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      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

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          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.

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          Most cited references37

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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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

            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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              The Determinants of Mortality

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                Author and article information

                Contributors
                Journal
                Int J Hyg Environ Health
                Int J Hyg Environ Health
                International Journal of Hygiene and Environmental Health
                Urban & Fischer
                1438-4639
                1618-131X
                1 June 2019
                June 2019
                : 222
                : 5
                : 765-777
                Affiliations
                [a ]Department of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland
                [b ]Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
                [c ]Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
                [d ]Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
                [e ]The Norwich School of Medicine, University of East Anglia, Norwich, UK
                [f ]Department of Environmental Health, Tshwane University of Technology, Pretoria, South Africa
                Author notes
                []Corresponding author. Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 20 Avenue Appia, Geneva, Switzerland. pruessa@ 123456who.int
                Article
                S1438-4639(18)31048-4
                10.1016/j.ijheh.2019.05.004
                6593152
                31088724
                da60ab41-3a59-4aa1-bbfa-22cf8c7030ff
                © The Authors. Published by Elsevier GmbH. All rights reserved.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/).

                History
                : 21 December 2018
                : 3 May 2019
                : 3 May 2019
                Categories
                Article

                burden of disease,comparative risk assessment,drinking water,water,sanitation,hygiene,diarrhoea,hand washing,cra, comparative risk assessment,dalys, disability-adjusted life years,hics, high-income countries,jmp, who/unicef joint monitoring programme for water supply, sanitation and hygiene,lmics, low- and middle-income countries,wash, water, sanitation and hygiene behaviours

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