Academic Publication

The Sub-Saharan Water Crisis: An Analysis of its Impact on Public Health in Urban and Rural Nigeria

Meghan Hannemann
Depauw University
Publication Year:
May 04, 2020
  • SDG 6 - Clean Water and Sanitation

This student research paper explores the Sub-Saharan Water crisis through various public health perspectives such as water-borne diseases. Overall, she seeks to inspire further progress towards water access for all and proposes that more international cooperation that works with community-based organizations occurs to do so.


Today, 11% of the global population still lacks access to clean water, one of humans’ most basic needs. Those who lack a safe water source are largely concentrated in sub-Saharan Africa, where only 61% have access to safe water. Within this region, large disparities exist that hide the severity of the problem for some communities. The term “water crisis” is often used to describe the lack of water access throughout the world and the resulting consequences. In this thesis, the impact the water crisis has on public health in sub-Saharan Africa was analyzed using Nigeria as a model nation. Specific forces that contribute to the persistence of the water crisis and the public health outcomes were examined. Urban and rural Nigeria were researched separately, as each setting has its own set of obstacles concerning the water crisis and its own set of public health issues. It was found that in both urban and rural Nigeria, the increased transmission of water-related diseases was a significant burden caused by the water crisis. In Lagos, a city in southern Nigeria, the poor environmental conditions allow for the spreading of diseases through the fecal-oral route of transmission. Additionally, diseases that are typically found in rural setting are becoming more prevalent in Lagos due to the unkempt environment. In rural Nigeria, the lack of safe water sources makes the chances of contracting waterborne diseases very high. The control of water-related diseases is made worse in rural areas because it is difficult to get resources to an isolated rural area. This problem is exacerbated in places suffering from ongoing conflict. However, the prevalence of several diseases has decreased as the availability of water sources increases. By pointing out the severe public health consequences that the water crisis has on sub-Saharan Africa, the goal of this thesis is to inspire further progress towards water access for all.


In this section, the city of Lagos has been used to highlight the factors contributing to the water crisis and the resulting public health consequences in an urban area. Although some of the ideas presented in this chapter are unique to Lagos, many of the themes can be applied more broadly to urban areas throughout sub-Saharan Africa.

One of the factors that contributes to the lack of water and sanitation infrastructure in Lagos is the history of inequality that dates back to the colonial era. When Great Britain took control of Nigeria as one of its colonies, it implemented the policy of racial segregation in all colonial towns. Most infrastructure improvements were directed at European enclaves. Once the colonial period ended, some of the existing infrastructure was not properly maintained, especially during the 1980s and 1990s when a global depression hit Nigeria hard. Additionally, as the city continued to grow, the government could not keep up with providing new infrastructure to the outskirts of the city. Many of the cities across sub-Saharan Africa may have experienced a similar history that led to a lack of sufficient infrastructure. The British implemented their policy of racial segregation throughout all of their colonies, resulting in areas of the city with top-notch infrastructure and others with none whatsoever. The French, the other dominant colonial power, did not segregate solely on race; they segregated based on culture. Unlike their British counterparts, they encouraged Africans to assimilate into French culture. If Africans did this, they were able to live in the European enclaves (Mazrui, 2004). However, this still set the stage for inequality in infrastructure throughout the city.

Also, the inequality between genders stretches to other cities throughout sub-Saharan Africa. Women throughout the region face problems similar to the ones seen in Lagos. For example, many women have to spend a significant part of their day tracking down water for their families. Women are faced with a higher chance of being victims to violence in cities. Finally, women are still underrepresented in local governments (Inter-Agency Network on Women and Gender Equality). Therefore, the exclusion of women in decision-making about infrastructure is a problem that is prevalent throughout sub-Saharan Africa. Strides towards gender equality could benefit many cities throughout the country, by increasing progress towards improved water access and the MDG for female empowerment.

