Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland.
Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland.
Lancet. 2023 Jun 17;401(10393):2060-2071. doi: 10.1016/S0140-6736(23)00458-0. Epub 2023 Jun 5.
Assessments of disease burden are important to inform national, regional, and global strategies and to guide investment. We aimed to estimate the drinking water, sanitation, and hygiene (WASH)-attributable burden of disease for diarrhoea, acute respiratory infections, undernutrition, and soil-transmitted helminthiasis, using the WASH service levels used to monitor the UN Sustainable Development Goals (SDGs) as counterfactual minimum risk-exposure levels.
We assessed the WASH-attributable disease burden of the four health outcomes overall and disaggregated by region, age, and sex for the year 2019. We calculated WASH-attributable fractions of diarrhoea and acute respiratory infections by country using modelled WASH exposures and exposure-response relationships from two updated meta-analyses. We used the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene public database to estimate population exposure to different WASH service levels. WASH-attributable undernutrition was estimated by combining the population attributable fractions (PAF) of diarrhoea caused by unsafe WASH and the PAF of undernutrition caused by diarrhoea. Soil-transmitted helminthiasis was fully attributed to unsafe WASH.
We estimate that 1·4 (95% CI 1·3-1·5) million deaths and 74 (68-80) million disability-adjusted life-years (DALYs) could have been prevented by safe WASH in 2019 across the four designated outcomes, representing 2·5% of global deaths and 2·9% of global DALYs from all causes. The proportion of diarrhoea that is attributable to unsafe WASH is 0·69 (0·65-0·72), 0·14 (0·13-0·17) for acute respiratory infections, and 0·10 (0·09-0·10) for undernutrition, and we assume that the entire disease burden from soil-transmitted helminthiasis was attributable to unsafe WASH.
WASH-attributable burden of disease estimates based on the levels of service established under the SDG framework show that progress towards the internationally agreed goal of safely managed WASH services for all would yield major public-health returns.
WHO and Foreign, Commonwealth & Development Office.
评估疾病负担对于制定国家、地区和全球战略以及指导投资非常重要。我们旨在使用监测联合国可持续发展目标（SDG）的用水、环境卫生和个人卫生（WASH）服务水平作为反事实的最低风险暴露水平，估计腹泻、急性呼吸道感染、营养不足和土壤传播性蠕虫病的 WASH 归因疾病负担。
我们评估了 2019 年这四种健康结果的 WASH 归因疾病负担，按区域、年龄和性别进行了细分。我们使用两个更新的荟萃分析中的模型化 WASH 暴露和暴露-反应关系，按国家计算了腹泻和急性呼吸道感染的 WASH 归因分数。我们使用世界卫生组织和联合国儿童基金会联合监测计划的供水、环境卫生和个人卫生公共数据库来估计不同 WASH 服务水平的人口暴露情况。通过结合不安全 WASH 引起的腹泻导致的人群归因分数（PAF）和腹泻导致的营养不足的 PAF，估计了与营养不足有关的 WASH 归因部分。土壤传播性蠕虫病完全归因于不安全的 WASH。
我们估计，在 2019 年，通过安全的 WASH 可以预防这四种指定结果的 140 万人（95%CI 130-150）死亡和 7400 万人（68-80）残疾调整生命年（DALY），占全球所有原因死亡的 2.5%和全球所有原因 DALY 的 2.9%。不安全 WASH 导致的腹泻比例为 0.69（0.65-0.72），急性呼吸道感染为 0.14（0.13-0.17），营养不足为 0.10（0.09-0.10），我们假设土壤传播性蠕虫病的全部疾病负担都归因于不安全的 WASH。
基于可持续发展目标框架下确定的服务水平进行的 WASH 归因疾病负担估计表明，朝着国际商定的为所有人提供安全管理的 WASH 服务目标取得进展将带来重大的公共卫生回报。
世界卫生组织和外交、联邦和发展办公室。
