The researchers examined national cholera trends over a ten-year period, from 2013 to 2022, and compared disease patterns with changes in environmental conditions. Their analysis highlights a sharp spike in cholera cases and deaths in 2021, underscoring how fragile public health gains can be when access to basic services remains uneven.
Cholera and Nepal’s Environmental Challenges
Cholera is an acute diarrheal disease transmitted through food and water contaminated with the bacterium Vibrio cholerae. While the disease is preventable and treatable, it can be fatal without timely care. In Nepal, cholera has long been associated with unsafe drinking water, poor sanitation infrastructure, and limited hygiene facilities, particularly in rural and low-income communities.
Environmental pressures have intensified these risks. Climate change has altered rainfall patterns across Nepal, increasing both water scarcity and flooding. These conditions disrupt safe water supplies and create environments where waterborne diseases can spread rapidly. Global health authorities, including the World Health Organization, have repeatedly warned that climate-related water stress increases the likelihood of cholera outbreaks in vulnerable countries.
Despite national efforts to improve water safety and sanitation coverage, cholera continues to emerge sporadically across Nepal, sometimes with severe consequences.
How the Study Was Conducted
Neupane and Subedi used a cross-sectional quantitative review of secondary data to track cholera incidence and mortality over a decade. Instead of collecting new field data, they analyzed existing national and international datasets to identify long-term patterns.
Their sources included:
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Official reports from Nepal’s Epidemiology and Disease Control Division (EDCD)
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Annual health reports from the Department of Health Services (DOHS)
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Global data from the World Health Organization (WHO)
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Water, sanitation, and hygiene data from the Joint Monitoring Programme (JMP)
The researchers compared cholera cases and deaths with indicators such as access to drinking water, open defecation rates, and availability of basic handwashing facilities. This approach allowed them to assess how environmental conditions aligned with disease trends over time.
Key Findings: A Decade of Fluctuations and a Major Spike
The analysis shows that cholera incidence in Nepal remained relatively low and stable between 2013 and 2019, with only minor fluctuations. A small increase appeared in 2016, but the situation quickly returned to baseline levels.
That stability ended in 2021.
According to the study:
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Cholera cases surged to approximately 1,600 cases in 2021, marking the highest level in the ten-year period
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Seven cholera-related deaths were recorded in 2021, after several consecutive years with zero reported deaths
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Both cases and deaths declined sharply again in 2022
The sudden spike suggests a short but severe outbreak, likely triggered by a convergence of environmental and social factors.
Sanitation Progress, but Persistent Gaps
The study also documents notable progress in reducing open defecation across Nepal. Between 2013 and 2022:
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Open defecation in rural areas fell from about 35 percent to around 5 percent
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Urban open defecation declined from roughly 10 percent to just over 2 percent
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The national average dropped to below 5 percent
However, progress in sanitation has not been matched by improvements in water access and hygiene.
The researchers found that:
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The proportion of people relying on limited drinking water services increased from about 3 percent to 4.5 percent
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The share of the population without basic handwashing facilities rose from 0.9 percent to 1.5 percent
These gaps help explain why cholera continues to circulate, even as sanitation indicators improve.
Why Water and Hygiene Still Matter
Cholera spreads through the fecal–oral route, meaning contaminated water and poor hygiene create direct pathways for infection. Neupane and Subedi emphasize that even small deficiencies in water quality or handwashing access can have large public health consequences.
As the authors note, “cholera transmission is closely linked to water scarcity, open defecation, and inadequate handwashing practices, which remain present in parts of Nepal despite ongoing interventions.” Their analysis reinforces findings from global studies showing that water, sanitation, and hygiene conditions are central to cholera prevention.
Implications for Policy and Public Health
The findings carry important implications for policymakers and public health planners. Nepal has implemented multiple initiatives, including community-led water safety planning and partnerships with UNICEF to promote water quality monitoring and hygiene education. Yet the 2021 outbreak demonstrates that coverage gaps remain.
For policymakers, the study highlights the need to:
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Strengthen reliable access to safe drinking water
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Maintain sanitation gains while addressing hygiene infrastructure
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Integrate climate resilience into water and health planning
For communities, the research underscores that behavioral practices, such as consistent handwashing with soap, remain critical defenses against cholera.
Author Profiles
Pradip Neupane, is a public health researcher at Nepal Open University, Lalitpur, specializing in communicable diseases and environmental health.
Mandawi Subedi,is a development researcher at the Community Development Society, Ramechhap, with expertise in community health and social development.
Source
Article Title: Cholera in Nepal: Examining the Role of Environmental Factors in Disease Incidence and Mortality
Journal: International Journal of Applied and Advanced Multidisciplinary Research (IJAAMR)
Year: 2026
Volume & Issue: Vol. 4, No. 1, pp. 31–38
DOI (active): https://doi.org/10.59890/ijaamr.v4i1.161
Official Journal URL: https://nvlmultitechpublisher.my.id/index.php/ijaamr/index
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