Risk structured model of cholera infections in Cameroon

Since 1991, Cameroon, a cholera endemic African country, has been experiencing large cholera outbreaks and cholera related deaths. In this paper, we use a "fitted" demographic equation (disease-free equation) to capture the total population of Cameroon, and then use a fitted low-high risk structured cholera differential equation model to study reported cholera cases in Cameroon from 1987 to 2004. For simplicity, our model has no spatial structure. The basic reproduction number of our fitted cholera model, R₀, is bigger than 1 and our model predicted cholera endemicity in Cameroon. In addition, the fitted risk structured model predicted a decreasing trend from 1987 to 1994 and an increasing trend from 1995 to 2004 in the pre-intervention reported number of cholera cases in Cameroon from 1987 to 2004. Using the fitted risk structured cholera model, we study the impact of vaccination, treatment and improved sanitation on the number of cholera infections in Cameroon from 2004 to 2022. The dual strategies of either vaccination and treatment or vaccination and improved sanitation or the combined strategy of vaccination, treatment and improved sanitation reduce the basic reproduction number of Cameroon from 1.1803 to 0.9982, 1.1803 to 0.9987 and 1.1803 to 0.9952, respectively, and the number of cholera cases by 99.6735%, 98.7498% and 99.7280%, respectively. Thus, each of these three strategies is capable of eliminating cholera in Cameroon with the combined strategy having the lowest value for the effective reproduction number, R_E, and the highest percentage decrease in the number of cholera cases. Finally, using sensitivity analysis, we study the impact of our model parameters on the demographic threshold, basic reproduction number, effective reproduction number and on the total number of our model's predicted cholera cases.