Study On Burden Of Diarrheal Diseases And Cost-benefit Analysis Due To Water Supply And Sanitation Facilities In Typical Rural Areas

Diarrheal diseases are identified as one of the most serious global public health problems by the World Health Organization. Diarrheal diseases are an important cause of morbidity and mortality in low- and middle-income countries, resulting in an annually 4.9‰mortality rate of children under five years of age in these regions. Unsafe water, short of sanitation and unhealthy practices are important risk factors leading to diarrhea and other diseases. Statistically about 94% of the diarrheal burdens were attributable to those risk factors. Up to now, there are still a hundred of million people who don't have access to safe water and sanitation in our country, and the iarrheal diseases hence occurred play an important role in the illness table.ObjectivesTo know the burden of disease attributable to unsafe water and lack of sanitation in villages with water supply and latrines improvement, with only water supply improvement, with only latrines improvement, and with no water supply and latrine improvement, as well as local patients'hospital-admission behavior and economic burden. To know the use and cost of water supply and sanitation in local families and to evaluate the cost-benefit of water supply and sanitation facilities in preventing diarrheal diseases.Methods11256 villager samples were selected through multistage stratified random sampling in the survyed villages with water supply and latrines improvement, with only water supply improvement, with only latrines improvement, and with no water supply and latrine improvement, meanwhile 200 housholds have been visited for the questionnaire0 through the caparison of diarrheal incidences among different villagers group, the relationship between types of water supply and sanitation facilities and the diarrhea was to be identifed, and the disability adjusted life years (DALYs) has been used to indicate the burden of diarrheal diseases for survey population. For the cost and use of all types of water supply and latrines, a descriptive study was conducted and cost-benefit was analyzed.Results4.1 A total of 11256 person-times is covered in this survey, whose incidence rates was 0.59 episodes per person per year. The incidence rate for children under 5 years was 0.64 episodes per person per year, which is higher than the overall average. There was no statistically significance among gender, occupation and educational background of the people in diarrhea diseases occurrence.4.2 The incidence rates of diarrhea for people in the villages with both improved water supply and latrines, only improved water, only improved latrines and no improved water supply and latrine were 0.26,0.30,0.41,1.42 episodes per person per year respectively. Comparing to villages with improved water supply and latrines, the relative risk of people suffering from diarrhea in villages with only improved water supply, only improved latrine and no improved water and latrine ranges from 1.22 to 5.88.4.3 The DALYs of diarrhea for total population was 0.2638 per1000 per year The burden of disease for diarrhea in villages with improved water supply and latrine was the lowest at 0.163582/1000 persons per year, that for other three types villages was increasing in turn at 0.175098/1000 persons per year, 0.190448/1000 persons per year and 0.431856/1000 persons per year respectively. 4.4 The outpatient admission rate was 47.75%, while inpatient admission rate was 1.258%. The average duration of hospitalization was 1.37 days, and the times of diarrhea during 24 hours were 3.7.4.5 In the investigation, the average economic burden for patients being treated was RMBY 55.99±61.14, among which the economic burden of direct treatment was RMBY 24.83 per case, accounting for 44.35%, the economic burden of direct non-treatment was RMBY 22.86 per case, accounting for 40.82%, and the indirect economic burden was RMBY 9.73 per case, accounting for 17.38%. The average economic burden for patients not being treated was RMBY 10.24±27.56 per case, and the rest 3 types economic burden for no- treatment patients were RMBY 6.40 per case, RMBY 3.40 per case and RMBY 1.79 per case respectively. The economic burden of diarrhea for outpatients is RMBY 61.74±63.30 per case and the average economic burden for inpatients is RMBY 448.04±217.22 per case.4.6 The average cost for villages with improved water supply and latrine were 117.74 yuan per person per year, RMBY 96.98 per person per year for villages with only improved water supply, RMBY 151.32 per person per year for villages with only improved latrine and RMBY 132.53 per person per year for villages with no improved water supply and latrine. The investment cost for villages with improved water supply and latrine were RMBY 52.50 per person per year, and the recurrent cost was RMBY 65.15 per person year. Those for villages with only improved water supply were RMBY 30.26 per person per year and RMBY 66.73 per person per year. Those for villages with only improved latrine were RMBY 73.50 per person year and RMBY 77.82 per person per year. Those for villages with no improved water supply and latrine were RMBY 76.01 per person per year and RMBY 53.51 per person per year.4.7 Comparing with the water supply and latrine in villages with no improvement, the benefit-cost radio for villages with improved water supply and latrine was RMBY 2.17, and annual net equivalent benefit was RMBY 140.24. Those for villages with only improved water supply RMBY 2.45 and RMBY 158.07. Those for villages with only improved latrine were RMBY 1.43 and RMBY 77.58. In sensitive analysis, if discount rate and length of life is determined, different indexes used in calculating the economic burden of diseases may cause great difference in the benefit cost ratios.Conclusions5.1 The incidence rate diarrhea for survey population was 0.59 episodes per person per year, which was lower than the state average figure. Children under 5 years and the older were High-risk groups for diarrheal diseases.5.2. The major medical institutions for diarrhea patients to be treated are village clinics. The economic burden of diarrhea mainly lie on procurement of medicines.5.3. Whether having water supply and latrine improved is obviously related to the incidence of diarrheal diseases. Having water supply and latrine improvement can not only reduce the incidence of diarrheal diseases and the burden of diseases, but also gain higher benefit cost ratio. Water supply and latrine improvement can generate better benefits.