Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years: an analysis of the Global Burden of Disease Study 2017
Open accessAbstract
BACKGROUND: Many countries have shown marked declines in diarrhoeal disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. METHODS: This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. FINDINGS: Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78·4 deaths (70·1-87·1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69·6% (63·1-74·6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13·3% decrease, 11·2-15·5), childhood wasting (9·9% decrease, 9·6-10·2), and low use of oral rehydration solution (6·9% decrease, 4·8-8·4). INTERPRETATION: Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness. FUNDING: Bill & Melinda Gates Foundation.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The decrease in diarrhoeal disease burden between 2010 and 2021 was due primarily to progress in the management of its risk factors among children younger than 5 years.
“due primarily to progress in the management of its risk factors among children younger than 5 years.30”
From Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 (2024) · cites this paper as [30]
The Results (page not provided) link reductions in under-5 diarrhoea mortality to changes in risk factors, including unsafe sanitation, childhood wasting, and use of oral rehydration solution. But the Methods specify an analysis of mortality rates from 1990 to 2017, not disease burden from 2010 to 2021; the paper therefore cannot establish the claimed explanation for that later period. Its Interpretation also says risk-factor changes appear related to the decline, rather than establishing them as its primary cause. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Roth, G. A., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)32203-7 · Cited by 8,600 · see citing works
Self-citationNull, C., Stewart, C. P., Pickering, A. J., Dentz, H. N., Arnold, B. F., Arnold, C. D., Benjamin-Chung, J., Clasen, T., Dewey, K. G., Fernald, L. C. H., et al. (2018) · The Lancet Global Health · doi:10.1016/s2214-109x(18)30005-6 · Cited by 602 · see citing works
Modeling causes of death: an integrated approach using CODEm
Foreman, K. J., Lozano, R., Lopez, A. D., & Murray, C. J. (2012) · Population Health Metrics · doi:10.1186/1478-7954-10-1 · Cited by 564 · see citing works
Troeger, C., Colombara, D. V., Rao, P. C., Khalil, I. A., Brown, A., Brewer, T. G., Guerrant, R. L., Houpt, E. R., Kotloff, K. L., Misra, K., et al. (2018) · The Lancet Global Health · doi:10.1016/s2214-109x(18)30045-7 · Cited by 200 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 27
- [2]GBD Diarrhoeal Diseases Collaborators Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015 Lancet Infect Dis 17 2017 909 948 28579426 PMC5589208
- [3]GBD 2016 Diarrhoeal Disease Collaborators Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016 Lancet Infect Dis 18 2018 1211 1228 30243583 PMC6202444
- [4]Golding N Burstein R Longbottom J Mapping under-5 and neonatal mortality in Africa, 2000–15: a baseline analysis for the Sustainable Development Goals Lancet 390 2017 2171 2182 28958464 PMC5687451
- [5]Reiner RC Jr Graetz N Casey DC Variation in childhood diarrheal morbidity and mortality in Africa, 2000–2015 N Engl J Med 379 2018 1128 1138 30231224 PMC6078160
- [7]Bhutta ZA Das JK Walker N Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet 381 2013 1417 1429 23582723
- [8]Burnett E Jonesteller CL Tate JE Yen C Parashar UD Global impact of rotavirus vaccination on childhood hospitalizations and mortality from diarrhea J Infect Dis 215 2017 1666 1672 28430997 PMC5543929
- [9]Cairncross S Hunt C Boisson S Water, sanitation and hygiene for the prevention of diarrhoea Int J Epidemiol 39 2010 i193 i205 20348121 PMC2845874
- [10]Luby SP Rahman M Arnold BF Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial Lancet Glob Health 6 2018 e302 e315 29396217 PMC5809718
