Published in PLOS One on 2025-12-08, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Deborah Tembo, Nedah Chikonde Musonda, Miyanda Simwaka, Chipo Nkwemu, Samson Shumba
Source: PLOS One • DOI 10.1371/journal.pone.0330969
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Cholera remains one of the most rapidly fatal infectious diseases globally, with untreated cases leading to death within hours due to severe dehydration. Despite being preventable and treatable, it continues to pose a significant public health threat, especially in low and middle-income countries where water, sanitation, and hygiene (WASH) services are inadequate. This study aimed at investigating the rapid progression and short-term mortality during the January 2023 to July 2024 Cholera Outbreaks in Zambia. We conducted a retrospective cross-sectional study using national cholera surveillance data from Zambia’s January 2023 to July 2024 outbreak to examine delays in care and associated outcomes. All suspected and confirmed cases with complete records on symptom onset, admission, and outcome were included. Key time intervals were calculated and analyzed using descriptive statistics and non-parametric tests, with subgroup comparisons by age, sex, and outcome status. Ethical approval was obtained, all data were anonymized, and analyses were performed using Stata version 14.2. A total of 3,655 cases were analyzed, of whom 52.2% were male and 37.8% were under 15 years. Nearly all patients (99%) were admitted as inpatients, and the overall mortality rate was 4.2%. The median time from symptom onset to death was 3 days, underscoring the rapid progression of the disease. Of the 3,655 cholera patients enrolled in the study, 2,162 patients were included in the survival analysis, the death rate was 0.85 per 100 person-days, with higher rates observed among males (1.05) and adults aged 50 years and above (2.71). Confirmed cases experienced the highest mortality, and survival probabilities were significantly lower among males (p = 0.0498), older adults (<0.0001), and confirmed cholera cases (<0.0001). Many cholera deaths in this outbreak happened within just a few days of admission, showing the need for quick assessment and urgent fluid treatment as soon as patients arrive. Older adults and men faced a higher risk of dying, which calls for triage protocols that pay closer attention to these groups. Laboratory confirmation was limited, with very few patients receiving rapid diagnostic tests, revealing a serious gap in surveillance and case management. Strengthening early warning systems, improving access to rapid tests, and focusing on high-risk groups are key steps to lowering deaths in future outbreaks.
Background
Cholera remains one of the most rapidly fatal infectious diseases around the world, capable of causing death within hours due to severe fluid loss if untreated [1,2]. It is caused by ingestion of Vibrio cholerae, a bacterium producing enterotoxins that disrupt intestinal ion transport, resulting in profuse watery diarrhea and vomiting [3,4]. Without prompt rehydration, severe dehydration leads to the majority of cholera-related deaths [5]. Transmission of this disease thrives in areas with poor sanitation and unsafe water, making cholera endemic in many low and middle income countries [6]. Outbreaks are associated with natural disasters or occur in overcrowded urban settings with inadequate water and sanitation infrastructure [7,8].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Deborah Tembo, Nedah Chikonde Musonda, Miyanda Simwaka, Chipo Nkwemu, Samson Shumba. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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