Epidemiological description and analysis of factors associated with cholera morbidity and mortality in Cameroon from 2018 to 2023

IntroductionCameroon has faced frequent and severe cholera outbreaks since 1971, with high lethality. Previous studies have examined some risk factors and groups, but not for the 2018-2023 period. We analysed the profiles of cholera epidemics and determined factors associated with morbidity and mortality from cholera during this period. Materials and methodsWe conducted an analytical cross-sectional study using Ministry of Health cholera databases from 2018-2023. We described the socio-demographic, clinical and geographical distribution of cholera cases and used multiple regression to identify factors associated with cholera lethality. ResultsBetween May 2018 and March 2023, there were four cholera epidemics with 18,986 cases, affecting 8/10 regions. The three coastal regions notified 83.4% (15,839/18,986) of cases. The most represented age group were those aged 25-35 years (21.9%; 4,163/1,876) and the M/F sex ratio was 1.27. The overall CFR was 2.7% (478 deaths/17,967 cases) and was highest among persons >65 years (6.8%; 59/869). Urban areas notified more cases than rural areas (13,267 vs 5,484). Factors associated with increased mortality were female sex (aOR 0.62, 95% CI 0.49-0.77), rainy season (aOR 0.60, 95% CI 0.45-0.78) and age below 45 years (aOR 0.56, 95% CI 0.45-0.69). Severe dehydration at consultation (aOR 12.76, 95% CI 7.66-21.25) was associated with higher mortality. ConclusionThere were frequent cholera epidemics affecting nearly all administrative regions in Cameroon from 2018 to 2023. Factors associated with decreased mortality from cholera were female sex, living in urban areas, the rainy season, and age less than 45 years. The high caseloads and case fatality rates further reiterate the need for a multisectoral approach to the fight against cholera in Cameroon.