- [11]Munos MK Walker CLF Black RE The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality Int J Epidemiol 39 2010 i75 i87 20348131 PMC2845864
- [12]GBD 2017 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 Lancet 392 2018 1789 1858 30496104 PMC6227754
- [13]GBD 2017 Risk Factor Collaborators Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 Lancet 392 2018 1923 1994 30496105 PMC6227755
- [14]Stevens GA Alkema L Black RE Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement Lancet 388 2016 e19 e23 27371184
- [16]Osgood-Zimmerman A Millear AI Stubbs RW Mapping child growth failure in Africa between 2000 and 2015 Nature 555 2018 41 47 29493591 PMC6346257
- [17]Guo Y Bai J Na H The history of China's maternal and child health care development Semin Fetal Neonatal Med 20 2015 309 314 26271835
- [18]Lamberti LM Walker CLF Chan KY Jian W-Y Black RE Oral zinc supplementation for the treatment of acute diarrhea in children: a systematic review and meta-analysis Nutrients 5 2013 4715 4740 24284615 PMC3847757
- [20]Khalil IA Troeger C Rao PC Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study Lancet Glob Health 6 2018 e758 e768 29903377 PMC6005120
- [21]Olofin I McDonald CM Ezzati M Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies PLoS One 8 2013 e64636 PMC3667136 23734210
- [22]Mosley WH Chen LC An analytical framework for the study of child survival in developing countries. 1984 Bull World Health Organ 81 2003 140 145 12756980 PMC2572391
- [24]Humphrey JH Mbuya MNN Ntozini R Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial Lancet Glob Health 7 2019 e132 e147 30554749 PMC6293965
- [25]Clasen T Household water treatment and safe storage to prevent diarrheal disease in developing countries Curr Environ Health Rep 2 2015 69 74 26231243
- [26]WHO Evaluation of the costs and benefits of water and sanitation improvements at the global level http://www.who.int/water_sanitation_health/publications/wash-improvements-costs-benefits/en/ 2004 17878561
- [27]Hutton G Chase C The knowledge base for achieving the Sustainable Development Goal targets on water supply, sanitation and hygiene Int J Environ Res Public Health 13 2016 e536 27240389 PMC4923993
- [29]Blum LS Oria PA Olson CK Breiman RF Ram PK Examining the use of oral rehydration salts and other oral rehydration therapy for childhood diarrhea in Kenya Am J Trop Med Hyg 85 2011 1126 1133 22144457 PMC3225165
- [30]Troeger C Khalil IA Rao PC Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years JAMA Pediatr 172 2018 958 965 30105384 PMC6233802
- [32]Kovacs SD Mullholland K Bosch J Deconstructing the differences: a comparison of GBD 2010 and CHERG's approach to estimating the mortality burden of diarrhea, pneumonia, and their etiologies BMC Infect Dis 15 2015 16 25592774 PMC4305232
- [33]Clark A Black R Tate J Estimating global, regional and national rotavirus deaths in children aged PLoS One 12 2017 e0183392 PMC5593200 28892480
- [34]Lopman B Hall A Incomplete use of global data for aetiological attribution of diarrhoeal disease in the Global Burden of Disease study Lancet Infect Dis 19 2019 128 30712833
Cited by
Sorted by citations
Ferrari, A. J., Santomauro, D. F., Aali, A., Abate, Y. H., Abbafati, C., Abbastabar, H., Abd ElHafeez, S., Abdelmasseh, M., Abd-Elsalam, S., Abdollahi, A., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)00757-8 · Cited by 5,112 · see citing works
Self-citation
- Authors
