Logo of bullwhoWHO Home PageBulletin Home PageBulletin Home PageAbout Bulletine-mail AlertSubmissions
Bull World Health Organ. 1992; 70(6): 705–714.
PMCID: PMC2393403

The magnitude of the global problem of diarrhoeal disease: a ten-year update.


In order to update global estimates of diarrhoeal morbidity and mortality in developing countries, we carried out a review of articles published from 1980 to the present and calculated median estimates for the incidence of diarrhoea and diarrhoeal mortality among under-5-year-olds. The incidence of diarrhoea obtained (2.6 episodes per child per year) was virtually the same as that estimated by Snyder & Merson in 1982, while the global mortality estimate was lower (3.3 million deaths per year; range, 1.5-5.1 million). The mortality estimate is based on a small number of active surveillance and prospective studies, and thus associated with a large degree of uncertainty, reflecting the weakness of the global database. However, many surveys reporting reductions in mortality in several locations are consistent with a decreased estimate for mortality. More accurate execution of WHO survey methods, including population-based sampling in representative locations, and repeat surveys every 5 years, are needed to monitor the progress of diarrhoeal disease control programmes and trends in diarrhoeal morbidity and mortality over time.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Snyder JD, Merson MH. The magnitude of the global problem of acute diarrhoeal disease: a review of active surveillance data. Bull World Health Organ. 1982;60(4):605–613. [PMC free article] [PubMed]
  • Black RE, Brown KH, Becker S, Yunus M. Longitudinal studies of infectious diseases and physical growth of children in rural Bangladesh. I. Patterns of morbidity. Am J Epidemiol. 1982 Mar;115(3):305–314. [PubMed]
  • Black RE, Brown KH, Becker S, Alim AR, Huq I. Longitudinal studies of infectious diseases and physical growth of children in rural Bangladesh. II. Incidence of diarrhea and association with known pathogens. Am J Epidemiol. 1982 Mar;115(3):315–324. [PubMed]
  • Black RE, Brown KH, Becker S. Effects of diarrhea associated with specific enteropathogens on the growth of children in rural Bangladesh. Pediatrics. 1984 Jun;73(6):799–805. [PubMed]
  • Goh Rowland SG, Lloyd-Evans N, Williams K, Rowland MG. The etiology of diarrhoea studied in the community in young urban Gambian children. J Diarrhoeal Dis Res. 1985 Mar;3(1):7–13. [PubMed]
  • Oyejide CO, Fagbami AH. An epidemiological study of rotavirus diarrhoea in a cohort of Nigerian infants: I. Methodology and experiences in the recruitment and follow-up of patients. Int J Epidemiol. 1988 Dec;17(4):903–907. [PubMed]
  • Oyejide CO, Fagbami AH. An epidemiological study of rotavirus diarrhoea in a cohort of Nigerian infants: II. Incidence of diarrhoea in the first two years of life. Int J Epidemiol. 1988 Dec;17(4):908–912. [PubMed]
  • Huttly SR, Blum D, Kirkwood BR, Emeh RN, Okeke N, Ajala M, Smith GS, Carson DC, Dosunmu-Ogunbi O, Feachem RG. The Imo State (Nigeria) Drinking Water Supply and Sanitation Project, 2. Impact on dracunculiasis, diarrhoea and nutritional status. Trans R Soc Trop Med Hyg. 1990 Mar-Apr;84(2):316–321. [PubMed]
  • Blum D, Emeh RN, Huttly SR, Dosunmu-Ogunbi O, Okeke N, Ajala M, Okoro JI, Akujobi C, Kirkwood BR, Feachem RG. The Imo State (Nigeria) Drinking Water Supply and Sanitation Project, 1. Description of the project, evaluation methods, and impact on intervening variables. Trans R Soc Trop Med Hyg. 1990 Mar-Apr;84(2):309–315. [PubMed]
  • el Alamy MA, Thacker SB, Arafat RR, Wright CE, Zaki AM. The incidence of diarrheal disease in a defined population of rural Egypt. Am J Trop Med Hyg. 1986 Sep;35(5):1006–1012. [PubMed]
  • Huttly SR, Hoque BA, Aziz KM, Hasan KZ, Patwary MY, Rahaman MM, Feachem RG. Persistent diarrhoea in a rural area of Bangladesh: a community-based longitudinal study. Int J Epidemiol. 1989 Dec;18(4):964–969. [PubMed]
