title: Estimating the impact of unsafe water, sanitation and hygiene on the global burden of disease: evolving and alternative methods.
abstract: The 2010 global burden of disease (GBD) study represents the latest effort to estimate the global burden of disease and injuries and the associated risk factors. Like previous GBD studies, this latest iteration reflects a continuing evolution in methods, scope and evidence base. Since the first GBD Study in 1990, the burden of diarrhoeal disease and the burden attributable to inadequate water and sanitation have fallen dramatically. While this is consistent with trends in communicable disease and child mortality, the change in attributable risk is also due to new interpretations of the epidemiological evidence from studies of interventions to improve water quality. To provide context for a series of companion papers proposing alternative assumptions and methods concerning the disease burden and risks from inadequate water, sanitation and hygiene, we summarise evolving methods over previous GBD studies. We also describe an alternative approach using population intervention modelling. We conclude by emphasising the important role of GBD studies and the need to ensure that policy on interventions such as water and sanitation be grounded on methods that are transparent, peer-reviewed and widely accepted.
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Clasen
authors.forename: Annette
authors.initials: A
authors.lastname: Pruss-Ustun
authors.forename: Colin D
authors.initials: CD
authors.lastname: Mathers
authors.forename: Oliver
authors.initials: O
authors.lastname: Cumming
authors.forename: Sandy
authors.initials: S
authors.lastname: Cairncross
authors.forename: John M
authors.initials: JM
authors.lastname: Colford
mesh_terms: D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology*; D060766:Drinking Water / Q000592:standards*; D004781:Environmental Exposure / Q000009:adverse effects; D014943:Global Health; D006801:Humans; D006920:Hygiene / Q000592:standards*; D007223:Infant; D012107:Research Design; D012307:Risk Factors; D012499:Sanitation / Q000592:standards*; D014881:Water Supply / Q000592:standards*
chemical_list: D060766:Drinking Water
keywords: Charge Mondiales de morbidité; agua; assainissement; carga global de enfermedad; eau; global burden of disease; saneamiento; sanitation; water