The burden of disease

In 2002, it had been estimated that the disease burden, caused unnecessarily from water, sanitation and hygiene, accounted for  4% of deaths worldwide, and 5.7% of all diseases worldwide (Prüss et al, 2002). Despite these figures appearing to be low numbers in the grand scheme of things, these are all preventable deaths and diseases if the appropriate water and sanitation requirements are achieved. The World Health Organisation estimates that improvements in sanitation and water provisions could prevent 9.1% of the total burden of disease worldwide, which equates to approximately 6.3% of deaths (Clasen, 2011).

The first half of this blog will look at a few diseases caused by inadequate water and sanitation facilities. The second half will look at why these diseases are such a burden to sub-Saharan Africa.

Common diseases

This section of the blog will briefly highlight a few of the diseases affecting sub-Saharan Africa today as a result of inadequate water and sanitation facilities. Many of these diseases come with very simple interventions, such as frequent hand-washing, however, without the appropriate water and sanitation facilities, these diseases continue to plague countries in sub-Saharan Africa.

Trachoma:

Trachoma is an infectious disease which commonly ends in blindness; figure 1 illustrates the lifecycle of the disease. The incidence of trachoma can be reduced dramatically when access to water is increased. In order to reduce the incidence of trachoma, hygiene needs to be improved. Face washing and access to a latrine have been linked to reducing rates of trachoma. A study of Ethiopian households revealed that having a 'lack of access to a latrine increased the risk of having active trachoma by 4.36-fold but perhaps more important, absence of a clean face...increased the odds of having trachoma by 7.59-fold' (Cook and Mariotti, 2011:181). The International Trachoma Initiative implemented the SAFE initiative (figure 2), highlighting the steps needed to prevent trachoma, two steps involved the use of water.

'lack of access to a latrine increased the risk of having active trachoma by 4.36-fold but perhaps more important, absence of a clean face...increased the odds of having trachoma by 7.59-fold'

Figure 1: The Life Cycle of Trachoma

Source: https://healthfoxx.com/trachoma-definition-symptoms-treatment-pictures/ 

Figure 2: International Trachoma SAFE initiative

Source: http://www.globalcontagions.com/2017/02/ntds-trachoma-blindness-caused-by-chlamydia-bacteria-yes-that-chlamydia/

Hookworm:

Hookworms are the result of open defecation due to a lack of adequate sanitation. There are three ways in which the incidence of hookworm can be greatly reduced, first by providing adequate sanitation facilities to reduce open defecation. Secondly, the provision of a sufficient water source to enable the washing of food. Thirdly, behavioural changes are required, often it is children who practice open defecation, changing behaviour towards open-defecation will reduce the incidence of hookworm (Blackburn and Barry, 2011). Unfortunately, though, it is more cost effective to provide deworming treatment per person than a latrine, as proven by studies in Vietnam (Blackburn and Barry, 2011).

Diarrhoea:

Diarrhoea is a leading cause of death globally. Diarrhoea can be prevented by disposing of waste appropriately, improving water quality, improving personal hygiene and washing food before consumption (Zarocostas, 2008). The World Health Organisation estimates 88% of all diarrhoeal deaths are a result of inadequate water and sanitation facilities (Fitzwater et al, 2011). However, if water is to be treated at the household level, 39% of diarrhoeal cases would be reduced, further reductions would take place with the education of handwashing and appropriate waste disposal (Fitzwater et al, 2011).

The burden of disease on sub-Saharan Africa

The diseases described above and many more can easily be prevented through the provision of adequate water and sanitation, for example, piped water and latrines. However, for many, this is not reality. These diseases can have great impacts on the lives of the infected and are often blamed for restricting development, I have highlighted below the three areas which I think are the most important.

The burden on the extended family:

One perhaps overlooked impact is the strain these diseases place on the extended family. If the parents die, as a result of water-related diseases, this can leave the extended family, such as grandparents, with the role of raising the children. Taking on this role comes with a huge financial burden, with many extended families being often unable to financially assist the orphans, placing the extended family at risk of falling into poverty, or the children being at a high risk of being placed in an orphanage, all of which are poor outcomes for an easily preventable death.

Lost education:

Many children who fall ill due to these preventable diseases face missing days, weeks or even months of school. This can have detrimental impacts on their future. The less education a child receives, the less prosperous their future is likely to be, they are likely to be unable to reach their full potential in the job market and therefore maintain in the vicious cycle of poverty, increasing attendance of school drastically reduces the incidence of poverty within a country (Ayiro, 2012), and with the introduction of adequate water and sanitation facilities the issue of missed school days can be reduced.

Fall in productivity:

This can be at both the local and the national scale.  Locally families are impacted when members of the family have to take time off work due to illness, this can lead to a reduction of income leaving families finding it difficult to make ends meet, it also reduces families financial saving potential (Boutayeb, 2010). Whereas on the national scale the higher the incidence of disease, the lower the rate of development, for example, the more a person works this increases their income (something which would not happen if they are regularly ill). An increase in income leads to an increase in consumer spending, this then drives the economy leading to growth in GDP and development (World Health Organisation, 2009).

Conclusion

The diseases discussed in this blog and more can easily be eradicated, or, casualties greatly reduced if the provision of adequate sanitation and water is implemented across sub-Saharan Africa. Next week’s blog will be looking at how a successful intervention programme has almost completely eradicated the Guinea Worm Disease in sub-Saharan Africa.