1.CholeraDoc2.docx

WASH Deficits and Cholera Persistence in Sub-Saharan Africa 1

HLTH 625

The Role of Inadequate Water, Sanitation, and Hygiene (WASH)

Infrastructure in Sustaining Cholera Outbreaks in Sub-Saharan Africa

WASH Deficits and Cholera Persistence in Sub-Saharan Africa 2

Introduction

Insufficient clean water, poor sanitation and poor hygiene (WASH) systems in the region

make cholera a serious health challenge in Sub-Saharan Africa. According to Asantewaa et al.

(2024), despite global actions to control cholera, LMICs, particularly in Sub-Saharan Africa, are

still affected by frequent outbreaks and many deaths. Experts estimate that every year, the

Through this review, I will examine the research done by Asantewaa et al. (2024)

regarding how a lack of proper infrastructure for water, sanitation and hygiene supports the

growth of cholera outbreaks in Sub-Saharan Africa. The reason is to learn about changes in the

disease, its treatment and areas where the system is lacking by reading up-to-date studies.

Article Summary and Infectious Disease Epidemiological Background

Asantewaa et al. (2024) conducted a systematic review and meta-analysis of cholera

outbreaks in LMICs between 2010 and 2022, focusing on epidemiological characteristics, risk

factors, and response mechanisms. Lack of water supply, greater numbers of people living in the

city and the way cholera was handled, were considered the main reasons the epidemic didn’t end.

A number of recent events have shown that we should spend more energy on disaster planning,

WASH Deficits and Cholera Persistence in Sub-Saharan Africa 3

soaping and toilet facilities is the most recommended way to avoid getting cholera, says the

The major topics focus on teamwork, early observation to see signs of danger and ways

to be active members of their communities. Making improvements to water and sanitation and

investing more in clean water systems should be covered in cholera plans. It proves that not

cholera, with countries like Nigeria, the Democratic Republic of Congo, and Mozambique

frequently experiencing large-scale outbreaks (Ahmed et al., 2024).

Climate change, people being displaced and poor city housing seem to be increasing

disaster risks. According to Kyeng et al. (2024), cholera surveillance systems in Africa are often

fragmented and under-resourced, making it difficult to predict or contain outbreaks. The disease's

impact is most severe in slums and refugee camps, where sanitation is minimal and access to

clean water is scarce. In case cholera breaks out, businesses may close, students stay at home and

the healthcare system becomes very busy.

Best Practices or Standard of Care

Processes for water, sanitation and hygiene are required in Sub-Saharan Africa to face

cases of cholera. Part of best practices is providing drinking water that is safe, constructing toilet

WASH Deficits and Cholera Persistence in Sub-Saharan Africa 4

facilities and recommending clean hygiene habits (Sikder et al., 2023). Bringing WASH into

Communities at risk of cholera greatly benefit from the use of oral cholera vaccines (OCVs).

According to Asantewaa et al. (2024), both emergency steps and ongoing sustainable efforts are

highlighted how neglect and underreporting of cholera outbreaks in Sub-Saharan Africa have

masked the urgency of investing in WASH systems. Both a poor infrastructure and weak

leadership, as the studies show, stop progress in tackling recurring epidemics.

surveillance can inhibit outbreaks which is generally overlooked. It points out that, if monitoring

is lacking, WASH actions might happen when the outbreak has already started.

Sikder et al. (2023) offer a more focused investigation into the environmental aspects of

cholera, revealing the direct correlation between poor sanitation, contaminated water sources,

WASH Deficits and Cholera Persistence in Sub-Saharan Africa 5

and disease prevalence. Research supports that Asantewaa was correct: Water, sanitation and

In contrast, Okesanya et al. (2024) provide a broader view of WASH, linking it to

sustainable development goals (SDGs) and gender equity. They connect WASH to cholera and

then they discuss ways that social-political issues influence the situation and stress the need to

They all agree WASH infrastructure has to improve, but they each assign varying

Asantewaa et al. (2024) present a comprehensive review supported by strong statistical

analysis and broad geographical coverage. One of the study’s main strengths is its inclusion of

country contexts. The article could benefit from more detailed case studies and actionable steps

for policymakers.

Additionally, while the meta-analysis is methodologically sound, the review depends

should bring WASH and policy changes together.

Conclusion

WASH Deficits and Cholera Persistence in Sub-Saharan Africa 6

Since water, sanitation and hygiene systems are not strong in the region, Sub-Saharan

for understanding the interconnectedness of sanitation, water access, and disease transmission.

For these reasons, many experts think we should use broad WASH approaches, better

Ensuring that community cooperation, strong rules and properly constructed infrastructure are a

priority is important in public health.

WASH Deficits and Cholera Persistence in Sub-Saharan Africa 7

References

1. Asantewaa AA, Odoom A, Donkor ES. Cholera outbreaks in low- and middle-income

countries in the last decade: a systematic review and meta-analysis. Microorganisms.

2024;12(12):2504. doi:10.3390/microorganisms12122504

2. Kyeng M, Pokhariyal G, Fongwen NT, Kivuti-Bitok L. Evaluation of cholera

surveillance systems in Africa: a systematic review. Front Epidemiol. 2024;4:1353826.

doi:10.3389/fepid.2024.1353826

4. Sikder M, Deshpande A, Hegde ST, et al. Water, sanitation, and cholera in Sub-Saharan

Africa. Environ Sci Technol. 2023;57(28):10185–10192.