School of Public Health, University of California, Berkeley, USA.
Bull World Health Organ. 2012 Aug 1;90(8):578-87. doi: 10.2471/BLT.11.098343. Epub 2012 May 31.
To estimate the disease burden attributable to unsafe water and poor sanitation and hygiene in China, to identify high-burden groups and to inform improvement measures.
The disease burden attributable to unsafe water and poor sanitation and hygiene in China was estimated for diseases resulting from exposure to biologically contaminated soil and water (diarrhoeal disease, helminthiases and schistosomiasis) and vector transmission resulting from inadequate management of water resources (malaria, dengue and Japanese encephalitis). The data were obtained from China's national infectious disease reporting system, national helminthiasis surveys and national water and sanitation surveys. The fraction of each health condition attributable to unsafe water and poor sanitation and hygiene in China was estimated from data in the Chinese and international literature.
In 2008, 327 million people in China lacked access to piped drinking water and 535 million lacked access to improved sanitation. The same year, unsafe water and poor sanitation and hygiene accounted for 2.81 million disability-adjusted life years (DALYs) and 62,800 deaths in the country, and 83% of the attributable burden was found in children less than 5 years old. Per capita DALYs increased along an east-west gradient, with the highest burden in inland provinces having the lowest income per capita.
Despite remarkable progress, China still needs to conduct infrastructural improvement projects targeting provinces that have experienced slower economic development. Improved monitoring, increased regulatory oversight and more government transparency are needed to better estimate the effects of microbiologically and chemically contaminated water and poor sanitation and hygiene on human health.
估计中国因不安全饮用水和环境卫生条件差导致的疾病负担，确定高负担人群，并为改进措施提供信息。
对中国因生物污染土壤和水导致的疾病（腹泻病、蠕虫病和血吸虫病）以及因水资源管理不善导致媒介传播的疾病（疟疾、登革热和乙型脑炎），评估不安全饮用水和环境卫生条件差导致的疾病负担。数据来源于中国国家传染病报告系统、全国寄生虫病调查和国家饮水与环境卫生调查。通过中国和国际文献中的数据，估计中国每一种健康状况归因于不安全饮用水和环境卫生条件差的比例。
2008 年，中国有 3.27 亿人无法获得自来水，5.35 亿人无法获得改良的环境卫生设施。同年，不安全饮用水和环境卫生条件差导致中国 281 万人残疾调整生命年（DALY）和 6.28 万人死亡，其中 83%的负担发生在 5 岁以下儿童。人均 DALY 呈东西梯度增加，人均收入最低的内陆省份负担最重。
尽管取得了显著进展，但中国仍需针对经济发展较慢的省份开展基础设施改善项目。需要加强监测、加强监管监督并提高政府透明度，以更好地评估微生物和化学污染水以及环境卫生条件差对人类健康的影响。