- Troeger, C. E., Khalil, I. A., Blacker, B. F., Biehl, M. H., Albertson, S. B., Zimsen, S. R. M., Rao, P. C., Abate, D., Ahmadi, A., Ahmed, M. L. C. B., Akal, C. G., Alahdab, F., Alam, N., Alene, K. A., Alipour, V., Aljunid, S. M., Al-Raddadi, R. M., Alvis-Guzman, N., Amini, S., Anber, N. H., Anjomshoa, M., Antonio, C. A. T., Arabloo, J., Aremu, O., Atalay, H. T., Atique, S., Avokpaho, E. F. G. A., Awad, S., Awasthi, A., Badawi, A., Balakrishnan, K., Banoub, J. A. M., Barac, A., Bassat, Q., Bedi, N., Bennett, D. A., Bhattacharyya, K., Bhutta, Z. A., Bijani, A., Car, J., Carvalho, F., Castañeda-Orjuela, C. A., Christopher, D. J., Dandona, L., Dandona, R., Daryani, A., Demeke, F. M., Deshpande, A., Djalalinia, S., Dubey, M., Dubljanin, E., Duken, E. E., El Sayed Zaki, M., Endries, A. Y., Fernandes, E., Fischer, F., Fullman, N., Gardner, W. M., Geta, B., Ghadiri, K., Gorini, G., Goulart, A. C., Guo, Y., Hailu, G. B., Haj-Mirzaian, A., Haj-Mirzaian, A., Hamidi, S., Hassen, H. Y., Hoang, C. L., Hostiuc, M., Hussain, Z., Irvani, S. S. N., James, S. L., Jha, R. P., Jonas, J. B., Karch, A., Kasaeian, A., Kassa, T. D., Kassebaum, N. J., Kefale, A. T., Khader, Y. S., Khan, E. A., Khan, M. N., Khang, Y.-H., Khoja, A. T., Kimokoti, R. W., Kisa, A., Kisa, S., Kissoon, N., Kochhar, S., Kosen, S., Koyanagi, A., Kuate Defo, B., Kumar, G. A., Lal, D. K., Leshargie, C. T., Li, S., Lodha, R., Macarayan, E. R. K., Majdan, M., Mamun, A. A., Manguerra, H., Melese, A., Memish, Z. A., Mengistu, D. T., Meretoja, T. J., Mestrovic, T., Miazgowski, B., Mirrakhimov, E. M., Moazen, B., Mohammad, K. A., Mohammed, S., Monasta, L., Moore, C. E., Mosser, J. F., Mousavi, S. M., Murthy, S., Mustafa, G., Nazari, J., Nguyen, C. T., Nguyen, L. H., Nisar, M. I., Nixon, M. R., Ogbo, F. A., Okoro, A., Olagunju, A. T., Olagunju, T. O., P A, M., Pakhale, S., Postma, M. J., Qorbani, M., Quansah, R., Rafiei, A., Rahim, F., Rahimi-Movaghar, V., Rai, R. K., Rezai, M. S., Rezapour, A., Rios-Blancas, M. J., Ronfani, L., Rosettie, K., Rothenbacher, D., Safari, S., Saleem, Z., Sambala, E. Z., Samy, A. M., Santric Milicevic, M. M., Sartorius, B., Sawhney, M., Seyedmousavi, S., Shaikh, M. A., Sheikh, A., Shigematsu, M., Smith, D. L., Soriano, J. B., Sreeramareddy, C. T., Stanaway, J. D., Sufiyan, M. B., Teklu, T. G. E., Temsah, M.-H., Tessema, B., Tran, B. X., Tran, K. B., Ullah, I., Updike, R. L., Vasankari, T. J., Veisani, Y., Wada, F. W., Waheed, Y., Weaver, M., Wiens, K. E., Wiysonge, C. S., Yimer, E. M., Yonemoto, N., Zaidi, Z., Zar, H. J., Zarghi, A., Lim, S. S., Vos, T., Mokdad, A. H., Murray, C. J. L., Kyu, H. H., Hay, S. I., & Reiner, R. C.
- Affiliations
- Haramaya University (ET)
- Australian National University (AU)
- Queensland Health (AU)
- University of Washington (US)
- Corresponding author
- Reiner, Robert C
- ORCID
- Blacker, Brigette F.
- Zimsen, Stephanie R M
- Abate, Degu
- Ahmed, Mohamed Lemine Cheikh brahim
- Alahdab, Fares
- Alam, Noore
- Alene, Kefyalew Addis
- Aljunid, Syed Mohamed
- Al-Raddadi, Rajaa M
- Anber, Nahla Hamed
- Antonio, Carl Abelardo T.
- Arabloo, Jalal
- Aremu, Olatunde
- Atalay, Hagos Tasew
- Atique, Suleman
- Avokpaho, Euripide F G A
- Awasthi, Ashish
- Badawi, Alaa
- Balakrishnan, Kalpana
- Barac, Aleksandra
- Bassat, Quique
- Bedi, Neeraj
- Bennett, Derrick A.
- Bhattacharyya, Krittika
- Bhutta, Zulfiqar A
- Bijani, Ali
- Car, Josip
- Carvalho, Félix
- Castañeda-Orjuela, Carlos A
- Christopher, Devasahayam J
- Dandona, Lalit
- Dandona, Rakhi
- Daryani, Ahmad
- Demeke, Feleke Mekonnen
- Deshpande, Aniruddha
- Djalalinia, Shirin
- Dubey, Manisha
- Dubljanin, Eleonora
- Endries, Aman Yesuf
- Fernandes, Eduarda
- Fischer, Florian
- Fullman, Nancy
- Gardner, William M.
- Ghadiri, Keyghobad
- Gorini, Giuseppe
- Goulart, Alessandra C
- Guo, Yuming
- Hamidi, Samer
- Hassen, Hamid Yimam
- Hoang, Chi Linh
- Hostiuc, Mihaela
- Hussain, Zakir
- Irvani, Seyed Sina Naghibi
- James, Spencer L.
- Jha, Ravi Prakash
- Karch, André
- Kasaeian, Amir
- Kassa, Tesfaye Dessale
- Kassebaum, Nicholas J
- Kefale, Adane Teshome
- Khader, Yousef Saleh
- Khan, Ejaz Ahmad
- Khan, Md Nuruzzaman
- Khang, Young-Ho
- Khoja, Abdullah T
- Kimokoti, Ruth W
- Kissoon, Niranjan
- Kochhar, Sonali
- Kosen, Soewarta
- Koyanagi, Ai
- Kumar, G Anil
- Leshargie, Cheru Tesema
- Li, Shanshan
- Macarayan, Erlyn Rachelle King
- Mamun, Abdullah A.
