Global burden of enteric infectious diseases, diarrhoeal diseases, and corresponding aetiologies, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023

Usha Adiga Emad M. Abdallah Dariush Abtahi Eman Abu-Gharbieh Amr Selim Abu Lila Siddig Ibrahim Abdelwahab Rashad Abdul-Ghani Anirudh Balakrishna Acharya Mohd Adnan Lorainne Tudor Car Victor Adekanmbi Reda Abdel-Hameed Asrat Agalu Abejew Ayo Stephen Adebowale Samar Abd Elhafeez Jeza Muhamad Abdul Aziz Ripon Kumar Adhikary Muhammad Sohail Afzal Nermeen Abu-Elala Auwal Abdullahi Rana Kamal Abu Farha Isaac Yeboah Addo Ahmad Y. Abuhelwa Victor Ibukun Agbajelola Zeleke Dutamo Agde Obed Adonteng-Kissi Piyush Agrawal Swetha Acharya Charles Oluwaseun Adetunji Lisa C. Adams Fuad Hamdi A. Abuadas Madineh Abbasi Omar Ahmed Abdelwahab Nurudeen A. Adegoke Jiawei He Makinde Adebayo Adeniyi Austin Carter Abdu A. Adamu Rezheen Fatah Abdulrahman Olumide Thomas Adeleke Feleke Doyore Agide Babatope Oluwadamilare Adebiyi Olifan Zewdie Abil Samuel B. Albertson Dina Abushanab Sawsan Abuhammad David Adedia Kamoru Ademola Adedokun Percival Delali Delali Agordoh A. Bhoomadevi Catherine Bisignano Qorinah Estiningtyas Sakilah Adnani Oluwawemimo Oluseun Adebowale Ebenezer Afrifa-Yamoah Hasan Aalruz Avina Vongpradith Samuel M. Ostroff Richard Gyan Aboagye Molalign Aligaz Aligaz Adisu Melese Shenkut Abebe Navidha Aggarwal Rizwan Suliankatchi Abdulkader Arman Abdous Nagah M. Abourashed Toufik Abdul-Rahman Belete Muluadam Admassie Regina Mae Villanueva Dominguez Hana J. Abukhadijah Abdullahi Tunde Aborode Abdulrakib Abdulrahim Abdelmuhsin Abdelgadir Hassan Abolhassani Adedeji Adenusi Saheed Ayodeji Adekola Yirgalem Abere Shairyar Afzal Oluwatobi E. Adegbile None Abdullah Sadik Abdulwehab Belayneh Jejaw Abate Aishah Fadila Adamu Syed Hani Abidi Tajudeen Adesanmi Adebisi Kulmira Abdykerimova Wakgari Mosisa Abdisa Alqassem H. Abuarqoub Ahmed Abdelrahman Abdelgalil Amanda Movo Rofiat Adewumi Adewumi Aderinoye-Rabiu Hasan Aalruz Krishna Prasad Acharya Meklit Girma Abebe Abdulbasit Sherfa Abduljelil Bhoomadevi A Ahmed AH Abdellatif Nermeen Abu-Elala Adekola George Adepoju Zirak Ahmed Abdulrahman Kalkidan Yibeltal Admassu Yau Adamu Nagah M. Abourashed Daniel Adeyemi Adepoju Olumide Abiodun Saira Afzal

Publication Name: Lancet Infectious Diseases

Publication Date: 2026-01-01

Volume: Unknown

Issue: Unknown

Page Range: Unknown

Description:

Background: Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. Methods: We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. Findings: In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963–1·68) deaths globally, declining from 3·69 million (3·04–4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0–92·9) per 100 000 population to 16·4 (12·6–21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811–1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000–882 000) and 501 000 (373 000–648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0–21·5]), followed by norovirus (10·2% [2·4–17·0]) and Shigella spp (9·3% [5·4–15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5–48·5) for rotavirus, 24·0% (15·1–36·7) for Shigella spp, and 23·4% (13·7–34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290–49 000) and 18 800 (4650–44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Interpretation: Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Funding: Gates Foundation.

