COVID-19 pandemic in Africa: Is it time for water, sanitation and hygiene to climb up the ladder of global priorities?

The authors would like to thank the authors of the freely-usable images from Unsplash and Pixnio included in the Graphical Abstract: photos by Janice-Haney Carr and Dr. Ray Butler (USCDCP), USCDCP and Crystal Thompsom (USAID) on Pixnio; photos by CDC, UN COVID- 19 response and Raymond Hui on Unsplash.Wewould also like to thank the reviewers for their comments and keen interest in this article.In the current pandemic context, it is necessary to remember the lessons learned from previous outbreaks in Africa, where the incidence of other diseases could rise if most resources are directed to tackle the emergency. Improving the access to water, sanitation and hygiene (WASH) could be a win-win strategy, because the lack of these services not only hampers the implementation of preventive measures against SARS-CoV-2 (e.g. proper handwashing), but it is also connected to high mortality diseases (for example, diarrhoea and lower respiratory infections (LRI)). This study aims to build on the evidence-based link between other LRI andWASH as a proxy for exploring the potential vulnerability of African countries to COVID-19, as well as the role of other socioeconomic variables such as financial sources or demographic factors. The selected methodology combines several machine learning techniques to single out the most representative variables for the analysis, classify the countries according to their capacity to tackle public health emergencies and identify behavioural patterns for each group. Besides, conditional dependences between variables are inferred through a Bayesian network. Results show a strong relationship between low access toWASH services and high LRI mortality rates, and that migrant remittances could significantly improve the access to healthcare and WASH services. However, the role of Official Development Assistance (ODA) in enhancing WASH facilities in the most vulnerable countries cannot be disregarded, but it is unevenly distributed: for each 50–100 US$of ODA per capita, the probability of directing more than 3 US$ toWASH ranges between 48% (Western Africa) and 8% (Central Africa)