Clinical Characteristics and Outcomes of Cholera Cases in Lusaka and Eastern Provinces of Zambia, January 2023 to July 2024 Cholera Outbreaks: A Retrospective Facility-Based Study

Cholera remains one of the major public health challenges in sub-Saharan Africa due to poor water, sanitation, and hygiene (WASH) systems and climate change (floods, droughts). Zambia had major outbreaks between 2023 and 2024, yet there is limited information about clinical characteristics and outcome predictors for the patients who were affected. Here, we describe clinical profiles and outcomes of cholera patients while identifying factors associated with mortality.

A retrospective cross-sectional study design was conducted using secondary data from the national cholera surveillance system. The study included those with confirmed cholera cases documented in Lusaka and Eastern Provinces from January 2023 to July 2024. Patients with incomplete records were excluded. Descriptive statistics, bivariate tests, and multivariable logistic regression were used to assess clinical characteristics, outcomes, and factors associated with mortality. A total of 2,844 confirmed cases were analyzed, with 97% from Lusaka and 3% from Eastern Province. The median age was 24 years (IQR: 6–35), with Eastern Province patients being older (median 34 years). Males comprised 53.3% of cases. Most patients (99.6%) were admitted as inpatients, with a mean hospital stay of 1.8 days. Overall, 95.6% survived and 4.4% (n=126) died. Mortality was highest among patients ≥65 years (17.1%) and infants <1 year (8.5%). Male patients (5.9% vs. 2.7% in females, p<0.001) and outpatients (54.8% vs. 3.9% in inpatients, p<0.001) were at greater risk. Multivariable analysis showed increased odds of death among those aged 25–44 (AOR 2.16, 95% CI: 1.25–3.73) and ≥65 years (AOR 5.34, 95% CI: 2.62–10.87). Being female (AOR 0.42, 95% CI: 0.27–0.63) and inpatient care (AOR, 95% CI: 0.02–0.07) were protective.

Adults 65 years and above, infants, males, and outpatients experienced the highest mortality during the outbreaks. Inpatient care was very protective, which shows how important it is to find high-risk patients early, refer them quickly, and admit them into care. To reduce the number of cholera-related deaths in Zambia, it is important to strengthen triage systems, teach people in the community, do WASH interventions, and improve preparedness.