Estimating the burden of disease from water, sanitation, and hygiene at a global level
Prüss, A.; Kay, D.; Fewtrell, L.; Bartram, J.
Environmental Health Perspectives 110(5): 537-542
2002
ISSN/ISBN: 0091-6765 PMID: 12003760 DOI: 10.2307/3455343Document Number: 251181
We estimated the disease burden from water, sanitation, and hygiene at the global level taking into account various disease outcomes, principally diarrhoeal diseases. The disability-adjusted life year (DALY) combines the burden from death and disability in a single index and permits the comparison of the burden from water, sanitation, and hygiene with the burden from other risk factors or diseases. We divided the world's population into typical exposure scenarios for 14 geographical regions. We then matched these scenarios with relative risk information obtained mainly from intervention studies. We estimated the disease burden from water, sanitation, and hygiene to be 4.0% of all deaths and 5.7% of the total disease burden (in DALYs) occurring worldwide, taking into account diarrhoeal diseases, schistosomiasis, trachoma, ascariasis, trichuriasis and hookworm disease. Because we based these estimates mainly on intervention studies, this burden is largely preventable. About 90% of this disease burden occurred in children <5 years of age. When adding the disease burden from diarrhoea estimated by the realistic approach to other diseases related to water, sanitation and hygiene, the totals amount to 2 213 000 deaths and 82 196 000 DALYs per year. This amounts to 4.0% of all deaths and 5.7% of all DALYs if compared with the figures reported for 1999. Other water- and sanitation-related diseases remain to be evaluated. This preliminary estimation of the global disease burden caused by water, sanitation, and hygiene provides a basic model that could be further refined for national or regional assessments. This significant and avoidable burden suggests that it should be a priority for public health policy.