Southern and eastern African countries are facing a resurgence of cholera, threatening worldwide progress toward eliminating the disease, a recent analysis has said.
The study, published in BMJ Global Health, assessed cholera elimination attempts in the World Health Organisation’s African region between 2018 and 2022. Since 2021, the region has faced “an acute upsurge” in cholera, the authors wrote.
Out of 27 African countries participating in the study, just three – Ethiopia, Kenya and Zambia – were on track to meet the region’s goal of eliminating cholera by 2030. While the region was on target with efforts like mapping hot spots and setting up surveillance systems, the researchers found, it lags on milestones involving increased funding for cholera control and elimination.
Insufficient water, sanitation and hygiene efforts and fragile healthcare systems are to blame, they said and climate change, war and poverty are making things worse. Overall, the region had progressed by just 53%.
One issue is that some countries treat cholera outbreaks as an emergency instead of investing in long-term infrastructure to combat the disease, the researchers write. What is needed is “sustainable and predictable” funding to meet its goals, they noted, calling for increased funding to the region, including a possible UN cholera fund.
Cholera is most prevalent in places that lack sanitation due to poverty, poor infrastructure, war and weak health systems. Though it’s easy to treat and there are vaccines available, outbreaks have risen worldwide in recent years.
In a recent report, the WHO documented more than 800 000 cases of cholera and 5 805 deaths in 2024.
According to the organisation’s most recent data release, 19 countries nationwide had cholera cases in January, led by South Sudan and the Democratic Republic of Congo in the Africa region and Afghanistan, Yemen and Sudan in the eastern Mediterranean.
Study details
An assessment of the progress made in the implementation of the regional framework for cholera prevention and control in the WHO African region
Fred Kapaya, Mory Keita, Vincent Dossou Sodjinou et al.
Published in BMJ Global Health on 22 January 2025
Abstract
High-burden cholera outbreaks, spreading beyond the traditional cholera-endemic countries, have been reported since 2021 in the WHO African region. Member states in the region have committed to the global goal of cholera elimination by 2030. To track progress towards this goal, WHO-African countries adopted a regional cholera prevention and control framework in 2018. This study reports on 27 countries’ five-year achievements in implementing the cholera regional framework for cholera prevention, and control. Data collected through a web-based self-assessment tool were analysed and visualised through Power BI. Data were provided by national teams of experts on cholera based on the milestones of the framework. Countries’ specific progress and regional progress were calculated. The overall regional progress was 53%, ranging from 19% in Mauritania to 76% in Ethiopia. Out of the 27 countries, three had made good progress while 14 had fair and 10 had insufficient progress. At the regional level, four milestones were on track, seven were fair and 10 had insufficient progress. Cholera hot spot mapping had the highest score at 85%, while development of investment cases for cholera control scored the lowest at 14%. Although appreciable progress was noted in some milestones, the progress against critical milestones, including for water, sanitation and hygiene, that form the bedrock of cholera control, was insufficient. Effective implementation of the cholera prevention and control framework anchored on strong government commitment and ownership is essential to curb the current trend of cholera outbreaks and improve the likelihood of cholera elimination by 2030 in Africa.
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