhoea was measured in disability-adjusted life-years (DALYs), a composite metric of mortality and morbidity. We hypothesised that diarrhoea is negatively associated with three common markers of growth: weight-for-age, weight-for-height, and height-for-age Z-scores. On the basis of these undernutrition exposures, we applied a counterfactual approach to quantify the relative risk of infectious disease (subsequent diarrhoea, lower respiratory infection, and measles) and protein energy malnutrition morbidity and mortality per day of diarrhoea and quantified the burden of diarrhoeal disease due to these outcomes caused by undernutrition.

findingsDiarrhoea episodes are significantly associated with childhood growth faltering. We found that each day of diarrhoea was associated with height-for-age Z-score (-0·0033 [95% CI -0·0024 to -0·0041]; p=4·43 × 10

interpretationDiarrhoea represents an even larger burden of disease than was estimated in the Global Burden of Disease Study. In order to adequately address the burden of its long-term sequelae, a renewed emphasis on controlling the risk of diarrhoea incidence may be required. This renewed effort can help further prevent the potential lifelong cost on child health, growth, and overall potential.

fundingBill & Melinda Gates Foundation.

Indexed as

Cost of IllnessQuality-Adjusted Life YearsChild, PreschoolDiarrheaFemaleGlobal HealthGrowth DisordersHumansInfantMaleMalnutritionPersons with DisabilitiesTime Factors

Identifiers

PMID29433665
PMCPMC5861379
OpenAlexW2785669008

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.