  • Chen LC, Huq E, Huffman SL. A prospective study of the risk of diarrheal diseases according to the nutritional status of children. Am J Epidemiol. 1981 Aug;114(2):284–292. [PubMed]
  • Bhan MK, Bhandari N, Sazawal S, Clemens J, Raj P, Levine MM, Kaper JB. Descriptive epidemiology of persistent diarrhoea among young children in rural northern India. Bull World Health Organ. 1989;67(3):281–288. [PMC free article] [PubMed]
  • Sircar BK, Deb BC, Sengupta PG, Mondal S, De SP, Sen D, Saha MR, Ghosh S, Sikdar SN, Pal SC. A longitudinal study of diarrhoea among children in Calcutta communities. Indian J Med Res. 1984 Nov;80:546–550. [PubMed]
  • Kumar V, Kumar R, Datta N. Oral rehydration therapy in reducing diarrhoea-related mortality in rural India. J Diarrhoeal Dis Res. 1987 Sep;5(3):159–164. [PubMed]
  • Lanata CF, Black RE, del Aguila R, Gil A, Verastegui H, Gerna G, Flores J, Kapikian AZ, Andre FE. Protection of Peruvian children against rotavirus diarrhea of specific serotypes by one, two, or three doses of the RIT 4237 attenuated bovine rotavirus vaccine. J Infect Dis. 1989 Mar;159(3):452–459. [PubMed]
  • Lopez de Romaña G, Brown KH, Black RE, Kanashiro HC. Longitudinal studies of infectious diseases and physical growth of infants in Huascar, an underprivileged peri-urban community in Lima, Peru. Am J Epidemiol. 1989 Apr;129(4):769–784. [PubMed]
  • Black RE, Lopez de Romaña G, Brown KH, Bravo N, Bazalar OG, Kanashiro HC. Incidence and etiology of infantile diarrhea and major routes of transmission in Huascar, Peru. Am J Epidemiol. 1989 Apr;129(4):785–799. [PubMed]
  • Cravioto A, Reyes RE, Trujillo F, Uribe F, Navarro A, De La Roca JM, Hernández JM, Pérez G, Vázquez V. Risk of diarrhea during the first year of life associated with initial and subsequent colonization by specific enteropathogens. Am J Epidemiol. 1990 May;131(5):886–904. [PubMed]
  • Giugliano LG, Bernardi MG, Vasconcelos JC, Costa CA, Giugliano R. Longitudinal study of diarrhoeal disease in a peri-urban community in Manaus (Amazon-Brazil). Ann Trop Med Parasitol. 1986 Aug;80(4):443–450. [PubMed]
  • Guerrant RL, Kirchhoff LV, Shields DS, Nations MK, Leslie J, de Sousa MA, Araujo JG, Correia LL, Sauer KT, McClelland KE, et al. Prospective study of diarrheal illnesses in northeastern Brazil: patterns of disease, nutritional impact, etiologies, and risk factors. J Infect Dis. 1983 Dec;148(6):986–997. [PubMed]
  • Schorling JB, Wanke CA, Schorling SK, McAuliffe JF, de Souza MA, Guerrant RL. A prospective study of persistent diarrhea among children in an urban Brazilian slum. Patterns of occurrence and etiologic agents. Am J Epidemiol. 1990 Jul;132(1):144–156. [PubMed]
  • Simhon A, Mata L, Vives M, Rivera L, Vargas S, Ramírez G, Lizano L, Catarinella G, Azofeifa J. Low endemicity and low pathogenicity of rotaviruses among rural children in Costa Rica. J Infect Dis. 1985 Dec;152(6):1134–1142. [PubMed]
  • Cravioto A, Reyes RE, Ortega R, Fernández G, Hernández R, López D. Prospective study of diarrhoeal disease in a cohort of rural Mexican children: incidence and isolated pathogens during the first two years of life. Epidemiol Infect. 1988 Aug;101(1):123–134. [PMC free article] [PubMed]
  • Grinstein S, Gómez JA, Bercovich JA, Biscotti EL. Epidemiology of rotavirus infection and gastroenteritis in prospectively monitored Argentine families with young children. Am J Epidemiol. 1989 Aug;130(2):300–308. [PubMed]
  • Mtango FD, Neuvians D. Acute respiratory infections in children under five years. Control project in Bagamoyo District, Tanzania. Trans R Soc Trop Med Hyg. 1986;80(6):851–858. [PubMed]
  • Omondi-Odhiambo, van Ginneken JK, Voorhoeve AM. Mortality by cause of death in a rural area of Machakos District, Kenya in 1975-78. J Biosoc Sci. 1990 Jan;22(1):63–75. [PubMed]
  • Tandon BN, Sahai A, Balaji LN, Vardhan VA. Morbidity pattern and cause specific mortality during infancy in ICDS projects. J Trop Pediatr. 1987 Aug;33(4):190–193. [PubMed]
