Regional disparities in the burden of disease attributable to unsafe water and poor sanitation in China

• Published in: Bulletin of the World Health Organization Vol. 90; no. 8; pp. 578 - 587
• Main Authors: CARLTON, Elizabeth J, SONG LIANG, MCDOWELL, Julia Z, HUAZHONG LI, WEI LUO, REMAIS, Justin V
• Format: Journal Article
• Language: English; Portuguese
• Published: Genève Organisation mondiale de la santé 01.08.2012; World Health Organization; The World Health Organization
• Subjects: Animals; Biological and medical sciences; Biological effects; China; China (People's Republic); China - epidemiology; Diarrhea - epidemiology; Disease; Disease control; Disease Vectors; Diseases; Drinking water; Encephalitis, Japanese - epidemiology; Epidemiology; General aspects; Health; Health Policy & Services; Health Surveys; Helminthiasis - epidemiology; Humans; Hygiene; Malaria; Medical sciences; Miscellaneous; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rural development; Sanitation; Schistosoma; Soil Microbiology; Surveys; Tropical diseases; Water management; Water Microbiology; Water Supply; Asia; China; China, People's Rep; Water quality; Tropical medicine; Disparity; Regional; Morbidity; Public health; WHO
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/blt.11.098343

To estimate the disease burden attributable to unsafe water and poor sanitation and hygiene in China, to identify high-burden groups and to inform improvement measures. The disease burden attributable to unsafe water and poor sanitation and hygiene in China was estimated for diseases resulting from exposure to biologically contaminated soil and water (diarrhoeal disease, helminthiases and schistosomiasis) and vector transmission resulting from inadequate management of water resources (malaria, dengue and Japanese encephalitis). The data were obtained from China's national infectious disease reporting system, national helminthiasis surveys and national water and sanitation surveys. The fraction of each health condition attributable to unsafe water and poor sanitation and hygiene in China was estimated from data in the Chinese and international literature. In 2008, 327 million people in China lacked access to piped drinking water and 535 million lacked access to improved sanitation. The same year, unsafe water and poor sanitation and hygiene accounted for 2.81 million disability-adjusted life years (DALYs) and 62,800 deaths in the country, and 83% of the attributable burden was found in children less than 5 years old. Per capita DALYs increased along an east-west gradient, with the highest burden in inland provinces having the lowest income per capita. Despite remarkable progress, China still needs to conduct infrastructural improvement projects targeting provinces that have experienced slower economic development. Improved monitoring, increased regulatory oversight and more government transparency are needed to better estimate the effects of microbiologically and chemically contaminated water and poor sanitation and hygiene on human health.