Key messages • Built water infrastructure has a strong influence on the prevalence of waterborne and water-

related diseases, which are of high public health relevance in the Volta Basin. • Compared to other basins, especially those with higher population densities, water quality

and pollution have had, so far, a low socioeconomic and environmental impact on the major rivers. However, there are hot spots of poor water quality, as well as natural water quality challenges, such as from fluoride and iodine.