  • Chen LC, Rahman M, Sarder AM. Epidemiology and causes of death among children in a rural area of Bangladesh. Int J Epidemiol. 1980 Mar;9(1):25–33. [PubMed]
  • Fauveau V, Wojtyniak B, Chakraborty J, Sarder AM, Briend A. The effect of maternal and child health and family planning services on mortality: is prevention enough? BMJ. 1990 Jul 14;301(6743):103–107. [PMC free article] [PubMed]
  • Barros FC, Victora CG, Vaughan JP, Teixeira AM, Ashworth A. Infant mortality in southern Brazil: a population based study of causes of death. Arch Dis Child. 1987 May;62(5):487–490. [PMC free article] [PubMed]
  • Victora CG, Barros FC, Vaughan JP, Teixeira AM. Birthweight and infant mortality: a longitudinal study of 5914 Brazilian children. Int J Epidemiol. 1987 Jun;16(2):239–245. [PubMed]
  • Bågenholm GC, Nasher AA. Mortality among children in rural areas of the People's Democratic Republic of Yemen. Ann Trop Paediatr. 1989 Jun;9(2):75–81. [PubMed]
  • el-Rafie M, Hassouna WA, Hirschhorn N, Loza S, Miller P, Nagaty A, Nasser S, Riyad S. Effect of diarrhoeal disease control on infant and childhood mortality in Egypt. Report from the National Control of Diarrheal Diseases Project. Lancet. 1990 Feb 10;335(8685):334–338. [PubMed]
  • Nazir M, Pardede N, Ismail R. The incidence of diarrhoeal diseases and diarrhoeal diseases related mortality in rural swampy low-land area of south Sumatra, Indonesia. J Trop Pediatr. 1985 Oct;31(5):268–272. [PubMed]
  • Bradley AK, Gilles HM. Malumfashi Endemic Diseases Research Project, XXI. Pointers to causes of death in the Malumfashi area, northern Nigeria. Ann Trop Med Parasitol. 1984 Jun;78(3):265–271. [PubMed]
  • Woodruff AW, Adamson EA, Suni AE, Maughan TS, Kaku M, Bundru N. Infants in Juba, southern Sudan: the first twelve months of life. Lancet. 1984 Sep 1;2(8401):506–509. [PubMed]
  • Yach D, Strebel PM, Joubert G. The impact of diarrhoeal disease on childhood deaths in the RSA, 1968-1985. S Afr Med J. 1989 Nov 4;76(9):472–475. [PubMed]
  • Shaikh K, Wojtyniak B, Mostafa G, Khan MU. Pattern of diarrhoeal deaths during 1966-1987 in a demographic surveillance area in rural Bangladesh. J Diarrhoeal Dis Res. 1990 Dec;8(4):147–154. [PubMed]
  • Clow DJ. Control of diarrhoeal disease in Tonga 1978-83. Br Med J (Clin Res Ed) 1985 Mar 2;290(6469):691–692. [PMC free article] [PubMed]
  • Mohs E. Infectious diseases and health in Costa Rica: the development of a new paradigm. Pediatr Infect Dis. 1982 May-Jun;1(3):212–216. [PubMed]
  • Phonboon K, Kunasol P, Chayaniyayodhin T, Srisomporn D. Surveillance of diarrhoeal diseases in Thailand. Bull World Health Organ. 1986;64(5):715–720. [PMC free article] [PubMed]
  • Sandiford P, Morales P, Gorter A, Coyle E, Smith GD. Why do child mortality rates fall? An analysis of the Nicaraguan experience. Am J Public Health. 1991 Jan;81(1):30–37. [PMC free article] [PubMed]
  • Greenwood BM, Greenwood AM, Bradley AK, Tulloch S, Hayes R, Oldfield FS. Deaths in infancy and early childhood in a well-vaccinated, rural, West African population. Ann Trop Paediatr. 1987 Jun;7(2):91–99. [PubMed]
  • Feachem RG, Hogan RC, Merson MH. Diarrhoeal disease control: reviews of potential interventions. Bull World Health Organ. 1983;61(4):637–640. [PMC free article] [PubMed]
  • Feachem RG, Koblinsky MA. Interventions for the control of diarrhoeal diseases among young children: measles immunization. Bull World Health Organ. 1983;61(4):641–652. [PMC free article] [PubMed]
  • Feachem RG. Interventions for the control of diarrhoeal diseases among young children: supplementary feeding programmes. Bull World Health Organ. 1983;61(6):967–979. [PMC free article] [PubMed]
  • Ashworth A, Feachem RG. Interventions for the control of diarrhoeal diseases among young children: weaning education. Bull World Health Organ. 1985;63(6):1115–1127. [PMC free article] [PubMed]

Articles from Bulletin of the World Health Organization are provided here courtesy of World Health Organization


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...