Unimproved water and sanitation: Reductions in prevalence, deaths, and DALYs in developing countries between 1980 and 2011

Abstract

<bold> Introduction</bold> Access to safe water and improved sanitation is a critical indicator of development and is directly associated with child health outcomes, particularly diarrheal morbidity and mortality. The methodology currently utilized by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP) for tracking progress toward achieving Millenium Development Goal 7c fails to address a substantial proportion of household survey options for water source and toilet facility type and uses an inflexible and outdated linear modeling strategy. <bold>Methods</bold> We empirically determine 14 additional classifications for household water source and sanitation facility to supplement those designated by the JMP and develop and implement an improved non-linear modeling technique that provides confidence intervals for country trends. We assess progress toward MDG 7c using these updated methods, then quantify the contribution of unimproved water and sanitation to deaths and DALYs in children under five. <bold>Findings</bold> Our improved approach allows for the systematic analysis of data from all households in censuses and surveys and results in trends that provide a measure of uncertainty and more accurately reflect rapid scale-ups in development in some countries. Of 137 developing countries, 69 and 71 are on track to meet MDG 7c for water and sanitation, respectively. Promising declines have occurred for deaths and DALYs attributable to unimproved water and unimproved sanitation, particularly in India and China, but the burden remains large.