The burden of waterborne diseases: a review of cholera and giardiasis associated with contaminated groundwater in developing countries

Abstract

Groundwater is the primary and most often essential resource for human survival. Its vital role in supporting human life and diverse ecosystems emphasizes its importance. A major use of groundwater is for drinking, yet access to clean and safe water remains limited, especially in low and middle-income countries. Providing safe drinking water is becoming increasingly difficult, creating a significant public health issue. About half of the global population faces challenges with polluted and contaminated freshwater, putting millions of lives, mainly in developing countries, at increased risk of waterborne diseases. This review synthesizes 105 studies (2003-2025) across developing countries. Results show that fecal sludge leakage is the dominant contamination pathway. Mitigation strategies demonstrate dual-intervention efficacy: pit latrine liners reduce coliform infiltration significantly. Household ceramic filtration and chlorination are also effective water treatment options. These findings necessitate groundwater risk zoning, shallow aquifer abandonment in high-risk carbonate geologies, and integrated fecal sludge management. Effective implementation of the mentioned strategies can potentially reduce disease burden. The review provides policymakers with evidence-based strategies to achieve SDG 6.2 (sanitation) and SDG 3.9 (waterborne disease reduction) through targeted aquifer protection and effective water treatment in rural populations in developing countries. The insights provided support governments and the public in developing strategic water safety plans to protect community health, especially in vulnerable populations.