Abstract
AbstractCholera is a significant health risk for low- and middle-income countries (LMIC), and the threat of outbreaks is likely to increase due to climate change. To keep up to date with the link between water quality and cholera, we conducted a systematic review and meta-analysis to update a previous review. We searched Embase, Web of Science and PubMed for literature published between 2016 and 2022. Search terms were consistent with the previous review. Study quality was assessed using Risk Of Bias In Non-randomized Studies - of Exposures (ROBINS-E). Exposures of water were categorized according to the WHO/UNICEF Joint Monitoring Program for Water Supply, Sanitation and Hygiene (JMP) and further divided by the service ladder. Odds ratios were extracted and pooled by performing random-effects meta-analysis. We identified 22 new eligible studies and analysed them together with the 45 studies included in the previous review. Analyses revealed higher odds of cholera when consuming sachet water (OR=1.69, 95% CI: 1.13 to 2.52), unimproved water (OR=2.91, 95% CI: 1.21 to 7.02), surface water (OR=3.40, 95% CI: 2.52 to 4.58), and untreated water (OR=2.51, 95% CI: 2.03 to 3.10). Meanwhile, treating water (OR=0.42, 95% CI: 0.27 to 0.65), by boiling (OR=0.38, 95% CI: 0.17 to 0.84) or chlorination (OR=0.37, 95% CI: 0.17 to 0.83), and drinking basic water (OR=0.44, 95% CI: 0.27 to 0.69) showed protection. Pooled estimates changed with updated evidence while qualitative insights on the protective or risk factors remain valid. Relatively low-cost methods like boiling or chlorinating water provide good protection comparable to providing basic water to the public.Systematic review registration: PROSPERO 2021 CRD42021271881
Publisher
Cold Spring Harbor Laboratory
Reference114 articles.
1. Epidemiology of cholera
2. World Health Organization. Disease Outbreak News; Cholera – Global situation. 2022 [30 December 2022]. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON426#:~:text=Current%20Situation&text=In%202021%2C%2023%20countries%20reported,have%20been%20reporting%20protracted%20outbreaks.
3. Cholera Outbreak in Yemen: Timeliness of Reporting and Response in the National Electronic Disease Early Warning System
4. World Health Organization. Cholera Annual Report 2020 Weekly Epidemiological Record. Geneva: World Health Organization, 2021 17 September 2021. Report No.: 37.
5. Cholera surveillance and estimation of burden of cholera