The surging cholera epidemic in Africa: a review of the current epidemiology, challenges and strategies for control

Abstract

Africa, a known region with abundant warm coastal waters and a natural reservoir for Vibrio cholera, is known to bear the highest burden of cholera morbidity and mortality globally. Malawi is currently experiencing the deadliest cholera outbreak in two decades, and neighbouring countries, Mozambique and Zambia, have also reported significant numbers of cases. If the current trend of cholera transmission is sustained, the number of fatalities recorded in 2021, Africa’s deadliest year for cholera over the past decade, might be exceeded. This article aims to review the current epidemiology, prevention and control strategies, and treatment of cholera in Africa to highlight context-specific challenges and recommend possible solutions. The authors found out that cholera outbreaks in Africa are taking place in the midst of epidemics (measles, mumps, etc.) and natural disasters like cyclones and flooding (Mozambique, Malawi), drought (Kenya, and Ethiopia), and conflict (Cameroon, the DR Congo, Nigeria, and Ethiopia). The shortages of medical supplies like cholera kits and oral cholera vaccines in many countries due to constrained and limited resources and antibiotic resistance further make management and control difficult. The outbreak is spreading throughout the region because of poor sanitation, unsafe water supplies, and increased cross-border travel. Cholera in Africa follows a seasonal pattern, suggesting specific periods for heightened outbreak preparedness and response. The authors suggest a targeted multisectorial approach and a coordinated mechanism to respond to the epidemic through sustained political will, formidable partnerships, resource mobilisation, and the provision of technical support and advocacy at sub-national, national, and international levels.