Environmental Health and Child Survival: Epidemiology, Economics, Experiences (Environment and Development Series)

CONTENTS......Page 6
Acknowledgments......Page 12
Abbreviations and Acronyms......Page 14
CHAPTER 1 Introduction......Page 16
Objectives......Page 19
A Primer on Environmental Health......Page 20
A Primer on Malnutrition......Page 21
Content and Organization......Page 22
PART I Epidemiology......Page 30
CHAPTER 2 Environmental Health, Malnutrition, and Child Health......Page 32
Tables 2.1 Water-Related Transmission Routes and Disease Outcome......Page 33
Figure 2.1 The F-Diagram: Transmission Routes for Infection......Page 34
Environmental Role in Early Childhood Health......Page 38
Averting Cognition and Learning Impacts......Page 43
Note......Page 45
CHAPTER 3 How Environmental Health Supplements Other Child Survival Strategies......Page 46
Figure 3.1 Range of Preventive Activities in Child Survival......Page 47
Adapting Environmental Management Programs......Page 53
Adjusting Infrastructure Strategies......Page 54
Notes......Page 58
PART II Economics......Page 60
CHAPTER 4 How Large Is the Environmental Health Burden?......Page 62
Burden of Disease......Page 63
Environmental Health Burdens......Page 66
Areas for Future Research......Page 73
Notes......Page 74
Existing Practice in Environmental Health Valuation......Page 76
Building New Estimates for Environmental Health Costs......Page 77
Case Studies of Ghana and Pakistan......Page 79
Results for Ghana and Pakistan......Page 81
Conclusion......Page 92
Tables 5.7 Annual Cost of Direct and Indirect Effect of Environmental Risk Factors in 2005......Page 94
Notes......Page 96
PART III Experiences......Page 98
CHAPTER 6 Approaches to Environmental Health......Page 100
History of Environmental Health......Page 101
Agenda Falling through the Cracks......Page 103
Environmental Health Experiences in Developing Countries......Page 105
Box 6.5 Vietnam’s Dengue Program......Page 112
Governance and Institutional Implications......Page 115
Institutional Requirements for Successful Environmental Health Governance......Page 119
Key Messages......Page 124
Note......Page 125
Contributions of This Report......Page 126
Next Steps......Page 128
Background......Page 132
Findings and Discussion......Page 133
Experimental Evidence from Deworming......Page 137
Conclusions......Page 138
Notes......Page 140
APPENDIX B: Review of Studies on Nutritional Status and Education......Page 156
Conclusions......Page 160
Note......Page 161
APPENDIX C: New Estimates for Burden of Disease from Water, Sanitation, and Hygiene......Page 162
Mortality......Page 166
Education......Page 175
Notes......Page 185
From Relative Risks to Attributable Fractions......Page 188
Dealing with Biased Estimates of Relative Risk......Page 191
Notes......Page 192
APPENDIX F: Monetary Valuation of the Cost of Environmental Health Risks......Page 194
Note......Page 196
References......Page 198
Index......Page 216
Box 1.1 What Is Environmental Health?......Page 17
Box 2.1 Impact of Diarrhea on Child Malnutrition: Evidence from Research......Page 37
Box 2.2 Overweight Mothers Carrying Underweight Children......Page 40
Box 4.1 Why 50 Percent? Supporting Evidence from Recent Cohort Studies......Page 65
Box 4.2 Revisiting the “Asian Enigma”......Page 69
Box 4.3 The Mills-Reincke Phenomenon......Page 71
Box 5.1 Basic Indicators for Ghana and Pakistan......Page 80
Box 5.2 Attributable Fractions and Burden of Disease When Multiple Risk Factors Are Present......Page 90
Box 5.3 How Policy-Makers Should Interpret These Results......Page 95
Box 6.1 Combating Disease through Improved Milk......Page 102
Box 6.2 Mexico: Multisectorality through a Diagonal Approach......Page 107
Box 6.3 Thailand’s National Nutrition Program......Page 108
Box 6.4 Ethiopia: The Toilet Revolution......Page 110
