Abstract
Myanmar faces a heavy public health burden from waterborne diseases (WBDs), particularly acute watery diarrhea and cholera. This problem is worsened by conflict, displacement, and frequent climate-related disasters such as floods. However, significant long-term assessments linking epidemiological, environmental, and policy dimensions remain limited. This study combined secondary epidemiological data from the World Health Organization and national health authorities with climatic variables and policy analyses to assess WBDs in Myanmar from 2021 to 2025. During this period, 822,241 cholera cases and 284 deaths were reported, corresponding to an overall case fatality rate (CFR) of 0.036 % (95 % confidence interval: 0.0319–0.0401 %), indicating low mortality relative to the disease burden. CFR varied spatially, with higher CFR in conflict-affected and infrastructure-limited regions, including Rakhine State. Pearson correlation indicated a weak, non-significant positive correlation of CFR with cholera incidence (r = 0.184, p = 0.092), while annual mean temperature showed a weak, non-significant negative correlation with CFR (r = −0.162, p = 0.795). These results indicate that climatic variables alone cannot explain disease patterns. Flooding events were associated with outbreak patterns, particularly in coastal and delta regions, such as Rakhine and Ayeyarwady. Flooding was identified as a potential contributing factor based on spatial trends; however, this could not be statistically validated owing to data limitations. By combining quantitative analysis with a Sustainable Development Goal (SDG)-oriented policy evaluation, this study highlights the interactions between environmental drivers, public health outcomes, and governance. Although existing policies provide a foundation for WBD control, implementation gaps remain. Strengthening integrated water–health governance, expanding localized water, sanitation, and hygiene services, and adopting climate-resilient planning are essential to advance SDGs 3 and 6.