National and Subnational Burden of Cholera in Ethiopia, 2019 to 2023: Findings From the Global Burden of Diseases Study 2023

Cholera remains a significant public health concern in Ethiopia, where recurrent epidemics have been reported for centuries. Despite the launch of the National Cholera Elimination Plan (NCP) aiming to eliminate cholera by 2028, the disease continues to cause substantial morbidity and mortality. This study assessed the national and subnational burden of cholera in Ethiopia from 2019 to 2023 using the Global Burden of Diseases (GBD 2023) estimates. A secondary analysis of GBD 2023 data was conducted to describe temporal trends in cholera mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) in Ethiopia between 2019 and 2023. The Cause of Death Ensemble model (CODEm) was used to estimate cause-specific mortality, and DisMod-MR 2.1 was used to model non-fatal outcomes. SPSS version 27 was used for the analyses. Nationally, cholera-related deaths decreased from 1.42 (UI: 0.40-3.70) to 1.10 (UI: 0.26-3.22). Total YLLs decreased from 116 593 (UI: 34 140-295 170) to 87 513 (UI: 20 036-244 597), while YLDs declined modestly from 192 (UI: 118-298) to 160 (UI: 97-250). YLLs consistently accounted for more than 99% of total DALYs. Mortality was higher among adults aged ≥50 years, whereas deaths among children under 5 declined. The national Case Fatality Rate (CFR) reached 3.13% in 2022, exceeding the World Health Organization (WHO) threshold of 1%. Subnational analysis of the Amhara region revealed that while deaths and YLLs declined, a 26.7% increase in YLDs led to a net 5.9% rise in DALYs. Cholera remains endemic in Ethiopia, with a gradually decreasing burden over the last 5 years. To achieve the 2028 elimination goal, Ethiopia must strengthen multi-sectoral coordination, scale up sustainable Water, Sanitation, and Hygiene (WaSH) interventions, expand oral cholera vaccine coverage, and reinforce surveillance and health system response capacities.