Peer-reviewed article
Economic Losses from Premature Under-Five Mortality due to Diarrhoeal Diseases in South Asia: Trends, Aetiologies, and Key Risk Factors.
Padhi BK, Soni M, Kumar V, Verma A, Satapathy P et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study estimates the economic losses from premature deaths of children under five due to diarrhoeal diseases across South Asia from 2010 to 2023. While mortality rates declined significantly, the economic burden remained substantial, with India experiencing the largest absolute loss and Pakistan the highest proportional loss relative to GDP. The main causes were rotavirus, Shigella, and E. coli, linked to unsafe water, poor sanitation, and child undernutrition. The authors recommend increased investment in WASH, nutrition, and vaccination to save lives and reduce future productivity losses.
Key points
- Age-standardized mortality rates for diarrhoeal diseases declined by 5.2% annually across South Asia, but economic burden remained substantial
- India experienced the largest absolute economic loss at USD 5,581 million PPP, while Pakistan faced the highest proportional loss at 0.055% of GDP in 2023
- Rotavirus, Shigella, and Escherichia coli were the major etiological agents responsible for diarrhoeal deaths
- Unsafe water, poor sanitation, and child undernutrition were identified as the leading attributable risk factors
- Strengthened investments in WASH infrastructure, nutrition, and vaccination programs are recommended to yield dual benefits of saving lives and reducing productivity losses
Limitations
This study quantifies economic losses using a human capital approach based on lost future labour income, which does not capture non-monetary impacts such as suffering, family disruption, or long-term health consequences of surviving diarrhoeal episodes. The analysis relies on secondary data from IHME and World Bank and does not include direct healthcare or treatment costs.
Abstract
Background Diarrhoeal diseases remain a major cause of under-five mortality in South Asia despite global health progress. This study quantifies the economic losses due to premature under-five deaths from diarrhoeal diseases, analyzing trends, aetiologies, and risk factors across five South Asian countries between 2010 and 2023. Methods Using data from the datasets published by the Institute for Health Metrics and Evaluation (IHME) and World Bank indicators, the study applied the human capital approach to estimate the present value of lost future labour income associated with diarrhoeal deaths among children under five. Losses were estimated in both purchasing power parity (PPP)-adjusted and nominal U.S. dollars to reflect real productivity losses and fiscal implications, respectively. Results While age-standardized mortality and DALY rates declined significantly across South Asia (EAPC - 5.2 for both), the economic burden of premature mortality due to childhood diarrhoeal diseases remained substantial. India accounted for the largest absolute loss in future labour income, estimated at USD 5,581 million PPP, followed by Pakistan (USD 1,571 million PPP) and Bangladesh (USD 360 million PPP). When expressed relative to national GDP using nominal estimates, Pakistan experienced the highest proportional economic loss, equivalent to approximately 0.055% of GDP in 2023, followed by India (0.020%), Bangladesh (0.012%), and Nepal (0.005%). Major etiological agents included rotavirus, Shigella, and Escherichia coli, while unsafe water, poor sanitation, and child undernutrition were the leading attributable risk factors. Conclusions and policy implications Despite epidemiological gains, diarrhoeal diseases continue to impose substantial economic and developmental costs in South Asia. Strengthened investments in WASH infrastructure, nutrition, and vaccination programs can yield dual benefits by saving lives and reducing future productivity losses. Integrating child health strategies into national economic planning is imperative for sustainable growth.