Global burden of diarrheal diseases attributable to 13 pathogens in children under five: a comprehensive analysis from GBD 2021

Introduction Diarrheal diseases remain a major cause of death and disability among children under five, especially in low- and middle-income countries (LMICs). Methods 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). Results From 1990 to 2021, global diarrheal deaths declined from 2.43 million to 0.56 million, and DALYs from 218.14 million (95% UI: 131.58–335.90 million) to 50.63 million (95% UI: 28.77–82.70 million). Rotavirus and Shigella 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). Discussion These findings underscore the need for pathogen-specific, regionally targeted interventions to further reduce child mortality and disability.