Study quantifies link between poor sanitation and child, maternal mortality

In countries with the poorest sanitation, child mortality is nearly 7 times higher than in countries with the best access to sanitation. This is one of the findings of a new study [1] by Canadian-based researchers who say they are the first to quantify the impact of unsafe water and poor sanitation on child and maternal mortality.

Researcher June J. Cheng. Photo: McMaster University

Researchers at the United Nations University and McMaster University analysed data on access to safe water and adequate sanitation across 193 countries and compared them with maternal and child deaths.

Dividing the countries into four tiers (“quartiles”), they found that countries ranked in the bottom 25% in terms of adequate sanitation had about 6.6 more deaths per 1,000 children under five years old compared to countries in the top 25% tier.

Similarly, when judged on access to safe water, countries ranked in the bottom quartile, child mortality was 4.7 higher than in the top quartile.

Relating adequate sanitation provision and maternal death rates (death within a year of childbirth), the paper says the odds of dying increase 48% from the top tier to each lower tier of countries; the corresponding odds with respect to unsafe inadequate sanitation: 42%.

[1] Cheng, J.J. et al., 2012. An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality. Environmental Health, 11 (4). Available at:  http://dx.doi.org/10.1186/1476-069X-11-4 [accessed 17 Feb 2012]

Related news:

• Diarrhoeal diseases: study predicts decline in global deaths, E-Source, 20 April 2011
• Health impact: effect of water quality, hygiene and sanitation in preventing diarrhoea deaths, E-Source, 22 Jun 2010

Related web sites:

• UNU-INWEH – Water-Health Nexus
• WHO – Water Sanitation and Health (WSH) – Burden of disease and cost-effectiveness estimates

Contact: June J Cheng (june.cheng@medportal.ca), Public Health and Preventive Medicine Residency Program, Dept. of Clinical Epidemiology and Biostatistics, McMaster University and United Nations University Institute for Water, Environment and Health (UNU-INWEH), Canada

Source: United Nations University, EurekaAlert!, 14 Feb 2011

Global deaths from diarrhoea, malaria, AIDS declining, study predicts

Under-five child mortality from diarrhoeal diseases, which was 1.7 million in 2005, is expected to fall to just over half a million by 2030 and around 130,000 in 2060, a new study [1] predicts.

The study notes that headway is being made in fighting communicable diseases such as diarrhoea, malaria and AIDS. At the global level disease burdens are shifting from communicable diseases to chronic ones such as cancer, diabetes and heart disease.

Diarrhoea kills over a million over-fives each year

Diarrhoea kills three times more over-five-year-olds in Africa and South-East Asia than previously thought, new research finds.

Some 1.15 million over-fives — thought to be mostly adolescents and the elderly — are dying in these regions each year from diarrhoeal diseases, according to the research, commissioned by the WHO. Until now the death toll estimate for these regions came to 380,000.

Preliminary results from the study — which has yet to be published — were presented at this week’s meeting of the Foodborne Disease Burden Epidemiology Reference Group (FERG) (29 October) in Switzerland.

“These estimates highlight the significant burden of diarrhoeal diseases in adolescents and adults in the developing world,” said Martyn Kirk, chair of the FERG Enteric Diseases Task Force, who presented the results.

For the study, Christa Fischer-Walker and Robert Black from Johns Hopkins School of Public Health in the US searched 25,000 journal articles for information on diarrhoea in the over-fives. Only six of the articles contained reliable figures on diarrhoeal deaths in developing countries for this age group (compared to hundreds for younger children) — and there was no data for China, Latin America, the Middle East or South Asia.

The new estimate is on a par with the global annual death toll for malaria. It is also equivalent to nearly one-third of all HIV deaths and to almost half the number of global deaths from tuberculosis, says Claudia Stein, medical officer of the WHO’s Department of Food Safety and Zoonoses.

“What makes the tragedy even greater is that many of these diseases are clearly preventable,” said Jørgen Schlundt, director of FOS. Schlundt calls for policymakers to be alerted to cheap strategies known to prevent diarrhoea.

Improvements in food safety, sanitation and hygiene are critical, says Kirk. He told the meeting that nearly half (48.9 per cent) of diarrhoeal deaths in the developing world are caused by the bacteria Enterotoxigenic Escherichia coli and Vibrio cholerae, both of which are associated with poor sanitation and are common in resource-poor countries.

Stein says major gaps remain in scientists’ understanding of diarrhoeal deaths. Research focusing on older people attracts little funding, as a result of which the problem has never been thoroughly assessed in this group.

But it is expected that some of these gaps will be filled next year, when results emerge from studies in China and India. The FERG is also planning country-level studies across the world, the results of which should begin to emerge in 2010.

Source: Sian Lewis, SciDev.net, 30 Oct 2009

The Case for Sanitation: Government failure to tackle global child mortality

Every year 9.7 million children die before reaching their fifth birthday. A new WaterAid report “Tacking the silent killer: The case for sanitation” asserts that improved sanitation could bring the single greatest reduction in these child deaths.

WaterAid’s report reveals that the current statistics on child mortality may be underestimating how many child deaths are attributable to poor sanitation. According to the report inadequate sanitation may be the biggest killer of children under the age of five, yet no governments are prioritising the issue, instead sanitation is the most neglected of all the Millennium Development Goal (MDG) sectors.

The report, released at the G8 Hokkaido summit in Japan, explores how the sanitation sector is being chronically and institutionally neglected by donors and developing country governments alike, resulting in as many as 2.4 million easily preventable child deaths a year; double the number of people killed worldwide in road traffic accidents.

Read more: WaterAid, 07 Jul 2008

Improving access to water, sanitation, and hygiene was also discussed in the editorial and podcast of The Lancet on 28 June 2008. The editorial mentioned how a new WHO report highlights how 9.1% of the global disease burden could be reduced by improved access to water and sanitation and by a staggering 15% in the 32 worst affected countries.

An upcoming analysis from the World Bank concludes that environmental infections and malnutrition are inextricably linked. However, these links have been neglected by policy makers in strategies aimed at improving child survival and development.

In July 2008, the WHO/UNICEF Joint Monitoring Programme will publish updated figures on water and sanitation coverage. The 2008 report is expected to have mixed results: despite some improvement, almost 600 million people in Africa still lack access to improved sanitation. Furthermore, 1·2 billion people worldwide still have no option but to continue to defecate in the open. Over 80% of these people live in 13 countries.

The Lancet, in partnership with leading global experts, will be publishing a Series to build on the evidence base of water, sanitation, and hygiene interventions and practices.

Source: Editorial. The Lancet ; vol. 371, no. 9631 (28 June 2008); p. 2145. doi:10.1016/S0140-6736(08)60925-3 [free registration required]