Mozambique Cholera Fact Sheet

Cholera Overview

Cholera was first reported in Mozambique in 1859. Since 1970, there have been large outbreaks in 1992-1993, 1998-1999, 2000-2004, 2008-2009 and 2015. The recent trend shows a decrease in reported cholera cases over time (Fig. 1).

Between 1989 and 2018, epidemiological surveillance reported 291,272 cases with 5,661 deaths (case fatality rate ≈ 1.9%)2.

Major outbreaks were reported in the provinces of Sofala, Nampula, Zambezia, Cabo Delgado, Tete, Niassa and Maputo (Fig. 2 and Table I).

Cholera Distribution

Cholera geographic distribution was markedly heterogeneous over the past 30 years, with half of the provinces reporting 85.7% of the burden.

The provinces in central and northern Mozambique reported a combined 74% of all cholera cases between 1989 and 2018, with the highest proportion reported by Sofala (17%), Nampula (15.5%) and Zambezia (15.2%) Provinces (Fig. 2 and Table I). The most affected districts tended to be located along the east coast or along main communication routes bordering Malawi and Zimbabwe.

The southern part of the country has been generally less affected, with the exception of Maputo city, which alone accounted for 17.8% of the total number of cases. Maputo and Beira seem to play a role in amplification of outbreaks. Years when Maputo and Beira were affected, a greater number of districts were affected and outbreaks were characterized by extended duration with a greater number of reported cases.

Cholera in Mozambique is highly season and displays an apparent correlation with the rainy season (November to April-May) (Fig. 3). Outbreaks tended to start between week 48 (late-November) and week 04 (late-January) (Table I and Fig. 3).

Strategic Recommendations

High-risk areas are located along the coast and in areas where cholera outbreaks spread between neighboring countries (such as Malawi and Zimbabwe) and around Maputo city (Fig. 4).

In cholera hotspots, preparedness and response plans should be developed and implemented including: (1) strengthening early detection and rapid response including community-based surveillance and cross-border alerts; (2) setting up coordination mechanisms across the sectors and borders; (3) building capacity on outbreak management; (4) targeted pre-positioning of supplies and (5) preparing communication messages and plans. In remote areas, access to health care and early rehydration (e.g., community oral rehydration points) should be enhanced to reduce the CFR (Table III – Types T1 to T4).

Sustainable water, sanitation and hygiene and social mobilization activities should be implemented in the 29 high-priority hotspot districts regularly affected with significant outbreak duration (Table II – Types T1 and T2).

While preventive measures are implemented, oral cholera vaccine campaigns may be conducted to reduce the likelihood of cholera epidemics in cholera foci and towards high-risk population.