Box 6.6 Atrophy of Environmental Health Functions in India......Page 116
Box 6.7 Institutional Evolution of Environmental Health: The Case of Ethiopia......Page 117
Figure 2.2 Relationship between Nutrition and Infection......Page 35
Figure 2.3 Environmental Health Inputs and Health Outcomes in the Child’s Life Cycle......Page 39
Figure 2.4 The Window of Opportunity for Addressing Undernutrition......Page 42
Figure 4.1 The Health Effects of Environmental Risks Factors......Page 67
Figure 4.2 Water-Related (WSH plus WRM) Burden of Disease in Children under Five Attributable to Environmental Risk Factors by WHO Region, 2002......Page 68
Figure 4.3 Mills-Reincke Ratios for Subregions......Page 70
Figure 5.1 Cost of Environmental Health Risks......Page 78
Tables 5.4 Malnutrition-Attributable Fractions of Child Mortality......Page 85
Figure 5.3 Two-Week Diarrheal Prevalence Rate by Age and Underweight Status in Ghana and Pakistan......Page 86
Figure 5.4 Underweight Malnutrition Rates in Children with and without Diarrheal Infections in Ghana and Pakistan......Page 88
Tables 5.5 Environmentally Attributable Fractions and Child Mortality with Malnutrition-Mediated Effects......Page 89
Figure 5.6 Final Results of Ghana and Pakistan Case Studies......Page 93
Tables D.1 Causes of Death and Risk Factors Considered in this Study......Page 167
Figure D.2 Exposure Categories......Page 170
Tables D.6 Estimated Mortality in Children under Five from Environmental Risk Factors, Ghana......Page 174
Tables 1.1 Millennium Development Goals and Environmental Health......Page 18
Tables 1.2 Annual Cost of Direct and Indirect Impact of Environmental Risk Factors in 2005......Page 25
Tables 2.2 Impact of Infection on Nutritional Status......Page 36
Tables 3.1 Role of Environmental Health in Supplementing Health System Strategies......Page 48
Tables 4.1 Environmental Risk Factors and Related Diseases Included in the Comparative Risk Assessment......Page 64
Tables 5.2 Estimated Mortality in Under-Five Children from Environmental Risk Factors, 2005......Page 82
Tables 5.3 Malnutrition Rates in Children under the Age of Five......Page 83
Tables 5.6 Effects of Malnutrition on Education......Page 91
Tables A.1 Cohort Follow-up Studies Relating Infectious Disease and Nutritional Status of Children in Developing Countries......Page 141
Tables B.1 Studies of the Effects of Malnutrition on Educational Outcomes......Page 157
Tables C.1 Burden of Disease (in DALYs) in Children under Five Years Attributable to Water, Sanitation, and Hygiene, by World Health Organization Subregions, 2002......Page 163
Tables D.2 Estimating the Cost of Environmental Health Risks: Information Types and Sources......Page 169
Tables D.3 Relative Risks by Exposure Categories, Assuming Cox Hazard Model......Page 171
Tables D.4 Weight Gain Retardation Factors by Age and z-Score......Page 172
Tables D.5 Weight for Age in Children under Five: Current Rates and Estimated Rates in the Absence of Diarrheal Infections in Ghana......Page 173
Tables D.7 Estimated Annual Cost of Education Outcomes from Stunting and Share from Environmental Factors in Ghana......Page 176
Tables D.9 Height-for-Age Rates in Children under Five: Current Rates and Estimated Rates in the Absence of Diarrheal Infections in Ghana......Page 177
Tables D.10 Parameter Values Applied in Estimation of Income Losses......Page 180
Tables D.11 Income Distribution across Malnutrition Categories and Wealth Quintiles in Ghana......Page 182
Tables D.12 Annual Cost of Environmental Factors (Percentage of GDP in 2005), Using 3 Percent Discount Rate......Page 183
Tables D.13 Annual Cost of Environmental Factors (Percentage of GDP in 2005), Using 5 Percent Discount Rate......Page 184
Tables E.1 Environmental Risk Factors and Related Diseases Included in the WHO Comparative Risk Assessment......Page 189