KATHMANDU,
Nepal – Despite significant national efforts to eliminate open defecation, a
new study suggests that Nepal’s fight against cholera is being undermined by
worsening water scarcity and a surprising decline in basic hygiene practices.
The study, titled "Cholera in Nepal: Examining
the Role of Environmental Factors in Disease Incidence and Mortality,"
was recently conducted by researchers Pradip Neupane and Mandawi Subedi. By
reviewing ten years of health data from 2013 to 2022, the researchers
identified a complex relationship between the environment and the persistence
of this deadly, yet preventable, disease.
The 2021 Wake-Up Call
For nearly a decade, cholera cases in Nepal remained relatively low and stable.
However, the study highlights a dramatic and "noticeable peak" in
2021, when the country saw a massive outbreak of approximately 1,600 cases and
7 recorded deaths. While the numbers dropped significantly in 2022, the sudden
spike served as a stark reminder that the bacteria Vibrio cholerae
remains a persistent threat in the region.
Success in the Fields, Gaps at the Tap
One of the most striking findings of the report is the contrast between
different types of sanitation progress. Nepal has seen "substantial
progress" in reducing open defecation, with national rates plummeting from
27% in 2013 to below 5% in 2022. Rural areas saw the most dramatic improvement,
falling from a 35% practice rate to just 5%.
However, the researchers found that other critical
factors are moving in the wrong direction. Access to limited drinking water
services—meaning water is either becoming scarcer or harder to access
daily—actually increased from 3% to 4.5% during the study period. Even more
concerning is the trend in basic hygiene; the percentage of the population
lacking handwashing facilities rose from 0.9% to 1.5% by 2022.
"This study shows that water scarcity, open
defecation, and handwashing practices are still prevalent in Nepal," the
authors noted, explaining that these factors accelerate the transmission of the
disease through the "fecal-oral route".
The Climate Change Factor
The report also points to rapid climate change as a major driver of shifting
disease patterns. Researchers warned that extreme weather events, such as
droughts that cause water shortages or floods that contaminate existing
supplies, are exposing vulnerable populations to new risks. The World Health
Organization has already recognized cholera as one of the primary health
threats linked to a changing climate.
A Call for Targeted Action
The Government of Nepal has not been idle. The study acknowledges ongoing
efforts like the Community Led Water Safe Planning (CLWSP) initiative, a
collaboration with UNICEF that certifies "Water Safe Communities"
based on strict sanitation and water quality standards. Furthermore, the
country has bolstered its surveillance, establishing a call center in 2021 and
utilizing media monitoring to catch outbreaks early.
Despite these programs, the researchers conclude that
as long as safe drinking water and basic personal hygiene remain out of reach
for a portion of the population, cholera will continue to claim
lives—particularly among children under five, for whom diarrheal disease is
already the second leading cause of death globally.
The findings suggest that for Nepal to truly become
cholera-free, the focus must shift from simply building toilets to ensuring
every household has a reliable source of clean water and the means to wash
their hands.
