背景:腹泻病严重影响低收入和中等收入国家(LMIC)的公共卫生影响,尤其是在非洲,以前的研究表明缺乏全面的数据。随着越来越多关于非洲肠道感染的初步研究,本研究旨在评估2020年非洲各年龄段腹泻病原体的发病率和死亡率.我们还探索了不同的方法论假设,以便与其他方法进行比较。
方法:通过对非洲低收入国家数据的系统回顾和荟萃分析,我们估计了腹泻病和死亡的病因比例.我们将病因比例与从2020年非洲人口调查收集的发病率数据和世卫组织全球卫生观察站的死亡率数据相结合。
结果:我们估计2020年非洲地区有10亿腹泻病例(95%UI4.47亿-14亿)和515,031例腹泻死亡(95%UI248,983-1,007,641)。在五岁以下的儿童中,肠聚集性大肠杆菌(EAEC)(每10万人中有44,073例,95%UI18,818-60,922)和G.lamblia(每100,000人中有36,116例,95%UI15,245-49,961)是导致疾病的主要原因。肠侵入性大肠杆菌(EIEC)(每100,000人中有155例死亡,95%UI106.5-252.9)和轮状病毒(每100,000人中有61.5例死亡,95%UI42.3-100.3)是死亡的主要原因。对于五岁以上的儿童和成人,沙门氏菌属。在5岁以上儿童和成人人群中,腹泻病例最多(每10万人中有122,090例,95%UI51,833-168,822),而轮状病毒(每10万人中有16.4人死亡,95%UI4.2-36.7)和肠聚集性大肠杆菌(EAEC)(每10万人中14.6例死亡,95%UI3.9-32.9)造成最多的死亡。地理上,腹泻发病率最高的是东非五岁以下儿童(每10万人中有114,389例,95%UI34,771-172,884)和中非五岁以上儿童和成人(每100,000人中有117,820例,95%UI75111-157584)。西非5岁以下及以上儿童腹泻死亡率最高(5岁以下儿童:每10万人有194.5例死亡,95%UI120-325.4;5岁及以上儿童:每100,000人中33.5例死亡,95%UI12.9-75.1)。
结论:这些发现提供了有关16种病原体的发病率和死亡率的新信息,并强调了在非洲监测和控制腹泻传染病的必要性。特定原因的估计对于优先考虑该地区的腹泻疾病预防至关重要。
BACKGROUND: 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.
METHODS: 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.
RESULTS: We estimated 1,008 billion diarrhea cases (95% UI 447 million-1,4 billion) and 515,031 diarrhea deaths (95% UI 248,983-1,007,641) in the African region in 2020. In children under five, enteroaggregative E. coli (EAEC) (44,073 cases per 100,000 people, 95% UI 18,818 - 60,922) and G. lamblia (36,116 cases per 100,000 people, 95% UI 15,245 - 49,961) were the leading causes of illness. Enteroinvasive E. coli (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, Salmonella spp. caused the largest number of diarrheal cases in the population of children ≥ 5 and adults (122,090 cases per 100,000 people, 95% UI 51,833 - 168,822), while rotavirus (16.4 deaths per 100,000 people, 95% UI 4.2-36.7) and enteroaggregative E. coli (EAEC) (14.6 deaths per 100,000 people, 95% UI 3.9-32.9) 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 - 172,884) and Central Africa for children over five and adults (117,820 cases per 100,000 people, 95% UI 75,111-157,584). Diarrheal mortality was highest in Western Africa for both children below five and above (children < 5: 194.5 deaths per 100,000 people, 95% UI 120-325.4; children ≥ 5 and above: 33.5 deaths per 100,000 people, 95% UI 12.9-75.1).
CONCLUSIONS: 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.