Journal of Korean Medical Science

Korean Acad Medical Sciences (대한의학회)
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Burden of Disease Attributable to Inadequate Drinking Water, Sanitation, and Hygiene in Korea

  • Kim, Jong-Hun (Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine) ;
  • Cheong, Hae-Kwan (Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine) ;
  • Jeon, Byoung-Hak (Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine)
  • Received : 2017.11.07
  • Accepted : 2018.08.09
  • Published : 2018.11.12
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Abstract

Background: Diarrheal and intestinal infectious disease caused by inadequate drinking water, sanitation, and hygiene (WASH) is not only a great concern in developing countries but also a problem in low-income populations and rural areas in developed countries. In this study, we assessed the exposure to inadequate WASH in Korea and estimated the burden of disease attributable to inadequate WASH. Methods: We used observational data on water supply, drinking water, sewage treatment rate, and hand washing to assess inadequate WASH conditions in Korea, and estimated the level of exposure in the entire population. The disease burden was estimated by applying the cause of death data from death registry and the morbidity data from the national health insurance to the population attributable fraction (PAF) for the disease caused by inappropriate WASH. Results: In 2013, 1.4% of the population were exposed to inadequate drinking water, and 1.0% were living in areas where sewerage was not connected. The frequency of handwashing with soap after contact with excreta was 23.5%. The PAF due to inadequate WASH as a cluster of risk factors was 0.353 (95% confidence interval [CI], 0.275-0.417), among which over 90% were attributable to hand hygiene factors that were significantly worse than those in American and European high-income countries. Conclusion: The level of hand hygiene in Korea has yet to be improved to the extent that it shows a significant difference compared to other high-income countries. Therefore, improving the current situation in Korea requires a continuous hand washing campaign and a program aimed at all people. In addition, continuous policy intervention for improvement of sewage treatment facilities in rural areas is required, and water quality control monitoring should be continuously carried out.

Keywords

Acknowledgement

Supported by : Korea Ministry of Environment

References

  1. United Nations Development Programme. UNDP support to the implementation of the sustainable development goals. http://www.undp.org/content/undp/en/home/librarypage/sustainable-development-goals/undp-support-to-the-implementation-of-the-2030-agenda/. Updated 2016. Accessed April 4, 2017.
  2. Hunter PR, MacDonald AM, Carter RC. Water supply and health. PLoS Med 2010;7(11):e1000361. https://doi.org/10.1371/journal.pmed.1000361
  3. Mara D, Lane J, Scott B, Trouba D. Sanitation and health. PLoS Med 2010;7(11):e1000363. https://doi.org/10.1371/journal.pmed.1000363
  4. Wolf J, Pruss-Ustun A, Cumming O, Bartram J, Bonjour S, Cairncross S, et al. Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: systematic review and meta-regression. Trop Med Int Health 2014;19(8):928-42. https://doi.org/10.1111/tmi.12331
  5. Hsu A, Zomer A. Environmental performance index. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118445112.stat03789.pub2. Updated 2016. Accessed April 4, 2017.
  6. Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins JP, Wolf J, et al. Hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Trop Med Int Health 2014;19(8):906-16. https://doi.org/10.1111/tmi.12339
  7. World Health Organization. Preventing Disease through Healthy Environments: a Global Assessment of the Burden of Disease from Environmental Risks. Geneva: World Health Organization; 2016.
  8. GBD compare. http://vizhub.healthdata.org/gbd-compare/. Updated 2016. Accessed March 29, 2017.
  9. Pruss-Ustun A, Bartram J, Clasen T, Colford JM Jr, Cumming O, Curtis V, et al. Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Trop Med Int Health 2014;19(8):894-905. https://doi.org/10.1111/tmi.12329
  10. Sewage treatment statistics. http://kosis.kr/statisticsList/statisticsList_01List.jsp?vwcd=MT_ZTITLE&parentId=E#SubCont. Updated 2016. Accessed April 5, 2017.
  11. Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;386(10010):2287-323. https://doi.org/10.1016/S0140-6736(15)00128-2
  12. Clasen T, Pruss-Ustun A, Mathers CD, Cumming O, Cairncross S, Colford JM Jr. Estimating the impact of unsafe water, sanitation and hygiene on the global burden of disease: evolving and alternative methods. Trop Med Int Health 2014;19(8):884-93. https://doi.org/10.1111/tmi.12330
  13. World Health Organization. WHO Methods and Data Sources for Global Burden of Disease Estimates 2000-2011. Geneva: World Health Organization; 2013.
  14. Usage of drinking water. http://kosis.kr/statisticsList/statisticsList_01List.jsp?vwcd=MT_ZTITLE&parentId=E#SubCont. Updated 2016. Accessed April 5, 2017.
  15. Soil and groundwater information system. http://sgis.nier.go.kr/sgis. Updated 2016. Accessed April 5, 2017.
  16. Lee MS, Hong SJ, Kim YT. Handwashing with soap and national handwashing projects in Korea: focus on the National Handwashing Survey, 2006-2014. Epidemiol Health 2015;37:e2015039. https://doi.org/10.4178/epih/e2015039
  17. Yu J, Wang C, Shin I, Kim D, Park K. Analysis of waterborne pathogenic bacteria among total coliform positive samples in the groundwater of Chungcheongnam-do province, Korea. J Environ Health Sci 2016;42(3):189-95.
  18. Sahoo PK, Kim K, Powell M. Managing groundwater nitrate contamination from livestock farms: implication for nitrate management guidelines. Curr Pollution Rep 2016;2(3):178-87. https://doi.org/10.1007/s40726-016-0033-5
  19. Wen Y, Schoups G, van de Giesen N. Organic pollution of rivers: combined threats of urbanization, livestock farming and global climate change. Sci Rep 2017;7(1):43289. https://doi.org/10.1038/srep43289
  20. 2013 sewage statistics. http://www.me.go.kr/home/web/policy_data/read.do?menuId=10264&seq=6564#. Updated 2015. Accessed April 12, 2017.
  21. Lee GC, Jheong WH, Jung GS, Oh SA, Kim MJ, Rhee OJ, et al. Detection and molecular characterization of human noroviruses in Korean groundwater between 2008 and 2010. Food Environ Virol 2012;4(3):115-23. https://doi.org/10.1007/s12560-012-9084-y
  22. Kim JH, Lee DH, Joo Y, Zoh KD, Ko G, Kang JH. Identification of environmental determinants for spatio-temporal patterns of norovirus outbreaks in Korea using a geographic information system and binary response models. Sci Total Environ 2016;569-570:291-9. https://doi.org/10.1016/j.scitotenv.2016.06.144
  23. Park SH, Kim EJ, Lee JH, Choi SS, Kim MS, Jung SS, et al. Molecular characterization of hepatitis A virus isolated from acute gastroenteritis patients in the Seoul region of Korea. Eur J Clin Microbiol Infect Dis 2009;28(10):1177-82. https://doi.org/10.1007/s10096-009-0760-2
  24. Cheong HK, Park SK, Ki M, Lee K. Six year national trend of childhood aseptic meningitis incidence in Korea, 1996-2001. Korean J Epidemiol 2008;30(2):252-62. https://doi.org/10.4178/kje.2008.30.2.252
  25. Park SK, Cheong HK, Ki M, Son YM, Kim H. Assessment of the availability of health insurance data for epidemiologic study of childhood aseptic meningitis. Korean J Prev Med 2003;36(4):349-58.
  26. Lee YA, Oh SH, Hong SJ, Kim YH, Moon HN, Hong CY. Hand, foot and mouth disease associated with the aseptic meningitis in Seoul, 1990. J Korean Pediatr Soc 1993;36(6):842-9.
  27. Murphy HM, Pintar KD, McBean EA, Thomas MK. A systematic review of waterborne disease burden methodologies from developed countries. J Water Health 2014;12(4):634-55. https://doi.org/10.2166/wh.2014.049
  28. Norman G, Pedley S, Takkouche B. Effects of sewerage on diarrhoea and enteric infections: a systematic review and meta-analysis. Lancet Infect Dis 2010;10(8):536-44. https://doi.org/10.1016/S1473-3099(10)70123-7
  29. Aiello AE, Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health 2008;98(8):1372-81. https://doi.org/10.2105/AJPH.2007.124610
  30. Levy K, Klein M, Sarnat SE, Panwhar S, Huttinger A, Tolbert P, et al. Refined assessment of associations between drinking water residence time and emergency department visits for gastrointestinal illness in Metro Atlanta, Georgia. J Water Health 2016;14(4):672-81. https://doi.org/10.2166/wh.2016.178
  31. Tinker SC, Moe CL, Klein M, Flanders WD, Uber J, Amirtharajah A, et al. Drinking water residence time in distribution networks and emergency department visits for gastrointestinal illness in Metro Atlanta, Georgia. J Water Health 2009;7(2):332-43. https://doi.org/10.2166/wh.2009.022
  32. Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis 2003;3(5):275-81. https://doi.org/10.1016/S1473-3099(03)00606-6
  33. Roberts L, Jorm L, Patel M, Smith W, Douglas RM, McGilchrist C. Effect of infection control measures on the frequency of diarrheal episodes in child care: a randomized, controlled trial. Pediatrics 2000;105(4 Pt 1):743-6. https://doi.org/10.1542/peds.105.4.743
  34. Black RE, Dykes AC, Anderson KE, Wells JG, Sinclair SP, Gary GW Jr, et al. Handwashing to prevent diarrhea in day-care centers. Am J Epidemiol 1981;113(4):445-51. https://doi.org/10.1093/oxfordjournals.aje.a113112
  35. Hunter PR, Pond K, Jagals P, Cameron J. An assessment of the costs and benefits of interventions aimed at improving rural community water supplies in developed countries. Sci Total Environ 2009;407(12):3681-5. https://doi.org/10.1016/j.scitotenv.2009.03.013

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