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

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          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.

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          Most cited references57

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          Maternal and child undernutrition and overweight in low-income and middle-income countries

          The Lancet, 382(9890), 427-451
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            The world health report 2002 - reducing risks, promoting healthy life.

            J Guilbert (2003)
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              Effect of washing hands with soap on diarrhoea risk in the community: a systematic review

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                Author and article information

                Journal
                Trop Med Int Health
                Trop. Med. Int. Health
                tmi
                Tropical Medicine & International Health
                BlackWell Publishing Ltd (Oxford, UK )
                1360-2276
                1365-3156
                August 2014
                30 April 2014
                : 19
                : 8
                : 894-905
                Affiliations
                [1 ]Department of Public Health and Environment, World Health Organization Geneva, Switzerland
                [2 ]Gillings School of Global Public Health, University of North Carolina at Chapel Hill Chapel Hill, NC, USA
                [3 ]Rollins School of Public Health, Emory University Atlanta, GA, USA
                [4 ]School of Public Health, University of California, Berkeley Berkeley, CA, USA
                [5 ]London School of Hygiene and Tropical Medicine London, UK
                [6 ]Centre for Research into Environment and Health, Aberystwyth University Aberystwyth, UK
                [7 ]Norwich Medical School, University of East Anglia Norwich, UK
                [8 ]Department of Environmental Health, Tshware University of Technology Pretoria, South Africa
                [9 ]EAWAG, Swiss Federal Institute of Aquatic Science and Technology Dübendorf, Switzerland
                [10 ]Department of Health Statistics and Information Systems, World Health Organization Geneva, Switzerland
                [11 ]Swiss Tropical and Public Health Institute Basel, Switzerland
                [12 ]University of Basel Basel, Switzerland
                Author notes
                Corresponding Author Annette Prüss-Ustün, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. E-mail: pruessa@ 123456who.int
                Article
                10.1111/tmi.12329
                4255749
                24779548
                c7ed05e7-4558-4c1b-8f4a-666f9a4b70ba
                © 2014 The Authors. Tropical Medicine and International Health published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Focus on the Global Burden of Disease From Water

                Medicine
                burden of disease,diarrhoea,water,sanitation,hygiene
                Medicine
                burden of disease, diarrhoea, water, sanitation, hygiene

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