Title

Investigation on the trend and burden of attributable diseases to community water supply and sanitation and analysis of their inequalities at subnational levels in Islamic Republic of Iran during 1990-2010

Principal Investigator

Dr. Reza Saeidi

Abstract

چکیده لاتین Having access to safe drinking water and sanitation is necessary to control communicable and non-communicable diseases and health promotion in the community. Provision of safe drinking water is directly connected to using sanitation facilities, so that lack of sanitation is resulted in the pollution of water resources and drinking water supply. The objective of this study was to determine the fraction of burden of attributable disease to water, sanitation and hygiene (WSH) and analysis of their inequalities between the provinces and between urban and rural communities of Iran in the period 1369-1389 (1990-2010). The required data were mostly extracted from general population and housing censuses conducted by Statistical Center of Iran. In the period, the sanitation coverage, in the whole country, urban and rural communities has steadily increased respectively from 93.14%, 95.88% and 88.88% in 1369 to 98.77%, 99.48% and 96.78% in 1389. During 1369-1389, the inequalities in access to improved sanitation among provinces and between urban and rural communities declined gradually. Study on access to safe drinking water showed that the parameter increased from 89.61% in 1369 to 96.38% in 1389, but in the middle years of 1375 to 1385, the access to safe drinking water has been almost unchanged, so the observed increase mainly occurred between 1369 to 1375 and 1385 to 1389. Survey on the status of urban and rural communities showed a different trend, where during the period, in rural communities access to safe drinking water steadily increased from 76.32% to 90.25% (an increase of 13.92% over 20 years), while in urban communities the parameter initially increased from 98.09% in 1369 to 98.92% 1375, then deceased to 95.92% in 1385 and finally reached to 98.70% in 1389 (an increase of 0.62% over 20 years). The reduced access to safe drinking water in the years 1375-1385 may be due to the conversion of some rural communities to urban communities in different provinces of the country. During 1369-1389, the inequalities in access to safe drinking water among provinces and between urban and rural communities were also reduced. Distribution of the population in exposure scenarios indicated that in the period 1369-1389, the attributable fraction of diarrheal diseases to WSH in the whole country, urban and rural communities has steadily declined respectively from 86.05% (equivalent of RR 7.17 on diarrheal diseases), 85.74% (equivalent of RR 7.01) and 86.44% (equivalent of RR 7.38) in 1369 to 81.79% (equivalent of RR 5.49), 79.47% (equivalent of RR 4.87) and 85.70% (equivalent of RR 6.99) in 1389. Estimated disease burden of intestinal nematode infections (ascariasis, trichuriasis and hookworm infection), schistosomiasis, trachoma and dracunculiasis should be fully attributed to WSH. The attributable fraction of malnutrition diseases to WSH is not depended to characteristic of community water supply and sanitation, in all of the cases the fraction is considered to be 50% of malnutrition in children under the age of 5 years, however, to estimate burden of disease attributable to WSH, the burden of infectious diseases originally intended as a direct consequence of WSH (including infectious diarrhea, schistosomiasis, intestinal nematodes, and trachoma and dracunculiasis) will be deducted from malnutrition diseases.

Year

2013