Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries

• Type of Material: Article
• Authors: Annette Pruess-Ustuen, World Health Organization; Jamie Bartram, University of North Carolina; Thomas Clasen, Emory University; John M Colford, University of California Berkeley; Oliver Cumming, London School of Hygiene & Tropical Medicine; Valerie Curtis, London School of Hygiene & Tropical Medicine; Sophie Bonjour, World Health Organization; Alan D Dangour, London School of Hygiene & Tropical Medicine; Jennifer De France, World Health Organization; Lorna Fewtrell, Aberystwyth University; Matthew Freeman, Emory University; Bruce Gordon, World Health Organization; Paul R Hunter, University of East Anglia; Richard B Johnston, World Health Organization; Colin Mathers, World Health Organization; Daniel Maeusezahl, University of Basel; Kate Medlicott, World Health Organization; Maria Neira, World Health Organization; Meredith Stocks, Emory University; Jennyfer Wolf, World Health Organization; Sandy Cairncross, London School of Hygiene & Tropical Medicine
• Language: English
• Date: 2014-06-30
• Publisher: Wiley Open Access
• Publication Version: Final Published Version
• Copyright Statement: © 2014 The Authors. Tropical Medicine and International Health published by John Wiley & Sons Ltd.
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1111/tmi.12329
• Title of Journal or Parent Work: Tropical Medicine and International Health
• ISSN: 1360-2276
• Volume: 19
• Issue: 8
• Start Page: 894
• End Page: 905
• Grant/Funding Information: The study was partially funded by the United Kingdom Department for International Development (DFID).
• Keywords: IMPACT; hygiene; SYSTEMATIC ANALYSIS; DIARRHEA; diarrhoea; DISINFECTING WATER; burden of disease; Public, Environmental & Occupational Health; Science & Technology; MICROBIOLOGICAL EFFECTIVENESS; TROPICAL MEDICINE; water; Life Sciences & Biomedicine; PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH, SCI; INTERVENTIONS; RISK-FACTORS; CHILD UNDERNUTRITION; Tropical Medicine; sanitation; GLOBAL BURDEN; DRINKING-WATER
• Research Categories: Health Sciences, Public Health

Abstract

Objective: To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases. Methods: For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. Results: In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group. Conclusions: This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene.