The Hidden Burden of Parkinson's Disease in Cambodia: A Call to Action.

Diarrheal diseases have remained a leading cause of death, especially in Africa, according to the World Health Statistics 2024 (). Rotavirus is a diarrheal pathogen spread predominantly by the fecal-oral route through contamination of food, water, and environmental surfaces. According to the Lancet Global Burden of Disease 2021 report, diarrhea caused approximately 1.17 million deaths globally in 2021, and rotavirus was a predominant pathogen causing 32.2% of diarrheal mortality in children under 5 years of age (). In Kenya, the prevalence of diarrhea among children under 5 years of age is estimated at 14% according to the 2022 Kenya Demographic and Health Survey (KDHS). Children living in urban informal settlements remain at greater risk of diarrhea and death (). Mukuru informal settlement is a under-resourced area located approximately 20 km from Nairobi city, characterized by large populations overcrowded in tiny spaces, poor structures, and open sewer drains, which greatly contribute to the risk of enteric infections. Poverty is also widespread in Mukuru, and the majority of residents survive on informal and unstable employment, further exacerbating vulnerability to catastrophic expenditures (, ). Diarrhea is highly prevalent in Mukuru and is caused by a broad range of diarrheal pathogens, not limited to , Salmonella, and typhoid (). Since Kenya’s introduction of rotavirus vaccines in 2014, there has been a reduction in child deaths from rotavirus diarrhea, with a prevalence of 14.5% in 2018 post-vaccine introduction, which is lower than the prevalence of 38.2% observed in 2008 pre-vaccine introduction (, ). However, significant cases of severe rotavirus diarrhea episodes, hospitalizations, and deaths continue to be detected post-vaccine introduction in Nairobi (). In 2010 and 2014, the Kenyan Ministry of Health formulated policies and guidelines to control diarrheal diseases, which addressed access to treatment, including improving the supply chain of zinc and ORS, handwashing, vitamin A supplements, and the introduction of rotavirus vaccines into the national immunization schedule (, ). Despite these efforts, the prevalence of diarrhea remains at 14%, as reported in the 2022 Kenya Demographic Health Survey (). Previous studies have evaluated the implementation of these national policies and guidelines and identified persistent gaps, including a limited focus on socioeconomic determinants of health, environmental and zoonotic transmission pathways, weak funding structures, and demographic and other contextual drivers of diarrhea (). In addition, suboptimal vaccine uptake continues to constrain effective diarrheal disease prevention efforts. In 2024, the national coverage of the last rotavirus vaccine dose was estimated to be 82% (), reflecting gaps in vaccine uptake. Barriers to vaccination include caregivers’ lack of awareness of vaccine benefits, safety concerns, and socioeconomic constraints that shape health-seeking behaviors (, ). Health-seeking behaviors directly influence both clinical outcomes and household economic burden. Caregivers may delay or forgo formal care because of distance, cost, or lack of knowledge, often resulting in higher medical expenses and productivity losses (, , ).