Abbreviated Name:
Mortality from unsafe water, unsafe sanitation and lack of hygiene
Indicator Name:
Mortality rate attributed to unsafe water, unsafe sanitation, and lack of hygiene (exposure to unsafe water, sanitation and hygiene for all (WASH) services)
Domain:
Health status
Related Terms:
Mortality by cause
Definition:
The mortality rate attributed to unsafe WASH is defined as the number of deaths from unsafe WASH in a year, divided by the population, and multiplied by 100,000. Evidence from epidemiological studies have shown that exposure to unsafe WASH is directly linked to diarrhoeal diseases, intestinal nematode infections and other diseases. Repeated diarrhoea episodes contribute to protein-energy malnutrition. There is also evidence that poor hand hygiene practices are associated with acute respiratory infections. SDG 3.9.2 estimates only include diarrhoea (ICD-10 code A00, A01, A03, A04, A06-A09), intestinal nematode infections (ICD-10 code B76-B77, B79), protein-energy malnutrition (ICD-10 code E40-E46) and acute respiratory infections (ICD-10 codes H65-H66, J00-J22, P23, and U04).
Measurment Method:
The included diseases are the WASH attributable fractions of diarrhoea (ICD–10 code A00, A01, A03, A04, A06–A09), intestinal nematode infections (ICD–10 code B76–B77, B79) and protein-energy malnutrition (ICD–10 code E40–E46).
Numerator:
Total number of deaths attributed to unsafe water, unsafe sanitation and lack of hygiene
Denominator
Total population
Estimation method:
For estimating the portion of diarrhoea and acute respiratory infections attributable to unsafe WASH, a comparative risk assessment approach is used. Attributable disease deaths are calculated by first combining information on the increased (or relative) risk of a disease resulting from exposure, with information on how widespread the exposure is in the population (in this case, the percentage of the population with exposure to unsafe WASH). This allows calculation of the 'population attributable fraction' (PAF), which is the fraction of disease seen in a given population that can be attributed to the exposure, in this case unsafe WASH. Applying this fraction to the total deaths from diarrhoea or acute respiratory infections results in the number of diarrhoea or acute respiratory infections deaths that results from inadequate WASH. Deaths from protein-energy malnutrition attributable to inadequate WASH are estimated by evaluating the impacts of repeated infectious diarrhoea episodes on nutritional status (in particular stunting). All deaths from intestinal nematode infections are attributed to inadequate WASH due to their transmission pathway. The methods with agreed international standard have been developed, reviewed and published in various documents (see links below).
Disaggregation:
By age, sex, location (urban/rural, major regions/provinces), and socio-economic characteristics (e.g., education, wealth quintile).
Primary data sources:
Civil registration with complete coverage and medical certification of cause of death
Alternate data sources:
Household surveys, special studies, sample or sentinel registration systems, population census, surveillance systems
Measurment frequency:
Annual or ever 5 yrs
