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

作者：Wanqi Wen, Wenxuan Zhao, Dashan Zheng, Jianheng Chen, Biao Kan, Haijian Zhou, B. Y. Pang, Hualiang Lin · 发表于：Global Transitions · 年份：2025 · DOI：10.1016/j.glt.2025.06.001 · 被引用次数：9 · 研究领域：Vibrio bacteria research studies、Child Nutrition and Water Access、COVID-19 epidemiological studies

Introduction The United Nations Sustainable Development Goals (UN SDG) 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). We aimed to assess the attributable burden of WASH on cholera under the UN SDG framework to inform global control efforts. Methods We extracted cholera-related information along with socioeconomic, geographical, and climate data across 89 LMICs from 2000 to 2017. Genome data from Enterobase and World Health Organization (WHO) weekly reports, were utilized to identify cholera occurrence. A modified Poisson generalized additive mixed model (GAMM) was employed to investigate the impact of WASH access on cholera, and the attributable burden and prevention fraction were further estimated. Results Statistically significant protective effects against cholera were observed for improved WASH facilities (e.g., piped water: prevalence ratio, PR=0.88, 95% CI: 0.85-0.91), while harmful effects were noted for unimproved facilities (e.g., open defecation: PR=1.09, 95% CI: 1.06-1.12). Regional disparities in WASH access further contributed to unequal cholera burden. In Sub-Saharan Africa, 25.77% of cholera occurrences were attributed to the high proportion of unimproved drinking water, much higher than 9.09% in Northern Africa and Western Asia. Achieving universal access to improved sanitation could reduce cholera risk by 32.98% in Sub-Sa...