Date of Conferral





Public Health


Aimee Ferraro


Cholera remains endemic in Africa, with limited access to safe drinking water and inadequate sanitation as 2 of the main drivers of its dissemination. Few studies have examined the impact of health system capacity, even though it plays an important role in prevention, early detection, and response to a cholera outbreak. Grounded in the ecosocial theory of infectious disease dissemination, this quantitative ecological study explored the effect of social vulnerability (as measured by access to safe drinking water and sanitation, rate of open defecation, poverty, income inequality, gender inequality, and adult literacy) and health system (as measured by health financing and density of human resources for health) capacity on incidence of cholera in the 47 countries of the African region of the World Health Organization.

Logistic regression results showed that only access to improved sanitation [p < .05; OR = .904; 95% CI: .823 – .992; N= 47], rate of open defecation [p < .05; OR = .894; 95% CI: .822 – .973; N= 47], and health system capacity [p < .05; OR = .792; 95% CI: .630 – .995; N=47] had a statistically significant association with incidence of cholera. The components of social vulnerability [p < .05; OR = 1.080; 95% CI: 1.004 – 1.162; N=47] and the interaction between social vulnerability and health system capacity [p < .05; OR = 1.004; 95% CI: 1.002 – 1.009; N= 47] were also significantly associated with the outcome. These findings can impact social change by guiding the development of effective multisectoral programs for cholera prevention and elimination.