Evolution of the World Health Organization's programmatic actions to control diarrheal diseases

Global burden of diarrhea disease in the older adult and its attributable risk factors from 1990 to 2021: a comprehensive analysis from the global burden of disease study 2021

Introduction

Diarrhea disease among the older adult is an underappreciated global health issue despite its substantial burden. This study provides a comprehensive analysis of the epidemiological trends of diarrhea in individuals over 65 years, examining incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021.

Methods

Utilizing data from the Global Burden of Diseases (GBD) 2021, this cross-sectional study assesses the older adult population across 204 countries and territories. The analysis includes metrics such as incidence, prevalence, mortality, DALYs, and estimated annual percentage changes (EAPCs), stratified by region, country, age, sex, and Sociodemographic Index (SDI).

Results

A nearly 200% increase in incidence and prevalence was observed worldwide, with the highest rise in those over 95 years. Mortality and DALYs have declined, especially in the 65-69 age group. High SDI regions showed the largest increase in incidence rates and are the only areas with increasing mortality and DALYs trends. Unsafe water sources emerged as the primary risk factor for diarrhea-related deaths among the older adult.

Discussion

The burden of diarrhea in the older adult has significantly increased, particularly in high-income regions, warranting targeted interventions. The positive correlation between EAPC and the Human Development Index underscores the need for improved water safety to mitigate the disease burden. This study's findings are crucial for shaping public health strategies and informing policy decisions regarding the older adult population.

Self-Powered Disinfection Using Triboelectric, Conductive Wires of Metal-Organic Frameworks

Efficient water disinfection is vitally needed in rural and disaster-stricken areas lacking power supplies. However, conventional water disinfection methods strongly rely on external chemical input and reliable electricity. Herein, we present a self-powered water disinfection system using synergistic hydrogen peroxide (H₂O₂) assisted electroporation mechanisms driven by triboelectric nanogenerators (TENGs) that harvest electricity from the flow of water. The flow-driven TENG, assisted by power management systems, generates a controlled output with aimed voltages to drive a conductive metal-organic framework nanowire array for effective H₂O₂ generation and electroporation. The injured bacteria caused by electroporation can be further damaged by facile diffused H₂O₂ molecules at high throughput. A self-powered disinfection prototype enables complete disinfection (>99.9999% removal) over a wide range of flows up to 3.0 × 10⁴ L/(m² h) with low water flow thresholds (200 mL/min; ∼20 rpm). This rapid, self-powered water disinfection method is promising for pathogen control.

Quercetin-3-O-β-D-glucopyranoside-rich fraction demonstrated efficacy against infectious, secretory, and osmotic models of diarrhoeal rats

BACKGROUND

The prevalence of diarrhoea remains high despite efforts by governments and NGOs to reverse trend. This study investigated the antidiarrhoeal activity and mechanism of Spondias mombin leaf fraction rich in quercetin-3-O-β-D-glucopyranoside (Q3G-RF) because of the acclaimed therapeutic efficacy. Secretory, osmotic, and infectious diarrhoea models using castor oil, magnesium sulphate, and Shigella flexneri respectively were evaluated at the doses of 100, 200, and 400 mg/kg in Wistar rats. Enteropathy was induced with castor oil and magnesium sulphate, while gastrointestinal motility was determined with charcoal meal.

RESULTS

Findings showed no mortality after 14 days of experimental period and no significant changes in behaviour, food, and water consumption. Relative to control, Q3G-RF inhibited the three models of diarrhoea, enteropathy, and gastrointestinal motility; bacterial colonies were reduced by Q3G-RF, while it improved the relative body weight of the animals. Q3G-RF also increased the intestinal concentration/activity of glucose, total protein, and Na⁺-K⁺ ATPase but reduced the concentration of TNF-α, PGE₂, IL-1β, nitric oxide, Na⁺, K⁺, and Cl^- in the diarrhoeal models. The intestinal fluid level of K⁺, Na⁺, and Cl^- was significantly decreased by Q3G-RF in the enteropathy model. Length of the small intestine in the motility model was also increased by Q3G-RF, while peristaltic index and inhibition of peristalsis were reduced.

CONCLUSION

Overall, quercetin-3-O-β-D-glucopyranoside from Spondias mombin leaves demonstrated efficacy against infectious, secretory, and osmotic form of diarrhoeal and further justified its traditional use in the treatment of diarrhoea due to its antimotility, antisecretory, and antimicrobial properties by mechanism related to enhanced Na⁺-K⁺ ATPase, repressed nitric oxide, and suppressed prostaglandins.

Global estimated Disability-Adjusted Life-Years (DALYs) of diarrheal diseases: A systematic analysis of data from 28 years of the global burden of disease study

BACKGROUND

Diarrheal disease (DD)-associated mortality has declined since 1990; however, the incidence of DD has experienced a less-pronounced decrease. Thus, it is important to track progress in managing DD by following loss of healthy years. A disability-adjusted life-year (DALY), which combines data on years-of-life lost (YLL) and years-lived with-disability (YLD), is a metric that can track such a burden.

METHODS AND FINDINGS

Using all 28 years of data in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we compared DD DALYs among different demographic subsets including sex, age, country, and World Bank (WB) income level. We also evaluated DD DALYs as a function of the socio-demographic index (SDI), a measure of a region's socio-demographic development. On a global level, DD DALYs have decreased by approximately 85.43% from 1990 to 2017. Incidence and prevalence have decreased by 1.53% and 4.45%, respectively. A dramatic decrease in DD DALYs were observed for WB low-income countries, but not for WB high-income constituents. The temporal decrease in DD DALY rates in WB low-income countries was likely driven by a decrease in YLL. Alternatively, temporal increases in both YLL and YLD may have contributed to the apparent lack of progress in WB high-income countries. Regardless of WB income classification, children under the age of five and the elderly were the most vulnerable to DD. In nearly every year from 1990 to 2017, DD DALYs for females were higher than those for males in WB high-income regions, but lower than those for males in WB low-income constituents. The reason for these differences is not known. We also observed that the rate of DD DALYs was highly correlated to SDI regardless of WB income classification.

CONCLUSIONS

To the best of our knowledge, this is the only temporal study of DD DALYs that encompasses all 28 years of data available from the GBD. Overall, our analyses show that temporal reductions in DD DALYs are not equivalent across regions, sexes and age groups. Therefore, careful attention to local and demography-specific risk factors will be necessary to tailor solutions in region- and demography-specific manners.

Revitalizing child health: lessons from the past

Essential health, education and other service disruptions arising from the COVID-19 pandemic risk reversing some of the hard-won gains in improving child survival over the past 40 years. Although children have milder symptoms of COVID-19 disease than adults, pandemic control measures in many countries have disrupted health, education and other services for children, often leaving them without access to birth and postnatal care, vaccinations and early childhood preventive and treatment services. These disruptions mean that the SARS-CoV-2 virus, along with climate change and shifting epidemiological and demographic patterns, are challenging the survival gains that we have seen over the past 40 years. We revisit the initiatives and actions of the past that catalyzed survival improvements in an effort to learn how to maintain these gains even in the face of today's global challenges.

IN VIVO AND IN VITRO EVALUATION OF PHARMACOLOGICAL ACTIVITIES OF Hedychium coccineum RHIZOMES EXTRACT

The study reports the in vivo antidiarrheal and in vitro anthelmintic, cytotoxic, and thrombolytic activity of methanol extract of Hedychium coccineum rhizomes (MEHC). The antidiarrheal activity was determined using Castor oil-induced diarrhea and Gastrointestinal motility test in mice at the doses of 200 and 400 mg/kg body weight, whereas an aquarium worm, Tubifex tubifex, was used to determine the anthelmintic activity. The cytotoxic and thrombolytic activity of MEHC was performed by Brine shrimp lethality bioassay and clot lysis method respectively. In antidiarrheal, castor oil-induced diarrhea and gastrointestinal motility exhibited a significant reduction in diarrhea and defecation and an extremely significant inhibition in intestinal motility and peristalsis index by 200 and 400 mg/kg of MEHC. The MEHC (5, 10, and 20 mg/mL) showed a significant dose-dependent manner paralysis time and times to death in multiple comparisons to the different levamisole concentrations (0.5, 0.8, and 1 mg/mL) at in vitro anthelmintic activity. The brine shrimp lethality bioassay exhibited a weak LC50 (681.95 µg/mL; R² = 0.951) while in thrombolytic a significant percentage of clot lysis (32.70%, P < 0.05) demonstrated. The findings demonstrate that H. coccineum rhizomes could be potential sources for biological activity.

Drivers of the reduction in childhood diarrhea mortality 1980-2015 and interventions to eliminate preventable diarrhea deaths by 2030

BACKGROUND

Childhood diarrhea deaths have declined more than 80% from 1980 to 2015, in spite of an increase in the number of children in low- and middle-income countries (LMIC). Possible drivers of this remarkable accomplishment can guide the further reduction of the half million annual child deaths from diarrhea that still occur.

METHODS

We used the Lives Saved Tool, which models effects on mortality due to changes in coverage of preventive or therapeutic interventions or risk factors, for 50 LMIC to determine the proximal drivers of the diarrhea mortality reduction.

RESULTS

Diarrhea treatment (oral rehydration solution [ORS], zinc, antibiotics for dysentery and management of persistent diarrhea) and use of rotavirus vaccine accounted for 49.7% of the diarrhea mortality reduction from 1980 to 2015. Improvements in nutrition (stunting, wasting, breastfeeding practices, vitamin A) accounted for 38.8% and improvements in water, sanitation and handwashing for 11.5%. The contribution of ORS was greater from 1980 to 2000 (58.0% of the reduction) than from 2000 to 2015 (30.7%); coverage of ORS increased from zero in 1980 to 29.5% in 2000 and more slowly to 44.1% by 2015. To eliminate the remaining childhood diarrhea deaths globally, all these interventions will be needed. Scaling up diarrhea treatment and rotavirus vaccine, to 90% coverage could reduce global child diarrhea mortality by 74.1% from 2015 levels by 2030. Adding improved nutrition could increase that to 89.1%. Finally, adding increased use of improved water sources, sanitation and handwashing could result in a 92.8% reduction from the 2015 level.

CONCLUSIONS

Employing the interventions that have resulted in such a large reduction in diarrhea mortality in the last 35 years can virtually eliminate remaining childhood diarrhea deaths by 2030.