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Objective: To assess the impact of inadequate water and sanitation on diarrhoeal disease in low- and middle-income settings.Methods: The search strategy used Cochrane Library, MEDLINE & PubMed, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low- and middle-income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified Ottawa-Newcastle scale. Study results were combined using meta-analysis and meta-regression to derive overall and intervention-specific risk estimates.Results: Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12,515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high-quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions.Conclusions: The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented. [ABSTRACT FROM AUTHOR]

Objective To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases. Methods For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years ( DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. Results In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group. Conclusions This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene. [ABSTRACT FROM AUTHOR]

Objective To assess the impact of inadequate water and sanitation on diarrhoeal disease in low- and middle-income settings. Methods The search strategy used Cochrane Library, MEDLINE & Pub Med, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low- and middle-income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified Ottawa- Newcastle scale. Study results were combined using meta-analysis and meta-regression to derive overall and intervention-specific risk estimates. Results Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12 515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high-quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions. Conclusions The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented. [ABSTRACT FROM AUTHOR]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The global burden of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infection due to percutaneous injuries among health care workers (HCWs) is estimated., Methods: The incidence of infections attributable to percutaneous injuries in 14 geographical regions on the basis of the probability of injury, the prevalence of infection, the susceptibility of the worker, and the percutaneous transmission potential are modeled. The model also provides the attributable fractions of infection in HCWs., Results: Overall, 16,000 HCV, 66,000 HBV, and 1,000 HIV infections may have occurred in the year 2000 worldwide among HCWs due to their occupational exposure to percutaneous injuries. The fraction of infections with HCV, HBV, and HIV in HCWs attributable to occupational exposure to percutaneous injuries fraction reaches 39%, 37%, and 4.4% respectively., Conclusions: Occupational exposures to percutaneous injuries are substantial source of infections with bloodborne pathogens among health-care workers (HCWs). These infections are highly preventable and should be eliminated., (2005 Wiley-Liss, Inc.)

Background: Occupational non-malignant respiratory disease arises from exposure of workers to airborne agents, mostly particulate or dusts. We describe the worldwide mortality and morbidity from asthma, chronic obstructive pulmonary disease (COPD), and pneumoconioses arising from these occupational exposure and focus on cases reported in the year 2000., Methods: The proportions of workers exposed to the agents, and their levels of exposure, were estimated using workforce data and the CAREX (CARcinogen EXposure) database. These were combined with relative risk measures (for asthma and COPD) or absolute risk measures (for the pneumoconioses) to develop estimates of deaths, disability-adjusted life years (DALYs) and attributable fraction (for asthma and COPD)., Results: There were an estimated 386,000 deaths (asthma: 38,000; COPD: 318,000; pneumoconioses: 30,000) and nearly 6.6 million DALYS (asthma: 1,621,000; COPD: 3,733,000, pneumoconioses: 1,288,000) due to exposure to occupational airborne particulates., Conclusions: Occupational airborne particulates are an important cause of death and disability worldwide., (2005 Wiley-Liss, Inc.)

Background: Around the globe, work has a heavy impact on health. To better advise policy makers, we assessed the global burden of disease and injury due to selected occupational hazards. This article presents an overview, and describes the methodology employed in the companion studies., Methods: Using the World Health Organization (WHO) Comparative Risk Assessment methodology, we applied relative risk measures to the proportions of the population exposed to selected occupational hazards to estimate attributable fractions, deaths, and disability-adjusted life years (DALYs). Numerous occupational risk factors had to be excluded due to inadequate global data., Results: In 2000, the selected risk factors were responsible worldwide for 37% of back pain, 16% of hearing loss, 13% of chronic obstructive pulmonary disease (COPD), 11% of asthma, 8% of injuries, 9% of lung cancer, and 2% of leukemia. These risks at work caused 850,000 deaths worldwide and resulted in the loss of about 24 million years of healthy life. Needlesticks accounted for about 40% of Hepatitis B and Hepatitis C infections and 4.4% of HIV infections in health care workers., Conclusions: Exposure to occupational hazards accounts for a significant proportion of the global burden of disease and injury, which could be substantially reduced through application of proven risk prevention strategies., (2005 Wiley-Liss, Inc.)

Background: The worldwide mortality and morbidity from lung cancer, leukemia, and malignant mesothelioma arising from occupational exposures to carcinogens are described. Cases reported in the year 2000 that resulted from relevant past and current exposures are assessed., Methods: The proportions of workers exposed to the carcinogens of interest, and their levels of exposure, were estimated using workforce data and the CAREX (CARcinogen EXposure) database. These were combined with relative risk measures (for lung cancer and leukemia) or absolute risk measures (for malignant mesothelioma) to develop estimates of deaths, disability-adjusted life years (DALYs) and attributable fraction (for lung cancer and leukemia)., Results: There were an estimated 152,000 deaths (lung cancer: 102,000; leukemia: 7,000; and malignant mesothelioma: 43,000) and nearly 1.6 million DALYS (lung cancer: 969,000; leukemia: 101,000; and malignant mesothelioma: 564,000) due to exposure to occupational carcinogens., Conclusions: Occupational carcinogens are an important cause of death and disability worldwide., (2005 Wiley-Liss, Inc.)