Environmental pollution and cholera outbreaks in sub–Saharan Africa examined through a review of public health interventions and community impacts

Aim Cholera remains a persistent public health threat in Sub‑Saharan Africa, disproportionately affecting underserved communities with limited access to safe water, sanitation, and hygiene (WASH). Although environmental pollution is recognised as a major driver of transmission, evidence on its specific pathways and the effectiveness of related interventions remains fragmented. This review aimed to synthesise current evidence on how environmental pollution contributes to cholera outbreaks in SSA and evaluate the effectiveness of WASH and public health interventions. Methods A systematic search of peer‑reviewed and grey literature published between 2015 and 2025 was conducted following PRISMA guidelines. Nineteen studies met the inclusion criteria, including cross‑sectional, case‑control, cohort, and surveillance designs from nine SSA countries. Data were analysed using thematic synthesis to identify environmental drivers, high‑risk settings, behavioural contributors, and intervention outcomes. Results Environmental pollution was consistently associated with increased cholera risk, particularly through contaminated water sources, inadequate sanitation, open defecation, poor drainage, ineffective waste disposal, and seasonal flooding. High‑burden settings included refugee settlements, peri‑urban informal communities, and fishing populations. Behavioural factors such as limited handwashing and consumption of unwashed food further heightened vulnerability. Intervention effectiveness varied: case‑area targeted interventions and water chlorination reduced transmission, while oral cholera vaccines provided short‑term protection but were limited by incomplete coverage and waning immunity. Integrated approaches combining vaccination, WASH improvements, surveillance, and community engagement demonstrated the most consistent impact. Conclusion Environmental pollution is a central driver of cholera persistence in SSA. Sustainable prevention requires integrated, context‑specific strategies that strengthen WASH systems, enhance surveillance, and address structural vulnerabilities linked to poverty, displacement, and inadequate infrastructure.