Cholera in Mozambique

The ongoing cholera epidemic in Mozambique was first reported on September 14, 2022 in Niassa Province (in Lago District, which borders Malawi) (1), followed by Sofala Province on September 29 (2). Outbreaks remained concentrated in these two provinces until cases were also reported in Tete on December 9 (2). In January and February 2023, cholera outbreaks continued to spread with case numbers increasing rapidly in these three provinces (2).

In February of 2023, heavy rainfall and floods due to Cyclone Freddy further exacerbated the situation (3). Cyclone Freddy first made landfall on February 22, affecting the provinces of Gaza, Inhambane and Sofala. The cyclone made second landfall on March 11, affecting the provinces of Zambezia, Tete, Sofala, Manica, Nampula and Niassa (2). Contamination of water sources and disruption to water, sanitation and hygiene services caused a sharp increase in cholera cases (4). Over a million people across eight provinces (Gaza, Inhambane, Manica, Maputo, Sofala, Tete, Niassa and Zambezia) were affected by the compound crisis of Cyclone Freddy, floods and cholera (3,4).

As of April 23, 2023, a total of 28,410 suspected cases and 127 deaths (case fatality rate: 0.5%) have been reported in 10 of 11 provinces in the country since September 2022 (2). The provinces with the highest number of total cases are Zambezia (12,358 cases, 43.5%) and Sofala (5,993 cases, 21.1%) (2).

Although weekly cholera case numbers have decreased since the peak between late-March and early-April, outbreaks persist in nine of 11 provinces (e.g., Sofala, Niassa, Tete, Manica, Inhambane, Zambezia, Cabo Delgado, Nampula and Maputo City). During week 16 (April 17-23), the majority of cases were reported from Nampula (344 cases, 28.8%), Sofala (319 cases, 26.7%) and Zambézia (212 cases, 17.8%). The widespread pattern of cholera cases throughout the country presents a major challenge to control the outbreaks. Furthermore, the cholera outbreaks in Mozambique are occurring in the context of a regional epidemic, with cholera also affecting neighboring Malawi, Tanzania, Zambia, Zimbabwe and South Africa (2), thus representing a continued threat of cross-border transmission.