According the recent WHO report, cholera cases surged in 2023, with 535,321 cases reported globally, marking a 13% increase from 2022. During this time, the geographical pattern of outbreaks significantly shifted: the Middle East and Asia reported a 32% decrease in case numbers, while Africa experienced a 125% increase (21 countries reported 225,857 cases). Cholera deaths in Africa also rose by 62% compared with the previous year (3,167 deaths reported in 2023 (CFR1 = 1.4%)2.
Situation in African countries
In Africa, very large outbreaks (more that 10,000 cases) were reported in the Democratic Republic of the Congo (DRC), Ethiopia, Malawi, Mozambique, Somalia and Zimbabwe. Three of these countries - Ethiopia, Mozambique and Somalia - were at greatest risk from the consequences of the 2023 El Niño event. Many countries in southern Africa (Mozambique, South Africa, Zambia, and Zimbabwe) reported case numbers that exceeded those recorded in the previous five years. The DRC reported 52,654 cases in 2023, which represents 23% of all cases reported on the continent and nearly three times that reported in the country in 2022. The surge in cholera outbreaks in the DRC is primarily due to ongoing conflict in the eastern part of the country, where cholera is endemic. The conflict has not only caused repeated population displacements but has also significantly hindered humanitarian access2.
The high CFR recorded in Africa is especially concerning, as a facility CFR greater than 1% suggests inadequate treatment quality. Furthermore, many countries in Africa reported many community deaths, which indicates serious issues in access to treatment.
Cholera risk factors in Africa
Limited access to water, sanitation and hygiene (WASH) is the major cholera risk factor in these countries. Among the countries experiencing large outbreaks, DRC, Ethiopia, Mozambique, Somalia and Zimbabwe have at least basic drinking water coverage estimates below 65%1. This pattern highlights a severe lack of long-term development investment, particularly in WASH infrastructure. Additional factors that contributed to the increase in cholera cases include conflict, the effects of climate change (drought, flooding and storms), and population displacement due to emerging and re-emerging risks2.
- WHO, Cholera, 2023. Available here.
- WHO, JMP, UNICEF. JMP Progress on Drinking Water, Sanitation and Hygiene [Internet]. 2022. Available from https://washdata.org
WHO recommendations
To address this escalating health crisis, the WHO has made several recommendations2:
Surveillance should be strengthened, including enhanced early detection, diagnosis (with laboratory confirmation), monitoring and data analysis to identify vulnerable populations in high-risk areas. Furthermore, real-time monitoring of facility CFRs and numbers of community deaths will help to identify critical areas and enable more effective targeting of responses.
Countries neighboring cholera-affected areas should strengthen disease surveillance and preparedness for rapid detection and response to cross-border cholera transmission.
Under-reporting or non-reporting of cholera cases and deaths should be addressed, as this hampers early detection, response, and accurate burden assessment and undermines advocacy for greater investment in sustainable cholera control.
The high proportion of community deaths highlights the need to improve access to treatment during outbreaks.
As community involvement is critical for an effective outbreak response, Risk Communication and Community Engagement should be integrated into national cholera plans.
Advocate for long-term investment in climate change-resilient WASH systems to reduce the risk of recurring outbreaks.