| Estimating the Burden of Disease from Water, Sanitation, and Hygiene at a Global Level Annette Prüss,1 David Kay,2 Lorna Fewtrell,2 and Jamie Bartram1 1World Health Organization, Protection of the Human Environment, Geneva, Switzerland; 2Centre for Research into Environment and Health, University of Wales, Aberystwyth, Ceredigion, Wales, United Kingdom Abstract
We estimated the disease burden from water, sanitation, and hygiene at the global level taking into account various disease outcomes, principally diarrheal 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 diarrheal diseases, schistosomiasis, trachoma, ascariasis, trichuriasis, and hookworm disease. Because we based these estimates mainly on intervention studies, this burden is largely preventable. 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. Key words: burden of disease, diarrhea, environmental exposure, hygiene, sanitation, water, water supply. Environ Health Perspect 110:537-542 (2002) . [Online 4 April 2002] http://ehpnet1.niehs.nih.gov/docs/2002/110p537-542pruss/ abstract.html Address correspondence to A. Prüss, World Health Organization, Protection of the Human Environment (PHE) , 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Telephone: + 41-22-791-3584. Fax: + 41-22-791-4159. E-mail: pruessa@who.int We gratefully acknowledge the comments and suggestions provided by S. Luby and C. Corvalán and the participants in the review meeting of the WHO Comparative Risk Assessment in Auckland in December 2000. The views expressed in this article are those of the authors and do not necessarily reflect the position of the World Health Organization. We acknowledge the valuable support and contribution of the U.S. Environmental Protection Agency. This report has not been subjected to agency review and therefore does not necessarily reflect the views of the agency. Received 6 August 2001 ; accepted 11 December 2001.
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