Cholera dynamics in Ethiopia

Cholera continues to represent a major public health concern in Ethiopia; however, the epidemiology of cholera in this country remains poorly understood. A recent study has established a comprehensive understanding of cholera dynamics and hotspots in Ethiopia over the period 2015 to 2021.

The study also identified cholera hotspots for targeted cholera prevention and preparedness interventions (1, 2).

From 2015 to 2021, Ethiopia was affected by cholera outbreaks every year, with a total of 99,548 suspected cases reported. The first epidemic of this period started in late 2015 (in Oromia and Somali Regions) and spread throughout the country in 2016. In 2016, a total of From 2015 to 2021, Ethiopia was affected by cholera outbreaks every year, with a total of 99,548 suspected cases reported. The first epidemic of this period started in late 2015 (in Oromia and Somali Regions) and spread throughout the country in 2016. In 2016, a total of From 2015 to 2021, Ethiopia was affected by cholera outbreaks every year, with a total of 99,548 suspected cases reported. The first epidemic of this period started in late 2015 (in Oromia and Somali Regions) and spread throughout the country in 2016. In 2016, a total of 30,718 suspected cases were reported across all regions (except Gambela Region). This epidemic continued into 2017 with a total of 47,540 suspected cases, of which 75% of suspected cases were reported from Somali Region (1). The severe drought affecting Somali Region at the time exacerbated the cholera epidemic in the region, as it forced pastoralists to travel longer distances in search of water, often relying on unsafe sources (3). Following the massive epidemic in 2017, several smaller-scale epidemics occurred from 2018 to 2021 (1). The study finds that cross-border transmission likely occurred between Ethiopia and neighboring countries such as Somalia, Kenya and South Sudan (1,2).

During this period, cholera hotspots were located along major routes between Addis Ababa and woredas (i.e., districts) adjacent to the Kenya and Somali borders. Hotspots were also located throughout Tigray Region, around Lake Tana (in Amhara Region), and in Afar Region along the Ethiopia-Djibouti road (2). 

Cholera transmission in Ethiopia is influenced by several key factors. Limited access to safe drinking water, sanitation and handwashing facilities plays a significant role in cholera dynamics. According to the 2020 national estimates, 49.6% of the population in Ethiopia had access to at least basic drinking water sources, and 8.9% of the population had access to at least basic sanitation (4). Beyond these infrastructure challenges, other drivers of cholera diffusion include conflict (5,6), population displacement (7), and severe climatic events (3,8). Climate change may lead to more frequent and intense extreme droughts and floods in the region, which will likely continue to exacerbate cholera outbreaks in Ethiopia in the absence of improved water and sanitation infrastructure as well as climate resilience measures.

Overall, this study provides the first comprehensive understanding of recent spatiotemporal cholera dynamics in Ethiopia to inform cholera control and elimination strategies. For further information, read the full reports here: