The overlapping burden of the three leading causes of disability and death in sub-Saharan African children
Robert C. Reiner, LBD Triple Burden Collaborators, Catherine A. Welgan, Christopher Troeger, Mathew M Baumann, Daniel J. Weiss, Aniruddha Deshpande, Brigette F. Blacker, Molly K. Miller-Petrie, Lucas Earl, Samir Bhatt, Hassan Abolhassani, Akine Eshete Abosetugn, Eman Abu‐Gharbieh, Victor Adekanmbi, Olatunji Adetokunboh, Mohammad Aghaali, Budi Aji, Fares Alahdab, Ziyad Al‐Aly, Robert Kaba Alhassan, Saqib Ali, Hesam Alizade, Syed Mohamed Aljunid, Amir Almasi‐Hashiani, Hesham M. Al‐Mekhlafi, Khalid A Altirkawi, Nelson Alvis‐Guzmán, Azmeraw T. Amare, Saeed Amini, Dickson A Amugsi, Robert Ancuceanu, Cătălina Liliana Andrei, Fereshteh Ansari, Davood Anvari, Seth Christopher Yaw Appiah, Jalal Arabloo, Olatunde Aremu, Maha Atout, Marcel Ausloos, Floriane Ausloos, Martin Amogre Ayanore, Yared Asmare Aynalem, Zelalem Nigussie Azene, Alaa Badawi, Atif Amin Baig, Maciej Banach, Neeraj Bedi, Akshaya Srikanth Bhagavathula, Dinesh Bhandari, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Zulfiqar A Bhutta, Ali Bijani, Tesega Tesega Mengistu Birhanu, Zebenay Workneh Bitew, Archith Boloor, Oliver J. Brady, Zahid A Butt, Josip Car, Félix Carvalho, Daniel Casey, Vijay Kumar Chattu, Mohiuddin Ahsanul Kabir Chowdhury, Dinh‐Toi Chu, Camila H. Coelho, Aubrey J. Cook, Giovanni Damiani, Farah Daoud, Jiregna Darega Gela, Amira Hamed Darwish, Ahmad Daryani, Jai K Das, Nicole Davis Weaver, Kebede Deribe, Assefa Desalew, Samath Dhamminda Dharmaratne, Mostafa Dianatinasab, Daniel Díaz, Shirin Djalalinia, Fariba Dorostkar, Eleonora Dubljanin, Bereket Duko, Laura Dwyer‐Lindgren, Andem Effiong, Maysaa El Sayed Zaki, Maha El Tantawi, Shymaa Enany, Nazir Fattahi, Valery L. Feigin, Eduarda Fernandes, Pietro Ferrara, Florian Fischer, Nataliya A Foigt, Morẹ́nikẹ́ Oluwátóyìn Foláyan, Masoud Foroutan, Joseph Frostad, Takeshi Fukumoto, Abhay Gaidhane
Abstract
Despite substantial declines since 2000, lower respiratory infections (LRIs), diarrhoeal diseases, and malaria remain among the leading causes of nonfatal and fatal disease burden for children under 5 years of age (under 5), primarily in sub-Saharan Africa (SSA). The spatial burden of each of these diseases has been estimated subnationally across SSA, yet no prior analyses have examined the pattern of their combined burden. Here we synthesise subnational estimates of the burden of LRIs, diarrhoea, and malaria in children under-5 from 2000 to 2017 for 43 sub-Saharan countries. Some units faced a relatively equal burden from each of the three diseases, while others had one or two dominant sources of unit-level burden, with no consistent pattern geographically across the entire subcontinent. Using a subnational counterfactual analysis, we show that nearly 300 million DALYs could have been averted since 2000 by raising all units to their national average. Our findings are directly relevant for decision-makers in determining which and targeting where the most appropriate interventions are for increasing child survival.