• National burden of disease studies are needed to define food safety priorities. • Initiatives to support capacity building and collaboration are emerging. • Novel methodologies provide opportunities to improve data collection for disease burden estimation in low-resource settings.

Background: Diarrheal diseases substantially affect public health impact in low- and middle-income countries (LMIC), particularly in Africa, where previous studies have indicated a lack of comprehensive data. With a growing number of primary studies on enteric infections in Africa, this study aimed to estimate the incidence and mortality of diarrheal pathogens across all ages in Africa in the year 2020. We also explored different methodological assumptions to allow comparison with other approaches. Methods: Through a systematic review and meta-analysis of data from African LMICs, we estimated the etiology proportions for diarrheal diseases and deaths. We combined the etiology proportions with incidence data collected from a population survey in Africa from 2020 and mortality data from the Global Health Observatory of WHO. Results: We estimated 1,008 billion diarrhea cases (95% UI 447 million-1,4 billion) and 515,031 diarrhea deaths (95% UI 248,983-1,007,641) in the African region in 2020. In children under five, enteroaggregative E. coli (EAEC) (44,073 cases per 100,000 people, 95% UI 18,818 − 60,922) and G. lamblia (36,116 cases per 100,000 people, 95% UI 15,245 − 49,961) were the leading causes of illness. Enteroinvasive E. coli (EIEC) (155 deaths per 100,000 people, 95% UI 106.5-252.9) and rotavirus (61.5 deaths per 100,000 people, 95% UI 42.3-100.3) were the primary causes of deaths. For children over five and adults, Salmonella spp. caused the largest number of diarrheal cases in the population of children ≥ 5 and adults (122,090 cases per 100,000 people, 95% UI 51,833 − 168,822), while rotavirus (16.4 deaths per 100,000 people, 95% UI 4.2–36.7) and enteroaggregative E. coli (EAEC) (14.6 deaths per 100,000 people, 95% UI 3.9–32.9) causing the most deaths. Geographically, the highest incidence of diarrhea was in Eastern Africa for children under five (114,389 cases per 100,000 people, 95% UI 34,771 − 172,884) and Central Africa for children over five and adults (117,820 cases per 100,000 people, 95% UI 75,111–157,584). Diarrheal mortality was highest in Western Africa for both children below five and above (children < 5: 194.5 deaths per 100,000 people, 95% UI 120-325.4; children ≥ 5 and above: 33.5 deaths per 100,000 people, 95% UI 12.9–75.1). Conclusion: These findings provide new information on the incidence and mortality of sixteen pathogens and highlight the need for surveillance and control of diarrheal infectious diseases in Africa. The cause-specific estimates are crucial for prioritizing diarrheal disease prevention in the region.

Micronutrient deficiencies, also known as “hidden hunger,” remain a pervasive public health issue in low- and middle-income countries, particularly among vulnerable populations within these countries. The main drivers of these deficiencies are poverty, limited dietary diversity, weak nutritional strategies, poor health service delivery and general health access barriers. This review assesses the prevalence, drivers, and consequences of selected micronutrient deficiencies: iron, iodine, zinc, vitamin A and vitamin D, within the scope of undernutrition, food insecurity, and socioeconomic inequity. The consequences associated with these deficiencies include stunted growth, increased susceptibility to illness, poor cognitive and social functioning, and deepened poverty. The primary strategies to address these deficiencies include dietary diversification, supplement provision, biofortification, and the production of fortified foods. Barriers to progress include the high cost of food, weak healthcare infrastructure, low educational levels, and ineffective policy implementation. Integrated food systems, personalised nutrition, and innovative food technologies have the potential to address both nutritional and health inequities. Addressing barriers to safe and nutritious food and healthcare systems in order to address health inequities requires integrated, multisectoral planning and contextual policy. Improving individual health outcomes is crucial, but addressing micronutrient deficiencies has a ripple effect throughout society, enabling economic development through poverty reduction and increased productivity.