Burden of disease attributable to unsafe drinking-water, sanitation and hygiene: 2019 update

Burdenofdiseaseattributabletounsafedrinking-water,sanitationandhygiene 2019Update Burdenofdiseaseattributabletounsafedrinking-water,sanitationandhygiene 2019Update Burdenofdiseaseattributabletounsafedrinking-water,sanitationandhygiene,2019update ISBN978-92-4-007561-0(electronicversion)ISBN978-92-4-007562-7(printversion) ©WorldHealthOrganization2023 Somerightsreserved.ThisworkisavailableundertheCreativeCommonsAttribution-NonCommercial-ShareAlike3.0IGOlicence(CCBY-NC-SA3.0IGO;https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Underthetermsofthislicence,youmaycopy,redistributeandadapttheworkfornon-commercialpurposes,providedtheworkisappropriatelycited,asindicatedbelow.Inanyuseofthiswork,thereshouldbenosuggestionthatWHOendorsesanyspecificorganization,productsorservices.TheuseoftheWHOlogoisnotpermitted.Ifyouadaptthework,thenyoumustlicenseyourworkunderthesameorequivalentCreativeCommonslicence.Ifyoucreateatranslationofthiswork,youshouldaddthefollowingdisclaimeralongwiththesuggestedcitation:“ThistranslationwasnotcreatedbytheWorldHealthOrganization(WHO).WHOisnotresponsibleforthecontentoraccuracyofthistranslation.TheoriginalEnglisheditionshallbethebindingandauthenticedition”. AnymediationrelatingtodisputesarisingunderthelicenceshallbeconductedinaccordancewiththemediationrulesoftheWorldIntellectualPropertyOrganization(http://www.wipo.int/amc/en/mediation/rules/). Suggestedcitation.Burdenofdiseaseattributabletounsafedrinking-water,sanitationandhygiene,2019update.Geneva:WorldHealthOrganization;2023.Licence:CCBY-NC-SA3.0IGO. Cataloguing-in-Publication(CIP)data.CIPdataareavailableathttp://apps.who.int/iris. Sales,rightsandlicensing.TopurchaseWHOpublications,seehttps://www.who.int/publications/book-orders.Tosubmitrequestsforcommercialuseandqueriesonrightsandlicensing,seehttps://www.who.int/copyright. Third-partymaterials.Ifyouwishtoreusematerialfromthisworkthatisattributedtoathirdparty,suchastables,figuresorimages,itisyourresponsibilitytodeterminewhetherpermissionisneededforthatreuseandtoobtainpermissionfromthecopyrightholder.Theriskofclaimsresultingfrominfringementofanythird-party-ownedcomponentintheworkrestssolelywiththeuser. Generaldisclaimers.ThedesignationsemployedandthepresentationofthematerialinthispublicationdonotimplytheexpressionofanyopinionwhatsoeveronthepartofWHOconcerningthelegalstatusofanycountry,territory,cityorareaorofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundaries.Dottedanddashedlinesonmapsrepresentapproximateborderlinesforwhichtheremaynotyetbefullagreement. Thementionofspecificcompaniesorofcertainmanufacturers’productsdoesnotimplythattheyareendorsedorrecommendedbyWHOinpreferencetoothersofasimilarnaturethatarenotmentioned.Errorsandomissionsexcepted,thenamesofproprietaryproductsaredistinguishedbyinitialcapitalletters. AllreasonableprecautionshavebeentakenbyWHOtoverifytheinformationcontainedinthispublication.However,thepublishedmaterialisbeingdistributedwithoutwarrantyofanykind,eitherexpressedorimplied.Theresponsibilityfortheinterpretationanduseofthemateriallieswiththereader.InnoeventshallWHObeliablefordamagesarisingfromitsuse. Contents AcknowledgementsV KeyfindingsVI Introduction1 Methods2 Diarrhoealdiseases4 Totaldiarrhoealdiseasedeaths4 Drinking-water5 Exposuretounsafedrinking-water5 Effectofimprovingdrinking-waterondiarrhoea6 Diarrhoealdiseaseburdenfromunsafedrinking-water8 Sanitation8 Exposuretoinadequatesanitation8 Effectofimprovingsanitationondiarrhoea9 Diarrhoealdiseaseburdenfrominadequatesanitation11 Handhygiene11 Exposuretoinadequatehandhygienepractices11 Effectofhandwashingwithsoapondiarrhoea12 Diarrhoealdiseaseburdenfrominadequatehandhygiene13 Drinking-water,sanitation,hygieneanddiarrhoea13 TrendsinWASH-attributablediarrhoealdisease(2000–2019)14 Acuterespiratoryinfections15 Totaldeathsfromacuterespiratoryinfections15 Handhygiene16 EffectofimprovinghandhygieneonARIs16 ARIdiseaseburdenfrominadequatehandhygiene16 Undernutrition17 Totaldeathsfromprotein–energymalnutritionamongchildrenunder517 PEMdiseaseburdenfromunsafeWASH18 Soil-transmittedhelminthiases 18 MortalityfromunsafeWASH 19 Policyimplications 22III References29 Annexes34 Annex1.Methods34 Annex2.WHOregionalgroupingsandcountrylist37 Annex3.Populationattributablefractions,deathsandDALYsbyriskfactorandWHOregionfordiarrhoeaandacuterespiratoryinfections,201938 Annex4.DeathsattributabletoinadequateWASH,byWHO,WorldBankIncomeandSDGregions,201941 Annex5.DALYsattributabletoinadequateWASH,byWHO,WorldBankIncomeandSDGregions45 Annex6.DeathsattributabletoinadequateWASH,bycountry,201949 Annex7.DALYsattributabletoinadequateWASH,bycountry,201969 IV Acknowledgements Thisreportisbasedonrecentpublications(1,2)andresultsfrommanyyearsofcollaborationbetweenalargegroupofscientistsandexperts.Theestimatespresentedinthereporthavebeenproducedwithcontributionsfromthefollowing: ArgawAmbelu,EthiopianInstitutionofWaterResources,AddisAbabaUniversity,Ethiopia;BenjaminF.Arnold,FrancisI.ProctorFoundation,UniversityofCalifornia,SanFrancisco,