title: Estimating the burden of disease attributable to unsafe water and lack of sanitation and hygiene in South Africa in 2000.
abstract: OBJECTIVE
  to estimate the burden of disease attributable to unsafe water, sanitation and hygiene (wsh) by age group for South Africa in 2000.
  
  
  METHODS
  World Health Organization comparative risk assessment methodology was used to estimate the disease burden attributable to an exposure by comparing the observed risk factor distribution with a theoretical lowest possible population distribution. A scenario-based approach was applied for estimating diarrhoeal disease burden from unsafe WSH. Six exposure scenarios were defined based on the type of water and sanitation infrastructure and environmental faecal-oral pathogen load. For 'intestinal parasites' and schistosomiasis, the burden was assumed to be 100% attributable to exposure to unsafe WSH.
  
  
  METHODS
  South Africa.
  
  
  METHODS
  Disease burden from diarrhoeal diseases, intestinal parasites and schistosomiasis, measured by deaths and disability-adjusted life years (DALYs).
  
  
  RESULTS
  13,434 deaths were attributable to unsafe WSH accounting for 2.6% (95% uncertainty interval 2.4 - 2.7%) of all deaths in South Africa in 2000. The burden was especially high in children under 5 years, accounting for 9.3% of total deaths in this age group and 7.4% of burden of disease. Overall, the burden due to unsafe WSH was equivalent to 2.6% (95% uncertainty interval 2.5 - 2.7%) of the total disease burden for South Africa, ranking this risk factor seventh for the country.
  
  
  CONCLUSIONS
  Unsafe WSH remains an important risk factor for disease in South Africa, especially in children under 5. High priority needs to be given to the provision of safe and sustainable sanitation and water facilities and to promoting safe hygiene behaviours, particularly among children.
authors.affiliation: Health Systems Research Unit, Medical Research Council of South Africa and Department of Public Health and Policy, London School of Hygiene and Tropical Medicine. simon.lewin@mrc.ac.za
authors.forename: Simon
authors.initials: S
authors.lastname: Lewin
authors.forename: Rosana
authors.initials: R
authors.lastname: Norman
authors.forename: Nadine
authors.initials: N
authors.lastname: Nannan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thomas
authors.forename: Debbie
authors.initials: D
authors.lastname: Bradshaw
mesh_terms: D000328:Adult; D000367:Age Factors; D002675:Child, Preschool; D017281:Cost of Illness; D004403:Dysentery / Q000453:epidemiology*; D006801:Humans; D006920:Hygiene; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology*; D012307:Risk Factors; D012499:Sanitation; D013019:South Africa / Q000453:epidemiology; D014871:Water Microbiology