The impact of diarrhoea measurement methods for under-fives in low and middle income countries on estimated diarrhoea incidence 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

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Abstract

Objective: We systematically reviewed all studies published between 2000 and June 2021 that estimated under-five 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: 296 studies met our inclusion criteria: four direct comparisons and 288 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 4X 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
JournalTropical Medicine & International Health
Early online date24 Feb 2022
DOIs
Publication statusE-pub ahead of print - 24 Feb 2022

Keywords

  • Child Health
  • Diarrhoea
  • Epidemiology
  • Surveillance
  • WASH
  • epidemiology
  • SYSTEMATIC REVIEW
  • REVIEW ARTICLE
  • child health
  • surveillance
  • diarrhoea

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