Although some of the obstacles seen in Lagos can be applied to other urban areas, there are several that are unique to Lagos. For example, the rate of population growth poses a problem to the city that other sub-Saharan African cities do not face. Not only is Lagos concerned with maintaining old infrastructure, but also with building new infrastructure for a rapidly growing city, both demographically and physically. Additionally, Lagos’ geography creates a distinct set of obstacles for the city. As a city built largely on swampland and water, it seems counterintuitive that there would be a water shortage problem. However, the surface water is polluted with runoff industrial and human waste. The groundwater, which is often tapped into for improved water sources, is also contaminated due to the porous nature of the soil. Furthermore, the flooding that occurs frequently in the area increases the amount of runoff that enters these water sources. This flooding is increased by climate change; although many regions in sub-Saharan Africa have begun to feel the effects of climate change, each region experiences climate change differently. Some regions face increased flooding, some face more severe droughts, and some face no changes at all. Therefore, the increase in flooding is unique to Lagos and other cities that fall in the tropical belt along the coastline of West Africa.

Although Lagos was used here as a case study, the factors that contribute to the persistence of the water crisis can be seen in many cities throughout sub-Saharan Africa. The lack of water and sanitation management has created an unhealthy environment that is favorable for the transmission of many diseases. In this chapter, cholera, schistosomiasis, and malaria were used as examples to demonstrate the dynamics in play that lead to the transmission of water-related disease in Lagos. However, it is important to note that there are other prevalent water-related diseases in Lagos other than the three that were discussed in detail. For example, typhoid fever, a bacterial waterborne disease, and hepatitis A, a viral waterborne disease, are seen frequently throughout the city.

When looking at the epidemiology of cholera, schistosomiasis, and malaria in Lagos, several trends emerge. First of all, it is apparent that because the environment in Lagos is not being controlled, diseases that are typically rural are becoming urban threats. The transmission of schistosomiasis in Lagos is possible because the standing water throughout the city is not taken care of. Thus, freshwater snails that can serve as hosts for the parasite are able to survive in the city. The prevalence of malaria, a disease that is typically found in rural areas, is increasing in Lagos. Once again, the standing water throughout the city acts as an environment for an animal vector that transmits the disease. In the case of malaria, that vector is a mosquito. Better water management systems that could prevent standing water from collecting in the city would decrease the transmission of these diseases. However, controlling diseases with animal vectors poses a problem, especially when they are able to adapt to a variety of environments. Even if standing water was cleared throughout the city, the Lagos Lagoon would still provide a breeding site for mosquitos. Although the polluted waters of the lagoon promote the spreading of other water-related diseases, the pollution should hinder activities of malaria vectors. However, the mosquitos have been able to adapt, so the prevalence of malaria remains high in the city.

Another trend that is observed in Lagos is the increased transmission of diseases through the fecal-oral route. This can be attributed to several geographical features of the city. For example, the fact that Lagos is built mostly on wetlands makes it difficult for the city to prevent 

the contamination of water sources, especially considering the lack of sanitation facilities. Human waste often times ends up in the freshwater sources throughout the city. The flooding that is frequently seen in Lagos only adds to this problem, because flooding pushes runoff waste into the lakes and creeks throughout the city. The high likelihood of water contamination is a risk factor for diseases, like cholera, that are spread through the fecal-oral route. A person can contract a disease if they drink this dirty water, if they use it to wash their food, or if it comes into contact with hands that then touch food. Because there are many risk factors for waterborne diseases in Lagos, the role of health education becomes more important. People have a better chance of avoiding disease if they take preventative steps, such as boiling their water. However, people only know to take these steps if their importance is made known to the public.

These trends can be applied to other cities throughout sub-Saharan Africa. Although cities generally have better access to water and sanitation facilities that their rural counterparts, there are often large disparities seen in cities. Many have large slum communities that lack appropriate water and sanitation and have large population densities. Therefore, the environment in some urban areas throughout sub-Saharan Africa may be just as unfavorable as it is in Lagos. Poor environmental conditions favor the transmission of rural diseases and diseases that are spread through the fecal-oral route. Thus, the transmission of water-related diseases is a problem that plagues cities across the continent. The large burden that is caused by these diseases could be relieved with the improvement in water and sanitation infrastructure. Next, the focus will turn to rural Nigeria.


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