Table 10.
Summary of WASH-attributable disease burden, 2016
| disease | PAF | 95% CI | method for PAF estimation | counterfactual exposure level | deaths | DALYs |
|---|---|---|---|---|---|---|
| Schistosomiasis | 0.43 | 0.40–0.46 | CRA | feasible minimum risk (universal access to/use of basic water and sanitation services) | 10,405 | 1,095,658 |
| total WASH-attributable disease burden using a feasible minimum risk | 10,405 | 1,095,658 | ||||
| Diarrhoea | 0.60* | 0.54–0.65 | CRA | plausible minimum risk (universal filtering/boiling of water + safe storage. access to/use of basic sanitation in communities >75% basic sanitation coverage, HWWS after potential faecal contact) | 828,651* | 49,773,959* |
| Acute respiratory infections | 0.13 | 0.08–0.16 | CRA | plausible minimum risk (universal HWWS after potential faecal contact) | 370,370 | 17,308,136 |
| Protein-energy malnutrition | 0.16* | 0.15–0.17 | based on diarrhoeal estimates | plausible minimum risk (see diarrhoea) | 28,194* | 2,995,329* |
| total WASH-attributable disease burden using a plausible minimum risk | 1,227,215 | 70,077,424 | ||||
| Malaria | 0.80 | 0.67–0.87 | comparing universal safe water resource management (WRM) against no WRM | theoretical minimum risk (universal safe WRM) | 354,924 | 29,707,805 |
| Soil-transmitted helminth infections | 1 | 1–1 | burden completely WASH-attributed | theoretical minimum risk (universal safely managed water and sanitation, access to essential hygiene conditions and practice of essential hygiene behaviours) | 6248 | 3,430,614 |
| Trachoma | 1 | 1–1 | burden completely WASH-attributed | theoretical minimum risk (universal safely managed water and sanitation, access to essential hygiene conditions and practice of essential hygiene behaviours) | <10 | 244,471 |
| total WASH-attributable disease burden using a theoretical risk | 361,175 | 33,382,890 | ||||
PAF: population attributable fraction, CI: confidence interval, DALYs: disability-adjusted life years, CRA: comparative risk assessment, HWWS: handwashing with soap, theoretical minimum risk: use of safely managed water and sanitation services, access to essential hygiene conditions and practice of essential hygiene behaviour, plausible minimum risk: boiling/filtering of drinking water with subsequent safe storage, access to/use of basic sanitation in a community with >75% basic sanitation coverage, handwashing with soap after potential faecal contact, feasible minimum risk: access to/use of basic drinking water and basic sanitation services, disease burden estimates are for low- and middle-income countries, diarrhoea and acute respiratory infections include disease burden in high-income countries from inadequate hygiene.