Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries

• Type of Material: Article
• Authors: Annette Pruss-Ustun, World Health Organization; Jennyfer Wolf, World Health Organization; Jamie Bartram, University of North Carolina Chapel Hill; Thomas Clasen, Emory University; Oliver Cumming, London School of Hygiene & Tropical Medicine; Bruce Gordon, World Health Organization; Matthew Freeman, Emory University; Paul R. Hunter, University of East Anglia; Kate Medlicott, World Health Organization; Richard Johnston, World Health Organization
• Language: English
• Date: 2019-06-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: Copyright © The Authors. Published by Elsevier GmbH. All rights reserved.
• License: Creative Commons Attribution 3.0 IGO License
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijheh.2019.05.004
• Title of Journal or Parent Work: International Journal of Hygiene and Environmental Health
• ISSN: 1438-4639
• Volume: 222
• Issue: 5
• Start Page: 765
• End Page: 777
• Grant/Funding Information: The study was partially funded by the United Kingdom Department for International Development (DFID).
• Keywords: METABOLIC RISKS; GLOBAL BURDEN; Public, Environmental & Occupational Health; SETTINGS; Drinking water; DIARRHEA; Hygiene; Life Sciences & Biomedicine; Water; Diarrhoea; NUTRITIONAL INTERVENTIONS; Infectious Diseases; Hand washing; Science & Technology; SYSTEMATIC ANALYSIS; DRINKING-WATER; Burden of disease; CHILD GROWTH; SAFETY PLANS; Sanitation; COMPARATIVE RISK-ASSESSMENT; Comparative risk assessment
• Research Categories: Environmental Sciences; Health Sciences, Public Health

Abstract

Background: To develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and middle-income countries. Methods: For each of the analysed diseases, exposure levels with both sufficient global exposure data for 2016 and a matching exposure-response relationship were combined into population-attributable fractions. Attributable deaths and disability-adjusted life years (DALYs) were estimated for each disease and, for most of the diseases, by country, age and sex group separately for inadequate water, sanitation and hygiene behaviours and for the cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. Findings: An estimated 829,000 WASH-attributable deaths and 49.8 million DALYs occurred from diarrhoeal diseases in 2016, equivalent to 60% of all diarrhoeal deaths. In children under 5 years, 297,000 WASH-attributable diarrhoea deaths occurred, representing 5.3% of all deaths in this age group. If the global disease burden from different diseases and several counterfactual exposure distributions was combined it would amount to 1.6 million deaths, representing 2.8% of all deaths, and 104.6 million DALYs in 2016. Conclusions: Despite recent declines in attributable mortality, inadequate WASH remains an important determinant of global disease burden, especially among young children. These estimates contribute to global monitoring such as for the Sustainable Development Goal indicator on mortality from inadequate WASH.