Supplementary file 1_Global burden of diarrheal diseases attributable to 13 pathogens in children under five: a comprehensive analysis from GBD 2021.docx

Introduction<p>Diarrheal diseases remain a major cause of death and disability among children under five, especially in low- and middle-income countries (LMICs).</p>Methods<p>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).</p>Results<p>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).</p>Discussion<p>These findings underscore the need for pathogen-specific, regionally targeted interventions to further reduce child mortality and disability.</p>