Unmasking and tackling the underestimation of the cholera burden in Africa: A viewpoint

Cholera remains a significant public health challenge in Africa, with the continent recording the highest Case Fatality Ratio of 1.9% among all regions from 2014 to 2023. Despite ongoing efforts, the true burden of cholera is substantially underestimated due to poor quality and incomplete data. This article aims to review the factors contributing to the underestimation of cholera in Africa and explore potential solutions to better characterize the disease epidemiology and burden on the continent. We drew on our field experiences and existing literature to identify the key factors responsible for cholera underestimation in Africa. We also propose strategies to improve cholera surveillance and reporting. We identified several factors contributing to cholera underestimation, including weaknesses in the Integrated Disease Surveillance and Response system, insecurity due to conflict situations, limited healthcare access, and the politicization of cholera outbreak data. We propose a comprehensive approach to address these challenges, including strengthening disease surveillance, adopting digital technologies to improve data collection and management, improving healthcare access, increasing public awareness and enhancing community engagement and participation in cholera reporting, and fostering political commitment to transparent data reporting. We urge African ministries of health and public health stakeholders to increase their commitment to and investment in strengthening cholera data management on the continent.Author summary: Cholera is a severe diarrheal disease caused by drinking or eating food contaminated with a bacteria called Vibrio cholerae. The disease is most common in Asia and Africa. The seventh cholera outbreak, which reached Africa in the 1970s, is still ongoing, with frequent and recurrent outbreaks in many countries. A major reason cholera keeps coming back is that the true number of cases is not accurately reported. This makes it difficult to plan and deliver effective responses, such as improving water and sanitation, sharing important health information, forecasting vaccine needs, and allocating resources. To solve this problem, we need better ways to collect and manage cholera data, use modern technology for tracking cases, improve access to healthcare, raise public awareness, and encourage governments to share cholera data openly. African health ministries and public health organizations should increase their efforts and investment in strengthening cholera data management across the continent.