The Importance of Maintenance : Geospatial Analysis of Cholera Risk and Water and SanitationInfrastructure in Harare, Zimbabwe

Understanding the specific factors associated with cholera outbreaks is an integral part ofdesigning better approaches to mitigate their impact. This paper uses georeferenced case data from the cholera epidemicthat occurred in Harare, Zimbabwe, from September 2018 to January 2019. The paper applies spatio-temporal modeling tounderstand how the outbreak unfolded and the factors associated with higher risk of being a reported case. Thestudy highlighted a number of findings. First, using call detail records to estimate weekly population movementthroughout the city, the results suggest that human movement helps to explain the spatiotemporal patterns of the casesobserved. In addition, the results highlight a number of sociodemographic risk factors and suggest that there is arelationship between cholera risk and water infrastructure, with populations living in close proximity to the sewernetwork with high access to piped water being at higher risk. A possible explanation for this surprising observationis that sewer bursts led to the contamination of the piped water network, turning access to piped water, usuallyassumed to be protective, into a risk factor. Although further studies are required to test this hypothesis, if itis true, it highlights the importance of maintenance for achieving the Sustainable Development Goals of improvedwater and sanitation infrastructure.