Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, UK .
S Afr Med J. 2022 Sep 30;112(8b):729-736. doi: 10.7196/SAMJ.2022.v112i8b.16498.
The incidence of diarrhoeal disease is closely linked to socioeconomic and environmental factors, household practices and access to health services. South African (SA) district health information and national survey data report wide variation in the incidence and prevalence of diarrhoeal episodes in children under 5 years of age. These differentials indicate potential for reducing the disease burden through improvements in provision of water and sanitation services and changes in hygiene behaviour.
To estimate the burden of disease attributed to unsafe water, sanitation and hygiene (WASH) by province, sex and age group for SA in 2000, 2006 and 2012.
Comparative risk assessment methodology was used to estimate the disease burden attributable to an exposure by comparing the observed risk factor distribution with a theoretical lowest possible population distribution. The study adapts the original World Health Organization scenario-based approach for estimating diarrhoeal disease burden from unsafe WASH, by assigning different standards of household water and sanitation-specific geographical classification to capture SA living conditions in rural, urban and informal settlements.
SA experienced an improvement in water and sanitation supply in eight of the nine provinces between 2001 and 2011, with the exception of Northern Cape Province. In 2011, 41% of South Africans lived with poor water and sanitation conditions; however, wide provincial inequalities exist. In 2012, it was estimated that 84.1% of all deaths due to diarrhoeal disease were attributable to unsafe WASH; this equates to 13 757 deaths (95% uncertainty interval (UI) 13 015 - 14 300). Of these diarrhoeal disease deaths, 48.2% occurred in children under 5 years of age, accounting for 13.9% of all deaths in this age group (95% UI 13.1 - 14.4). Between 2000 and 2012, the proportion of deaths attributable to diarrhoea reduced from 3.6% to 2.6%. Gauteng and Western Cape provinces experienced much lower WASHattributable death rates than the more rural, poorer provinces.
Unsafe WASH remains an important risk factor for disease in SA, especially in children. High priority needs to be given to the provision of safe and sustainable sanitation and water facilities and promoting safe hygiene behaviours. The COVID-19 pandemic has reinforced the critical importance of clean water for preventing and containing disease.
腹泻病的发病率与社会经济和环境因素、家庭卫生习惯以及获得卫生服务的机会密切相关。南非（SA）地区卫生信息和国家调查数据报告称，5 岁以下儿童腹泻病的发病率和流行率存在很大差异。这些差异表明，通过改善供水和卫生服务以及改变卫生行为，有潜力减轻疾病负担。
按省份、性别和年龄组估算 2000 年、2006 年和 2012 年南非因不安全水、环境卫生和个人卫生（WASH）导致的疾病负担。
采用比较风险评估方法，通过比较观察到的危险因素分布与理论上可能的最低人口分布来估算暴露导致的疾病负担。该研究通过对家庭用水和卫生设施进行特定的地理分类，采用世界卫生组织基于情景的方法来估计因不安全 WASH 导致的腹泻病负担，以适应南非农村、城市和非正规住区的生活条件。
2001 年至 2011 年期间，除北开普省外，南非 9 个省份中有 8 个在供水和卫生供应方面有所改善。2011 年，41%的南非人生活在供水和卫生条件差的环境中，但存在广泛的省级不平等。2012 年，估计所有因腹泻病死亡的病例中有 84.1%可归因于不安全的 WASH；这相当于 13 757 例死亡（95%不确定区间[UI]为 13 015-14 300）。在这些腹泻病死亡病例中，48.2%发生在 5 岁以下儿童中，占该年龄组所有死亡人数的 13.9%（95% UI 为 13.1-14.4）。2000 年至 2012 年期间，因腹泻病导致的死亡比例从 3.6%降至 2.6%。豪登省和西开普省的 WASH 归因死亡率远低于较农村和较贫困的省份。
不安全的 WASH 仍然是南非疾病的一个重要危险因素，特别是在儿童中。需要高度重视提供安全和可持续的卫生和供水设施，并促进安全的卫生行为。COVID-19 大流行凸显了清洁水对于预防和控制疾病的重要性。
