Editing IPCC:AR6/WGII/Chapter-9 (section)

===== 9.10.2.2.1 Diarrhoeal diseases =====

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Observed impacts

Africa has the highest rates of death due to diarrhoeal diseases in the world ( [[#Havelaar--2015|Havelaar et al., 2015]] ; [[#Troeger--2018|Troeger et al., 2018]] ) and many children have repeated diarrhoeal episodes with impaired growth, stunting, immune dysfunction and reduced cognitive performance ( [[#Squire--2017|Squire and Ryan, 2017]] ). High land and sea temperatures ( [[#Paz--2009|Paz, 2009]] ; [[#Musengimana--2016|Musengimana et al., 2016]] ) and precipitation extremes increase transmission of bacterial and protozoal diarrhoeal disease agents ( [[#Boeckmann--2019|Boeckmann et al., 2019]] ) through contamination of drinking water and food preparation and preservation practices (Figure 9.33; [[#Levy--2016|Levy et al., 2016]] ; [[#Soneja--2016|Soneja et al., 2016]] ; [[#Walker--2018|Walker, 2018]] ).

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[[File:c3b4526bd1974f2e1a69e02691601cc4 IPCC_AR6_WGII_Figure_9_033.png]]

'''Figure 9.33 |''' '''Schematic showing the pathways to diarrhoeal disease impacts in Africa as a result of exposure to climate hazards.''' Numbers in the figure refer to chapter sections of this report.

Cholera incidence has been shown to increase with temperature ( [[#Trærup--2011|Trærup et al., 2011]] ). Outbreaks, however, are most frequent in east and southern Africa following tropical cyclones ( [[#Moore--2017b|Moore et al., 2017b]] ; [[#Troeger--2018|Troeger et al., 2018]] ; [[#Ajayi--2019|Ajayi and Smith, 2019]] ; [[#Cambaza--2019|Cambaza et al., 2019]] ).

Africa’s rapidly urbanising population increases the demand for freshwater and is occurring in places that already have stretched water and sanitation infrastructure ( [[#Howard--2016|Howard et al., 2016]] ). These conditions, especially during periods of water scarcity, can reduce the frequency and adequacy of hand washing and thereby increase disease transmission.

Projected risks

Disruptions in water availability, such as during droughts or infrastructure breakdown, will jeopardise access to safe water and adequate sanitation, undermine hygiene practices and increase environmental contamination with toxins ( [[#Howard--2016|Howard et al., 2016]] ; [[#WWF-SA--2016|WWF-SA, 2016]] ; [[#Miller--2017|Miller and Hutchins, 2017]] ).

Climate change is projected to cause 20,000–30,000 additional diarrhoeal deaths in children (&lt;15 years old) by mid-century under 1.5°C–2.1°C global warming ( [[#WHO--2014|WHO, 2014]] ), with west Africa most affected, followed by east, central and southern Africa. Cholera outbreaks are anticipated to impact east Africa most severely during and particularly after ENSO events ( [[#Moore--2017b|Moore et al., 2017b]] ).

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