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Official websites use. Share sensitive information only on official, secure websites. 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 We calculated WASH-attributable fractions of diarrhoea and acute respiratory infections by country using modelled WASH exposures and exposureβresponse relationships from two updated meta-analyses. Soil-transmitted helminthiasis was fully attributed 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.
Despite substantial progress, unsafe drinking water, sanitation, and hygiene WASH services continue to pose important risks to health. Unsafe WASH increases the risk of diarrhoea, 4 chronic undernutrition because of repeated bouts of diarrhoea, 5 , 6 acute respiratory infections, 7 and soil-transmitted helminthiasis. Examples include: trachoma; 9 schistosomiasis; 10 hepatitis; 11 conditions related to naturally occurring and synthetic chemical exposures such as arsenicosis, fluorosis, and lead poisoning; 11 and longer term consequences such as childhood stunting.
Safely managed: Drinking water from an improved source that is accessible on the premises, available when needed and free from faecal and priority chemical contamination. Basic: Drinking water from an improved source, provided collection time is not more than 30 min for a round trip, including queuing. Limited: Drinking water from an improved source, for which collection time exceeds 30 min for a round trip, including queuing.
Unimproved: Drinking water from an unprotected dug well or unprotected spring. Surface water: Drinking water directly from a river, dam, lake, pond, stream, canal, or irrigation canal. Improved drinking water sources include piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water. Safely managed: Use of improved facilities that are not shared with other households and where excreta are safely disposed of in situ or removed and treated offsite.