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

Each year, millions of children in developing countries fall sick and die from diseases caused by polluted air, contaminated water and soil, and poor hygiene behavior. Repeated infectious also contribute to malnutrition in children, and subsequently impacts future learning and productivity. This book analyzes the linkages between malnutrition and environmental health, and assesses the burden of disease on young children, and its economic costs. 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 This book examines the links between environmental health risks and malnutrition; analyzes new data for the environmental health burden of disease that relates to children under five; and highlights how environmental health interventions are being created in developing countries through a variety of health, infrastructure, and environmental programs. It discusses epidemiology, economics, and experiences; as well as how environmental health supplements other child survival strategies, estimating the environmental health burden and costs at the country level, and approaches to environmental health