Open Access: Yes

DOI: 10.1016/S1473-3099(26)00194-5

Authors - 104

Usha Adiga

14057674100

Emad M. Abdallah

16644652400

Dariush Abtahi

18036750600

Eman Abu-Gharbieh

24586714800

Amr Selim Abu Lila

25723054600

Siddig Ibrahim Abdelwahab

26029049500

Rashad Abdul-Ghani

26032503400

Anirudh Balakrishna Acharya

35751874500

Mohd Adnan

36022136700

Lorainne Tudor Car

48561867100

Victor Adekanmbi

53463192900

Reda Abdel-Hameed

54883057400

Asrat Agalu Abejew

55204820500

Ayo Stephen Adebowale

55351009300

Samar Abd Elhafeez

55551273300

Jeza Muhamad Abdul Aziz

55670686800

Ripon Kumar Adhikary

55847469100

Muhammad Sohail Afzal

56009310800

Nermeen Abu-Elala

56073088900

Auwal Abdullahi

56102934500

Rana Kamal Abu Farha

56283149600

Isaac Yeboah Addo

56305995900

Ahmad Y. Abuhelwa

56588047800

Victor Ibukun Agbajelola

56600782900

Zeleke Dutamo Agde

56835695400

Obed Adonteng-Kissi

56841541000

Piyush Agrawal

57189379359

Swetha Acharya

57190209243

Charles Oluwaseun Adetunji

57192176047

Lisa C. Adams

57192991712

Fuad Hamdi A. Abuadas

57193453829

Madineh Abbasi

57193923353

Omar Ahmed Abdelwahab

57194482197

Nurudeen A. Adegoke

57196007299

Jiawei He

57201492225

Makinde Adebayo Adeniyi

57201493506

Austin Carter

57201756395

Abdu A. Adamu

57202024381

Rezheen Fatah Abdulrahman

57202378819

Olumide Thomas Adeleke

57204237787

Feleke Doyore Agide

57204329765

Babatope Oluwadamilare Adebiyi

57204551152

Olifan Zewdie Abil

57204558002

Samuel B. Albertson

57204573505

Dina Abushanab

57205329983

Sawsan Abuhammad

57205384547

David Adedia

57207309355

Kamoru Ademola Adedokun

57207983240

Percival Delali Delali Agordoh

57208491603

A. Bhoomadevi

57208576447

Catherine Bisignano

57211140934

Qorinah Estiningtyas Sakilah Adnani

57211604149

Oluwawemimo Oluseun Adebowale

57211681492

Ebenezer Afrifa-Yamoah

57213592889

Hasan Aalruz

57216547615

Avina Vongpradith

57216661011

Samuel M. Ostroff

57219860984

Richard Gyan Aboagye

57221438826

Molalign Aligaz Aligaz Adisu

57222321507

Melese Shenkut Abebe

57222671594

Navidha Aggarwal

57224993442

Rizwan Suliankatchi Abdulkader

57226205764

Arman Abdous

57263159900

Nagah M. Abourashed

57450956800

Toufik Abdul-Rahman

57576497300

Belete Muluadam Admassie

57845081200

Regina Mae Villanueva Dominguez

57861613300

Hana J. Abukhadijah

57865346000

Abdullahi Tunde Aborode

57916532700

Abdulrakib Abdulrahim

58090198900

Abdelmuhsin Abdelgadir

58182669400

Hassan Abolhassani

58597704600

Adedeji Adenusi

58682114800

Saheed Ayodeji Adekola

58761789400

Yirgalem Abere

58767642000

Shairyar Afzal

58879708600

Oluwatobi E. Adegbile

58998875200

None Abdullah

59244237300

Sadik Abdulwehab

59335627100

Belayneh Jejaw Abate

59371996200

Aishah Fadila Adamu

59432178200

Syed Hani Abidi

59663694600

Tajudeen Adesanmi Adebisi

59997997500

Kulmira Abdykerimova

59998147700

Wakgari Mosisa Abdisa

59998578600

Alqassem H. Abuarqoub

60140494900

Ahmed Abdelrahman Abdelgalil

60174812100

Amanda Movo

60175065400

Rofiat Adewumi Adewumi Aderinoye-Rabiu

60210459400

Hasan Aalruz

60262109200

Krishna Prasad Acharya

60410586000

Meklit Girma Abebe

60656179200

Abdulbasit Sherfa Abduljelil

60705761700

Bhoomadevi A

60705875100

Ahmed AH Abdellatif

60705875200

Nermeen Abu-Elala

60705875300

Adekola George Adepoju

60706111900

Zirak Ahmed Abdulrahman

60706234500

Kalkidan Yibeltal Admassu

60706234600

Yau Adamu

60706349700

Nagah M. Abourashed

60706538900

Daniel Adeyemi Adepoju

60706588300

Olumide Abiodun

7003859089

Saira Afzal

7004381116