The impact of diarrhoea measurement methods for under 5s in low- and middle-income countries on estimated diarrhoea rates at the population level: a systematic review and meta-analysis of methodological and primary empirical studies

Ryan Rego, Samuel Watson, Paramjit Gill, Richard Lilford

Research output: Contribution to journalReview articlepeer-review

89 Downloads (Pure)

Abstract

Objective: We systematically reviewed all studies published between 2000 and June 2021 that estimated under 5 diarrhoea rates in low- and middle-income countries and extracted data on diarrhoea rates, measurement methods and reactivity. Methods: We summarised data from studies that performed direct comparisons of methods, and indirectly compared studies which utilised only one method using meta-regression to determine the association between methods and estimated diarrhoea rates. Results: In total, 288 studies met our inclusion criteria: 4 direct comparisons and 284 studies utilising only one measurement method. Meta-regression across all studies showed that diarrhoea rates were sensitive to method of measurement. We estimated that passive surveillance methods were associated with a 97% lower estimated rate than active surveillance (IRR = 0.03, 95% CI [0.02, 0.06]). Among active surveillance studies, a doubling of recall period was associated with a 48% lower rate (IRR = 0.52 [0.46, 0.60]), while decreased questioning frequency was associated with a higher estimated rate: at the extreme, one time questioning yielded an over 4× higher rate than daily questioning (IRR = 4.22 [2.73, 6.52]). Conclusions: Estimated diarrhoea rates are sensitive to their measurement methods. There is a need for a standardisation of diarrhoea measurement methods, and for the use of other outcomes in the measurement of population-level gastrointestinal health.

Original languageEnglish
Pages (from-to)347-368
Number of pages22
JournalTropical Medicine & International Health
Volume27
Issue number4
Early online date24 Feb 2022
DOIs
Publication statusPublished - Apr 2022

Bibliographical note

Funding Information:
This project was funded by the National Institutes for Health Research Global Health Research Unit on Improving Health in Slums (16/136/87) using UK aid from the UK Government. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder had no role in study design, implementation or interpretation. RL and PG are supported by NIHR ARC West Midlands.

Publisher Copyright:
© 2022 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Keywords

  • Child Health
  • Diarrhoea
  • Epidemiology
  • Surveillance
  • WASH
  • epidemiology
  • SYSTEMATIC REVIEW
  • REVIEW ARTICLE
  • child health
  • surveillance
  • diarrhoea
  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Parasitology

Fingerprint

Dive into the research topics of 'The impact of diarrhoea measurement methods for under 5s in low- and middle-income countries on estimated diarrhoea rates at the population level: a systematic review and meta-analysis of methodological and primary empirical studies'. Together they form a unique fingerprint.

Cite this