Association of drinking water services with the disease burden of diarrhea in children under five in 200 countries from 2000 to 2021

<h2>Summary</h2> In 2019, diarrheal diseases were the second leading cause of death in children under five, emphasizing the need to explore water services' impact on pediatric diarrhea. Data from the Global Burden of Disease Study 2021 and the World Bank were used to analyze the association between drinking water services and diarrhea in children under five across 200 countries. From 2000 to 2021, global diarrheal rates declined by 4.84% annually. Low socio-demographic index (SDI) regions had the highest burden but saw a 5.10% annual reduction, while high SDI regions had a 2.03% decrease. Increased use of basic and safely managed drinking water services generally correlated with reduced diarrhea. However, in high SDI regions, a 1% increase in basic drinking water services was associated with a 26.61% rise in diarrhea incidence. These findings highlight the need for targeted, context-specific strategies to combat childhood diarrheal diseases and achieve the Sustainable Development Goals.