- Melese, Addisu
- Memish, Ziad A
- Mengistu, Desalegn Tadese
- Meretoja, Tuomo J
- Miazgowski, Bartosz
- Mirrakhimov, Erkin M
- Moazen, Babak
- Mohammad, Karzan Abdulmuhsin
- Mohammed, Shafiu
- Monasta, Lorenzo
- Moore, Catrin E
- Mosser, Jonathan F.
- Mousavi, Seyyed Meysam
- Murthy, Srinivas
- Mustafa, Ghulam
- Nazari, Javad
- Nguyen, Cuong Tat
- Nguyen, Long Hoang
- Nisar, Muhammad Imran
- Ogbo, Felix Akpojene
- Olagunju, Andrew T
- Olagunju, Tinuke O
- Pakhale, Smita
- Postma, Maarten J
- Qorbani, Mostafa
- Quansah, Reginald
- Rafiei, Alireza
- Rahim, Fakher
- Rezai, Mohammad Sadegh
- Ronfani, Luca
- Rosettie, Katherine
- Rothenbacher, Dietrich
- Safari, Saeed
- Saleem, Zikria
- Sambala, Evanson Zondani
- Samy, Abdallah M.
- Sartorius, Benn
- Seyedmousavi, Seyedmojtaba
- Sheikh, Aziz
- Smith, David L
- Soriano, Joan B
- Sreeramareddy, Chandrashekhar T
- Stanaway, Jeffrey D
- Sufiyan, Mu'awiyyah Babale
- Temsah, Mohamad-Hani
- Tessema, Belay
- Tran, Bach Xuan
- Tran, Khanh Bao
- Ullah, Irfan
- Vasankari, Tommi Juhani
- Veisani, Yousef
- Waheed, Yasir
- Weaver, Marcia
- Wiens, Kirsten E
- Wiysonge, Charles Shey
- Yimer, Ebrahim M
- Yonemoto, Naohiro
- Zaidi, Zoubida
- Zar, Heather J
- Zarghi, Afshin
- Lim, Stephen S
- Vos, Theo
- Mokdad, Ali H
- Murray, Christopher J L
- Kyu, Hmwe Hmwe
- Hay, Simon I.
- Reiner, Robert C
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 20
- Issue
- 1
- Pages
- 37-59
- ISSN
- 1473-3099 (ISSN-L)
- PMC
- PMC7340495
- OpenAlex
- W2982702311
- Cited by
- 210
- References
- 4
- Citations by year
- 2026: 19 · 2025: 34 · 2024: 40 · 2023: 44 · 2022: 32 · 2021: 27 · 2020: 12 · 2019: 2
- FWCI
- 13.89
- Type
- journal article
- Language
- en
- Update notices
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Infectious Diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- Monash University Research Portal (Monash University) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (publishedVersion, other-oa)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DSPACE System - Metalibrary (University of the Coast) (acceptedVersion, public-domain)
- BCU Open Access Repository (Birmingham City University) (acceptedVersion)
- OPUS - Open Publications of UTS Scholars (University of Technology Sydney) (submittedVersion, other-oa)
- Federal Open Science Repository of Canada / Le Dépôt fédéral de science ouverte du Canada (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by)
- Research Repository Portal (Ilam University of Medical Sciences) (submittedVersion)
- Työväentutkimus Vuosikirja (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion, cc-by)
- Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, other-oa)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Griffith Research Online (submittedVersion, cc-by)
- ResearchSpace (University of Auckland) (submittedVersion, cc-by)
- Seoul National University Open Repository (Seoul National University) (submittedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- Kuwait University
- Universiti Kebangsaan Malaysia
- Ministarstvo Prosvete, Nauke i Tehnološkog Razvoja (175087, III45005)
- Department of Science and Technology, Ministry of Science and Technology, India
- Public Health Agency of Canada
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- diarrhea mortality, children under five, risk factors, intervention, oral rehydration solution, child wasting, clean water, hand washing, mortality trends, Global Burden of Disease 2017, verbal autopsy, diarrhea treatment
- MeSH terms
- Global Burden of Disease, Child, Child, Preschool, Developing Countries, Diarrhea, Female, Humans, Infant, Life Expectancy, Male, Sanitation, Socioeconomic Factors, Global Health, Models, Statistical, Prevalence, Risk Assessment, Child Mortality
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
