Water and sanitation access shapes cholera burden in low- and middle-income countries

The United Nations Sustainable Development Goals (UNSDG) include targets for safe drinking water, sanitation, and hygiene (WASH), which are critical in preventing cholera, a persistent health threat in low- and middle-income countries (LMICs). The Global Task Force on Cholera Control (GTFCC) launched a global strategy titled Ending Cholera: A Global Roadmap to 2030, which aims to reduce cholera-related deaths by 90% and eliminate cholera in up to 20 countries by 2030. However, the effect of disparities in WASH access on the unequal cholera burden across geographic regions remains poorly understood.

In a new study published in the KeAi journal Global Transitions, a team of Chinese researchers evaluated the impact of WASH access on cholera and the unequal burden across 89 low- and middle-income countries from 2000 to 2017 under the UNSDG framework.

“Safe WASH are the only long-term and sustainable solutions to effective prevention and control of cholera,” shares first author of the study, Wanqi Wen from Sun Yat-sen University. “Evaluating the impact and attributable burden of WASH on cholera can help cholera-affected areas formulate targeted control strategies tailored to the specific conditions of each country, as outlined in the GTFCC’s Global Roadmap.”

Notably, the proportions of piped water and sewer/septic sanitation negatively relate to cholera, while harmful effects on cholera were noted for proportions of surface water and open defecation. Corresponding author Hualiang Lin, also from Sun Yat-sen University, emphasized that this research highlights the need for maintaining and increasing access to safe WASH in cholera-affected countries.

“Regional disparities in WASH access further contributed to unequal cholera burden. In Sub-Saharan Africa, 25.77 % of cholera were attributed to the high proportion of unimproved drinking water, much higher than 9.09 % in Northern Africa and Western Asia,” explains Lin. “Our findings offer comprehensive information for implementing targeted, local-level control approaches to end cholera globally.”

The authors also emphasize that their estimates of WASH-related prevention fractions offer actionable reference points for countries implementing UN SDG 6 (clean water and sanitation) and the GTFCC’s 2030 Roadmap. “Achieving universal access to improved sanitation could reduce cholera risk by 32.98 % in Sub-Saharan Africa, compared to 7.47 % in Central and Southern Asia,” says Lin. “Scaling up safe WASH access is not just a development goal—it’s a core requirement for eliminating cholera.”

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Contact Author: Hualiang Lin, School of Public Health, Sun Yat-sen University, linhualiang@mail.sysu.edu.cn

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