Showing papers by "Annette Prüss-Ustün published in 2018"

Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta-analysis and meta-regression

Abstract: OBJECTIVES: Safe drinking water, sanitation and hygiene are protective against diarrhoeal disease; a leading cause of child mortality. The main objective was an updated assessment of the impact of unsafe water, sanitation and hygiene (WaSH) on childhood diarrhoeal disease. METHODS: We undertook a systematic review of articles published between 1970 and February 2016. Study results were combined and analysed using meta-analysis and meta-regression. RESULTS: A total of 135 studies met the inclusion criteria. Several water, sanitation and hygiene interventions were associated with lower risk of diarrhoeal morbidity. Point-of-use filter interventions with safe storage reduced diarrhoea risk by 61% (RR = 0.39; 95% CI: 0.32, 0.48); piped water to premises of higher quality and continuous availability by 75% and 36% (RR = 0.25 (0.09, 0.67) and 0.64 (0.42, 0.98)), respectively compared to a baseline of unimproved drinking water; sanitation interventions by 25% (RR = 0.75 (0.63, 0.88)) with evidence for greater reductions when high sanitation coverage is reached; and interventions promoting handwashing with soap by 30% (RR = 0.70 (0.64, 0.77)) vs. no intervention. Results of the analysis of sanitation and hygiene interventions are sensitive to certain differences in study methods and conditions. Correcting for non-blinding would reduce the associations with diarrhoea to some extent. CONCLUSIONS: Although evidence is limited, results suggest that household connections of water supply and higher levels of community coverage for sanitation appear particularly impactful which is in line with targets of the Sustainable Development Goals.

Data integration for the assessment of population exposure to ambient air pollution for global burden of disease assessment

Abstract: Air pollution is a leading global disease risk factor. Tracking progress (e.g., for Sustainable Development Goals) requires accurate, spatially resolved, routinely updated exposure estimates. A Bayesian hierarchical model was developed to estimate annual average fine particle (PM2.5) concentrations at 0.1° × 0.1° spatial resolution globally for 2010–2016. The model incorporated spatially varying relationships between 6003 ground measurements from 117 countries, satellite-based estimates, and other predictors. Model coefficients indicated larger contributions from satellite-based estimates in countries with low monitor density. Within and out-of-sample cross-validation indicated improved predictions of ground measurements compared to previous (Global Burden of Disease 2013) estimates (increased within-sample R2 from 0.64 to 0.91, reduced out-of-sample, global population-weighted root mean squared error from 23 μg/m3 to 12 μg/m3). In 2016, 95% of the world’s population lived in areas where ambient PM2.5 lev...

Data integration model for air quality: a hierarchical approach to the global estimation of exposures to ambient air pollution

Abstract: Summary Air pollution is a major risk factor for global health, with 3 million deaths annually being attributed to fine particulate matter ambient pollution (PM2.5). The primary source of information for estimating population exposures to air pollution has been measurements from ground monitoring networks but, although coverage is increasing, regions remain in which monitoring is limited. The data integration model for air quality supplements ground monitoring data with information from other sources, such as satellite retrievals of aerosol optical depth and chemical transport models. Set within a Bayesian hierarchical modelling framework, the model allows spatially varying relationships between ground measurements and other factors that estimate air quality. The model is used to estimate exposures, together with associated measures of uncertainty, on a high resolution grid covering the entire world from which it is estimated that 92% of the world's population reside in areas exceeding the World Health Organization's air quality guidelines.