Addis Abeba — It is mesmerizing to see that Ethiopia is still struggling with Cholera in 2023, while the last Cholera outbreak in the United States occurred in 1911 and Europe has not seen an outbreak since 1970. Cholera is a preventable yet lethal infectious disease, reflecting the state of a country. It is a clear indicator of political leadership, economic status, and health system. An outbreak of cholera highlights the people's understanding of hygiene and clean drinking water, as well as the government's performance, the strength of the health system, the scholars' problem-solving abilities, and the stakeholders' engagement to address the problem.
Despite the success history in many parts of the world, Cholera remains a concern in Ethiopia. Since 1634, when the first suspected case of Cholera in Ethiopia was recorded, the country has endured its devastating effects for centuries. In the 19th century, five devastating epidemics occurred, with two separate waves in 1831-1836, outbreaks in 1856 and 1866-1867, and two waves during the great famine of 1889-1892. The seventh global cholera pandemic swept the world in 1970 and made its impacts felt in Ethiopia.
In the late 20th and early 21st centuries, cholera continued to be a common occurrence in the country. Between 2015 and 2023, the number of cases and deaths from cholera have been steadily rising, with the most recent years' occurrences particularly concerning and alarming. According to the World Health Organization (WHO), Cholera cases are decreasing globally due to increased awareness of hygiene during the COVID-19 pandemic. However, Ethiopia has seen a contrary rise in cases, particularly in the Oromia and Somalia regions.
In the past few years, Oromia has been grappling with a range of issues including ongoing wars, drought, the Covid-19 pandemic, and economic crisis, leading to dire living conditions. This has resulted in an outbreak of epidemic cholera, malaria, measles and neglected tropical diseases in many areas of the region. Cholera cases have been on the rise from 2015 to 2023, creating an even greater challenge for the region. In that time frame, there have been 109 cases and 1 death in 2015, 5232 cases and 59 deaths in 2016, 3433 cases and 21 deaths in 2017, 123 cases in 2018, 970 cases and 5 deaths in 2019, 1488 cases and 13 deaths in 2020, 604 cases and 4 deaths in 2021, and 1329 cases and 22 deaths in 2022, resulting in an average case fatality rate of 1.7% in the region, beyond the World Health Organization's acceptable rate of 1%. The outbreak has been mainly concentrated in 4 zones and 97 woredas, with Bale Zone having the highest case fatality rate of 3.1%, and Delo Mena woreda's case fatality reaching as high as 9.1%.
The number of cases has been increasing rapidly in the current year. As of the end of February 2023, Bale had 733 cases, Guji had 293 cases, East Bale had 162 cases, and West Arsi had 141 cases, with the majority of cases occurring in children aged 5-14, and an unusually high proportion of cases in children under the age of 2, accounting for 9% of total cases. The number of cases may be even higher, as many areas are inaccessible due to security issues and the limited capacity for data access and collection.
The main cause of these outbreaks is the failure to effectively implement the four steps necessary for the control of outbreaks and pandemics: prevention, response, management and control. Compounding this are the ongoing wars in various parts of the country, displacement of people, drought and deteriorating living conditions due to economic challenges. Specifically, over the last five years, Cholera has remained a persistent issue and the number of cases has seen a sharp increase due to the absence of appropriate measures being taken.
Despite the widespread nature of the outbreak, the government has yet to commit to the needed strategies to prevent, respond to, manage, and control the disease. Additionally, coordination between different levels of the health system is lacking and inadequate budgeting is an issue.
The science of the molecular aspects of bacteria causing Cholera, transmission methods, methods for preparedness and prevention, case identification, and treatment is well-studied. Oral Cholera Vaccines (OCV) are already on the market and have been shown to be effective in preventing disease outbreaks. No new science is required to address the outbreak, apart from generating local evidence about its source and unique situation. What is required is simply the implementation of these methods. This requires a political commitment. It is of utmost importance that the Ethiopian Government, with the help of international organizations, takes immediate action to stop this Cholera outbreak in Oromia Region.
If the government and all involved parties do not take immediate action, the situation will continue to worsen and lead to disastrous consequences. More importantly, since internal displacement of people and drought are the main causes that have exacerbated the condition, the government and all involved parties must work courageously to bring a satisfactory solution. This measure can address the root of the problem and provide a lasting solution.
Editor's Note: Oromia Physicians Association (OPA) is a nonpartisan and not-for-profit professional association that aims at improving healthcare system for betterment of public health in Oromia Regional State and Ethiopia.