Work

The management of cholera in populations affected by conflict in Africa and the Middle-East: a scoping review

Year: 2025

Type: article

Abstract: BACKGROUND: Cholera is a life-threatening disease caused by ingesting food or water contaminated with V. cholerae. Armed conflicts disrupt healthcare infrastructure, limit access to clean water, and exacerbate population displacement, leading to increased vulnerability to cholera outbreaks. This scoping review aims to assess cholera control strategies in conflict settings in Africa and the Middle East, with the goal of identifying effective and feasible interventions. METHODS: We followed PRISMA guidelines and conducted a comprehensive search of peer-reviewed literature in PubMed, Web of Science, Scopus, and Cochrane in November 2024. We included all study types on public health interventions for cholera management in Africa and the Middle East during conflict that were published from 1st January 2009 to 15 November 2024. RESULT: Twenty-five studies were included in this review; the data were synthesized narratively following PRISMA guidance. The review identified various cholera control interventions implemented in conflict settings, categorized into four main themes: vaccination, water, sanitation, and hygiene (WASH) interventions, case management and clinical interventions, and multicomponent strategies. Oral cholera vaccine (OCV) campaigns significantly reduced cholera incidence (up to 80%), especially when achieving high coverage rates (70-90%). Vaccination campaigns were effective, but they faced logistical challenges, including vaccine shortages and limitations in the cold chain. WASH interventions, including water purification and hygiene promotion, were effective in lowering microbial contamination and improving health outcomes. WASH interventions were often disrupted by conflict-related damage to infrastructure. Case management approaches, such as oral rehydration therapy and antibiotic use, played a crucial role in reducing mortality, but they required improved accessibility and antibiotic stewardship. Multicomponent interventions integrating vaccination, WASH, and case management demonstrated the highest impact on cholera control. CONCLUSION: Cholera control in conflict settings demands a phased and evidence-based approach backed by flexible funding and prospective operational research. Prioritization should be given to immediate high-impact measures, short-term completion of two-dose vaccination and case area targeted interventions (CATIs), and long-term resilient WASH and vaccine reserves.

Source: Conflict and Health

DOI: 10.1186/s13031-025-00737-2