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.