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Visualizing death and disease from lack of sanitation

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

toilet mrlego54
Flickr, mrlego54

Earlier this week we marked World Toilet Day, created to raise awareness of the fact that billions of people around the world lack access to this basic necessity. The day is not so much about toilets as it is one of many attempts aimed at making sanitation a development priority worldwide.

Recent articles in news outlets such as CNN, Al Jazeera, and The Hindu discuss the importance of sanitation for everything from preventing diarrhea to protecting women from sexual assault and promoting girls’ education. In Humanosphere’s World Toilet Day post, we noted that the World Bank estimates that poor sanitation costs the globe an estimated $2.6 billion every year in lost productivity (a word economists use to tally up, among other things, the cost of death and disability).

Today’s post explores the extent to which poor sanitation contributes to the death toll in developing countries.

We’ll also explore developing countries’ progress in reducing deaths from poor sanitation, also known as “unimproved sanitation.” In 2010, an estimated 243,586 deaths in developing countries were attributable to poor sanitation. Lack of an adequate toilet contributes to deadly conditions such as diarrheal diseases and typhoid.

The screen grab below shows deaths attributable to poor sanitation in children under 5 between 1990 and 2010. The screen grab also shows the dramatic progress developing countries made in reducing deaths from poor sanitation in this age group, which dropped from 326,733 to 107,040 during this period.

Deaths attributable to unimproved sanitation in developing countries in children under 5 years, 1990-2010

Sanitation 1

Note: “unimproved sanitation” is defined as households using traditional latrines, open latrines without squatting slabs, bucket latrines, hanging latrines, open defecation or no facilities, and other unspecified facilities.

In 1990, poor sanitation was the sixth leading risk factor for death in children under 5 in developing countries, as shown in the next screen grab. By 2010, deaths linked to poor sanitation in this age group dropped by 68% to rank seventh. Childhood underweight (a measure of malnutrition), suboptimal breastfeeding (includes non-exclusive breastfeeding from 0 to 5 months and discontinued breastfeeding from 6 to 23 months of age), air pollution (includes air pollution from inside and outside the house), and secondhand smoke contributed to more deaths than poor sanitation in children under 5 in 2010.

Changes in leading risk factors for death in children under 5 years, developing countries, 1990 and 2010

Sanitation 2The following screen grab shows the percentage of deaths linked to different risk factors across the life span in developing countries. GBD 2010 estimates that sanitation (shown in pale yellow) contributed to a relatively small percentage of deaths in children, and the percentage of deaths attributable to poor sanitation in older age groups is barely visible. In children ages 28 to 364 days, poor sanitation accounted for an estimated 2.7% of total deaths. This risk factor was linked to 2.1% of deaths in ages 1 to 4 years. In contrast, childhood underweight accounted for more than 20% of total deaths in these age groups, while household air pollution contributed to 10% and 6.6% of deaths, respectively.

Deaths attributable to potentially preventable risk factors in developing countries by age group, 2010

Sanitation 3

Note: Due to the nature of the methodology used to estimate risk factors attributable to death and disability, the percentage of different risk factors can add up to more than 100% of total deaths. As a result, only the individual attribution of deaths to specific risk factors should be considered instead of the combined height of each bar.

GBD estimates show that poor sanitation accounted for more than 200,000 deaths in developing countries in 2010 and reveal the impressive progress made in this area. At the same time, GBD research helps put these numbers in context: lack of toilets isn’t as much of a threat to children’s health in comparison to risk factors such as childhood underweight, suboptimal breastfeeding, and household air pollution.

When interpreting these estimates of the impact of poor sanitation on health, it’s important to be aware of the limitations of the research. Scientific studies that have examined the impact of sanitation on health in different settings are rarely standardized. This poses challenges for researchers attempting to quantify the relationship between better sanitation and lower death rates. As a result, GBD estimates that poor sanitation contributed to as few as 6,014 and as many as 477,195 deaths in developing countries in 2010. This interval captures the uncertainty surrounding the estimate of deaths from poor sanitation.  While the latest GBD study took advantage of the latest available data and scientific knowledge to study the effects of poor sanitation on health, better data are needed to fully understand the number of deaths it causes.


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