CHAPTER 2.2 DOMESTIC WATER AND SANITATION


(Mutonga et al. 2013); and of 23,000 cases during a 2012 outbreak in Sierra Leone, 52% were women and girls and 48% men and boys, figures that roughly correspond with the overall population balance (Rancourt 2013).


A large share of deaths from water-borne diseases in poorer countries is caused by faecal contamination of water supplies (Bain et al. 2014). According to recent WHO estimates, 58% of total cases of diarrhoea in low- and middle-income countries are attributable to environmental factors (Prüss-Ustün et al. 2016). The gender profile for deaths from diarrhoea due to poor water and sanitation is consistent across most regions: more males suffer and die from diarrhoea everywhere except South-East Asia, where the share of female deaths and illness is notable and produces a global tilt towards higher female deaths and DALYs overall (Table 2.2.1).


Children are particularly vulnerable to diseases such as diarrhoea, parasite infections and acute respiratory infections, which are spread as a result of poor WASH provision. The World Health Organization (WHO) estimates that this is the main cause of around 28% of child deaths worldwide (WaterAid 2009). Among children under five diarrhoea is a leading cause of morbidity and mortality, responsible for 20% of total deaths in this age group (WHO 2015; Walker et al. 2012). WASH-related diseases, especially parasitic infections, can severely impede children’s physical and intellectual development (Ziegelbauer et al. 2012). For children with HIV/AIDS, diarrhoea is particularly deadly: the fatality rate for these children is 11 times higher than for those who do not have it (CDC 2015).


Water shortages accelerate and facilitate the spread of disease. For example, trachoma is the leading infectious cause of blindness globally. Survey data consistently show that trachoma-related blindness is two to four times higher in women than men. Disease transmission occurs primarily between children and the women who care for them, especially where water is in short supply, flies are numerous, and living conditions are crowded (WHO 2006; Coutright and West 2004). People who are already sick, particularly if suffering from long-term debilitating illnesses such as HIV/AIDS, have greater water and sanitation needs than healthy ones, and water scarcity accelerates health impairment. Good access to safe water and sanitation is indispensable for people living with HIV/AIDS and for those providing home-based care. Water is needed to bathe patients and wash clothing and bedding, while safe drinking water is necessary in order to take medications. Latrines need to be located nearby for weak patients. Water is also required to keep homes and latrines clean to reduce the risks of opportunistic infections. Adequate water and sanitation also increase the sense of dignity of both patients and caregivers (Kamminga and Wegelin-Schuringa 2003).


In both developed and developing countries water supplies are threatened by many types of pollution, and protecting drinking water from chemical and pesticide pollution is a continuous challenge (K’oreje et al. 2016; Tahrani et al. 2016; Amar 2010; Clasen 2015; Diamond et al. 2015; Crocker and Bartram 2014). In the United States a recent crisis in Flint, the fourth-largest city in the state of Michigan, revealed the dimensions of this problem. In 2014, in an effort to save money, municipal authorities in Flint switched the city’s public water supply from a municipal


Table 2.2.1: Deaths and disability-adjusted life years (DALYs) from diarrhoea due to poor water and sanitation Region


Africa


Americas (low and middle income)


Eastern Mediterranean (low and middle income)


Europe (low and middle income)


Southeast Asia


Western Pacific region (low and middle income)


Total


Deaths (male) 186 130 6 021


41 227 1 890


150 179 7 626


393 073


Deaths (female) DALY (male) 181 476 5 525


14 408 971 498 565


39 838 1 675


213 725 6 536


448 775 3 337 950 191 048


8 101 272 869 126


27 406 932


DALY (female) 13 764 653 443 354


3 154 444 175 136


10 786 489 740 089


29 064 165 Source: Data based on Prüss-Üstün et al. (2014) 61


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