Assessment of water scarcity as a risk factor for cholera outbreaks

• Published in: The Science of the total environment Vol. 978; p. 179412
• Main Authors: Magers, Bailey, Usmani, Moiz, Brumfield, Kyle D., Huq, Anwar, Colwell, Rita R., Jutla, Antarpreet S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 25.05.2025
• Subjects: Cholera; Cholera - epidemiology; Climate; Disease Outbreaks; Drought; Droughts; dry environmental conditions; Ethiopia; etiological agents; human health; Humans; Kenya; Nigeria; odds ratio; rain; risk assessment; Risk Factors; Senegal; Temperature; Vibrio cholerae; water pollution; water shortages; Water Supply - statistics & numerical data; Kenya; Nigeria; Senegal; Ethiopia; Climate; Cholera; Drought; Vibrio cholerae
• ISSN: 0048-9697; 1879-1026; 1879-1026
• DOI: 10.1016/j.scitotenv.2025.179412

Increasing aridity and incidence of droughts pose a significant threat to human health, primarily in exacerbating water scarcity, and is projected to become more frequent and severe as a result of related environmental changes in many regions globally. Concomitantly, water scarcity will force populations to utilize potentially contaminated water sources, hence increasing exposure to waterborne diseases, notably cholera. Proliferation of Vibrio cholerae, causative agent of cholera, is driven by environmental factors. Notably, temperature and precipitation have been employed in providing predictive awareness of cholera, allowing early warning and mitigation. The impact of droughts on incidence and spread of cholera is less understood. This study aimed to quantify relationships among temperature, precipitation, and droughts as a basis for establishing the connection of environmental parameters and outbreaks of cholera. Thirteen cholera outbreaks between 2003 and 2023 in four African countries (Ethiopia, Kenya, Nigeria, and Senegal) were assessed using odds ratio and k-means clustering analysis. Cholera outbreaks were 3.07 (95 % CI: [0.95, 9.88]) times more likely when drought conditions (negative precipitation anomalies, positive temperature anomalies, and negative Standardized Precipitation-Evapotranspiration Index) were present, compared to their absence. When excess rainfall was also considered, the odds ratio increased to 3.50 (95 % CI: [1.03, 11.90]). Complementary evidence obtained using k-means clustering analysis supported the conclusion that outbreaks of cholera were common during drought conditions. Considering the last few decades with increased severity and frequency of droughts in cholera-impacted regions, climate projections indicate the threat of cholera outbreaks will continue, especially noting increasing reports of cholera globally. Hence, predictive intelligence systems for rapid risk assessment, with respect to climate, drought, and human health, are warranted. [Display omitted] •Cholera outbreaks due to drought is an under explored area in current research.•Most outbreaks studied occurred under a hydrological extreme scenario, like drought.•Cholera outbreaks were 3.50 times more likely under hydrological extreme conditions.•Hydrological extremes are predicted to become more frequent with climate change.•Future predictive models for cholera should incorporate drought as an indicator.