Abstract
Cholera remains a heavy burden worldwide, especially in Sub-Saharan African countries, which account for the majority of the reported cases on the continent. In this study, a 27-year retrospective analysis of cholera epidemics in Guinea-Bissau was performed in order to highlight major stressors fueling the trigger and dissemination of the disease. Although the role of environmental factors did not always have the same degree of importance for the onset of epidemics, a cholera seasonal pattern was clearly perceived, with most of the reported cases occurring during the wet season. The generated theoretical hypothesis indicated rainfall above climatological average, associated with a lack of WASH (water, sanitation and hygiene) infrastructure, and the occurrence of concomitant epidemics in neighboring countries as the key indicators for optimal conditions for cholera to thrive in Guinea-Bissau. Warmer air temperature, the increase in sea surface temperature, and the decrease in salinity in the coastal areas may also contribute to the emergence and/or aggravation of cholera events. Prediction of the conditions favorable for cholera growth and identification of risk pathways will allow the timely allocation of resources, and support the development of alert tools and mitigation strategies.