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.

Annette Prüss-Ustün,Paul R Hunter,Richard Johnston,Matthew C Freeman,Jamie Bartram,Bruce Gordon,Thomas Clasen,Kate Medlicott,Jennyfer Wolf,Oliver Cumming

doi:10.1016/j.ijheh.2019.05.004

Abstract

BackgroundTo 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.MethodsFor 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.FindingsAn 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.ConclusionsDespite 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.

Highlights

Global burden of disease assessments are important to identify priorities for improving population health and tracking changes in the relative importance of different diseases, injuries and risk factors (Murray and Lopez, 2013)
The objective of this paper is to present updated WASH-attributable burden of diarrhoeal disease estimates for the year 2016 and to add the WASH-attributable burden of further selected adverse health outcomes including respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma
In low- and middle-income countries (LMICs), 62% used basic sanitation services and 45% of the population lived in communities with basic sanitation coverage above 75% (Table 4)

Summary

Introduction

Global burden of disease assessments are important to identify priorities for improving population health and tracking changes in the relative importance of different diseases, injuries and risk factors (Murray and Lopez, 2013). 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. 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. Conclusions: Despite recent declines in attributable mortality, inadequate WASH remains an important determinant of global disease burden, especially among young children.

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