Evaluation of Household Water Treatment Technologies for Cholera Eradication in Sub-Saharan Africa: Epidemiological and Economic Perspectives

Abstract

Cholera has been a global pandemic in past centuries, and its persistent emergence and spread pose a significant public health challenge globally. Despite efforts to contain the disease, recurrent cholera outbreaks in sub-Saharan Africa remain a major health threat. This has attracted substantial research interest, raising questions about the effectiveness of prevention and control methods of cholera spread in sub-Saharan Africa. Addressing this health challenge by adopting a sustainable, convenient, and cost-effective intervention will improve the health, well-being, and productivity of vulnerable populations in sub-Saharan Africa. Household-level solutions, which are characterized by relatively low-cost and independence from potentially insufficient public water supply infrastructure were examined to determine their effectiveness in reducing the incidence of cholera if widely adopted across the continent. We perform a mixed-methods retrospective analysis on the Cholera epidemic data obtained from 2010 to 2016 in sub-Saharan Africa. Using an empirical epidemiological model, we estimate the performance efficacy of a suite of household water treatment (HWT) technologies. We also develop economic estimations to perform benefit–cost analyses to determine the cost effectiveness, convenience of use and durability of these products. We find that—if universally adopted—the HWT technologies evaluated here offer comparable and effective microbiological potential for eradicating cholera disease in sub-Saharan Africa but are potentially not affordable for low-income households that reside in cholera hotspots. As such, household subsidies are necessary in lowering barriers to economic access to these products. This finding provides substantial insights on the efficacy and affordability of these household water treatment technologies—insights which can inform stakeholder decisions on the applicability of this intervention in eradicating cholera.