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

Introduction Cameroon 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 methods We 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. Results Between 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.   Conclusion There 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was not funded by any grant donor or partner. The authors were responsible for the financing of the entire research project and the publication process. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of the University of Buea, Cameroon. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data are already included in the tables and figures in the manuscript.