Evidence map›Paper›PMID 31088724›Full record

ArticleInternational journal of hygiene and environmental health2019

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

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In one paragraph

Article in International journal of hygiene and environmental health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 291 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
291citing papers in PubMed, 15 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

291 citing papers in PubMed, 15 syntheses or guidelines pooled it.

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231 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Annette Prüss-UstünDepartment of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland. Electronic address: pruessa@who.int.
Jennyfer WolfDepartment of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland. Electronic address: jennyfer.wolf@gmail.com.
Jamie BartramGillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: jbartram@email.unc.edu.
Thomas ClasenDepartment of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: thomas.f.clasen@emory.edu.
Oliver CummingDepartment of Disease Control, London School of Hygiene and Tropical Medicine, London, UK. Electronic address: Oliver.Cumming@lshtm.ac.uk.
Matthew C FreemanDepartment of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: matthew.freeman@emory.edu.
Bruce GordonDepartment of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland. Electronic address: gordonb@who.int.
Paul R HunterThe Norwich School of Medicine, University of East Anglia, Norwich, UK; Department of Environmental Health, Tshwane University of Technology, Pretoria, South Africa. Electronic address: paul.hunter@uea.ac.uk.
Kate MedlicottDepartment of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland. Electronic address: medlicottk@who.int.
Richard JohnstonDepartment of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland. Electronic address: johnstonr@who.int.

Funding

World Health Organization 001
6 · The paper itself

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.

Indexed as

Epidemiological MonitoringHygieneSanitationWater SupplyDeveloping CountriesDiarrheaHelminthiasisHumansIntestinal Diseases, ParasiticMalariaMalnutritionPovertyRespiratory Tract InfectionsRisk AssessmentSchistosomiasisBurden of diseaseComparative risk assessmentDiarrhoeaDrinking waterHand washingHygieneSanitationWater

Identifiers

PMID31088724
PMCPMC6593152

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.