Africa Water, Sanitation & Hygiene December 2018 Vol.13 No.6 | Page 26

Hygiene
To beat cholera, what is most needed is a reliable drinking water supply
By Florent Bédécarrats,
positive, the effectiveness of these
vaccines can be limited and short-
lived.
To date though there has been
limited rigorous research to evaluate
the effectiveness of investment in
drinking water supply infrastructure
to prevent cholera. There are two
reasons behind this: on the one
hand, the cholera disease burden is
concentrated in low income settings,
many of which are affected by
political instability, where building and
maintaining largescale public health
infrastructure is challenging.
On the other hand, public health
research increasingly values
experimental trials which require a
random allocation of treatment and
control groups. Whilst pills or awareness-raising sessions
can be randomly allocated with relative ease, doing this
with piped water connections presents various logistical
and ethical challenges. At a time when the evidence-
based policy paradigm reigns supreme (requiring that
public investment decisions be founded upon high quality
scientific evidence), these challenges may discourage
national and international investment in preventive
The city of Uvira, in the South Kivu province, study site for new research on cholera. Credit:
MONUSCO Photos / Flickr, CC BY-SA
I
n fighting cholera, the international community
usually favours responsive actions which have limited
and short-term effectiveness. Such actions are often
mobilised in responses to sudden epidemics, such as those
in Yemen and Zimbabwe. However, there is a profound
lack of evidence for how longer-term interventions, which
are usually harder to achieve, can be delivered effectively.
New research addressing this gap is currently under way in
the city of Uvira, South Kivu, DRC, to provide evidence
for improving the supply of safe drinking
water as a public health priority.
A critical issue in guiding the public
fight against cholera
According to the World Health
Organization (WHO), diarrhoeal diseases
relating to unsafe water, sanitation and
hygiene cause over 1,000 deaths a day
in Africa. And, every year, cholera alone
accounts for the deaths of 100,000 to
120,000 people.
Yet, the debate as to what is the most
efficient way to prevent and control
cholera persists. Some favour a focus on
rapid short-term responses, where the
cost of interventions is relatively low –
home chlorination/filtration kits, the distribution of small
quantities of water intended exclusively for drinking,
raising hygiene awareness, etc. Moreover, oral cholera
vaccines (OCV) are increasingly presented as a priority.
There are many new OCV studies that have attracted
substantial attention; but, while the findings are generally
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Africa Water, Sanitation & Hygiene • December 2018
Uvira - RDC. Credit: Isabelle Serro Photography - Fondation Veolia
actions as we lack strong scientific evaluations of their
effectiveness.
Changes in attitude are evident. The humanitarian sector
is increasingly committed to the urgency-reconstruction-
development continuum. One example in DRC is the