Limited access to clean water and sanitation in Mopeia, Mozambique: a description in the context of a cholera outbreak.

Background: Inadequate access to safe water, sanitation, and hygiene (WASH) accounts for a high burden of morbidity and mortality in impoverished regions. This is significantly due to infectious diseases and the direct impact on social and economic well-being. The high burden of communicable diseases and malnutrition in Mozambique, as well as high vulnerability to climate change, results in increased risk of WASH-related diseases. Our objective was to describe access to safe water and sanitation practices in Mopeia, a remote rural district in Mozambique. Methods: The source of data for this analysis is a cross-sectional, demographic survey carried out in Mopeia in 2021 under the Broad One Health Endectocide-based Malaria Intervention in Africa project, a cluster-randomised trial to assess the impact of ivermectin on malaria transmission. The survey was conducted in all households of a sub-population created for the trial, and it included questions about WASH-related practices at the household level. Results: The results showed that  4200 (56.29%) households have an improved water source at walking distance, which is drastically different to sanitation practices, where 6608 (88.56%) households do not have access to at least one basic sanitation service. Data on water access for Mopeia was similar to that reported in rural contexts in sub-Saharan Africa, yet the district remains off-track from achieving universal safe water coverage in the next few years. Regarding sanitation, the use of unsafe sanitation services is more widespread than in the average rural sub-Saharan Africa (75.00%), with twice as many households (n = 3897, 56.08%) practising open land defecation. Conclusions: Mopeia is still far from achieving universal safe water and sanitation coverage by 2030, especially in sanitation, and remains prone to outbreaks and has a high burden of WASH-related diseases.