Temporal and Geographic Trends in Burden of Cholera and Case Fatality Rates in Sub-Saharan Africa (2000-2023)

Cholera remains a significant public health challenge in sub-Saharan Africa (SSA), with notable regional variations in disease burden and case fatality rates (CFR). This study examines temporal and geographic trends in cholera incidence and mortality from 2000 to 2023, revealing distinct patterns across different countries and sub-regions. Statistical analyses indicate an overall weak correlation (r = ？0.082, p-value < 0.016) between total cholera cases and CFR, suggesting that improved outbreak response measures can mitigate mortality despite rising cases. However, country-specific disparities were observed, with Malawi showing a significant positive correlation (r = 0.512 and p-value < 0.015) between case numbers and CFR, likely due to healthcare system strain, whereas Niger exhibited a moderate negative but significant correlation (r = ？0.570 and p-value < 0.013), suggesting improved outbreak management or underreporting. Regional disparities significantly influence cholera mortality trends, as evidenced by an analysis of variance (F = 7.592, p < 0.001), which confirms that sub-regional factors—such as conflict, water access, and emergency response capacity—are critical determinants of CFR. However, when the equality of variance in CFR was independently assessed in coastal and inland regions, no statistical significance (F = 0.987, p-value < 0.321) was observed, indicating that water access might not be of the crucial determinants. The findings underscore the urgency of region-specific public health interventions, integrating climate resilience strategies and strengthening healthcare infrastructure.