Cholera is an infectious disease caused by the bacterium Vibrio cholerae (Gunti et al., 2015). It is typically transmitted through contaminated water or food and can cause severe diarrhea and dehydration, often leading to death if left untreated (Mazaba et al., 2019). Over the years, there has been a transition from sporadic epidemics to endemicity in some continents (Buse et al., 2022). Between 1995 and 2016, cholera outbreaks were reported in many countries, particularly in sub-Saharan Africa and Asia (Zindoga et al., 2022). The World Health Organization (WHO) estimates that there are 1.34 million cases of cholera each year, and between 21,000 and 143,000 deaths from cholera annually (Sivan et al., 2019; Joshi et al., 2020). The burden of this disease is particularly high in developing countries, with inadequate health systems and limited access to safe water and sanitation (Hur et al., 2019). In this research, I used a descriptive epidemiological approach to provide an in-depth analysis of the incidence of global cholera outbreaks from 1995 to 2016 using data obtained from Kaggle, analyzed with Python, and visualized with Tableau.
The findings of this analysis will guide future efforts to reduce the global burden of cholera and to develop evidence-based preventive and control strategies. Moreover, this analysis could serve as a model for the analysis of other infectious diseases, highlighting the importance of integrating epidemiological and demographic data to inform public policy and health strategies to reduce the global burden of infectious diseases.
Figure 1 : Cholera Dashboard
1.0 Methodology
A diverse range of data sources was utilized to comprehensively analyze cholera outbreaks from 1995 to 2016. The primary data source for this analysis was Kaggle, a widely recognized platform that provides access to various datasets contributed by researchers, programmers and organizations. The Kaggle dataset focuses specifically on the global cholera epidemic and provides valuable information on its incidence, geographic distribution, and fatality rate.
To ensure the reliability and accuracy of the data, I cross-referenced and validated them with other reputable sources, such as the World Health Organization (WHO) databases and national surveillance systems. These additional sources have allowed me to gather better and more reliable data on cholera outbreaks during the specified timeframe.
The selection of the timeframe from 1995 to 2016 was based on the availability and relevance of the data. This period was deemed significant, as it covered over two decades and allowed me to observe long-term trends and patterns in cholera outbreaks. My analysis incorporated a range of variables and indicators to comprehensively measure and analyze cholera outbreaks. These variables included incidence rates, which allowed me to quantify the frequency and severity of cholera outbreaks in different continents. Geographical locations were also considered to assess the spatial distribution and identify high-risk areas.
Various statistical and analytical methods were used to interpret and analyze the collected data. Descriptive statistics were used to summarize and present the key features of the data, providing an overview of the magnitude and distribution of cholera outbreaks. Correlation analysis was used to assess the relationship between the reported cases and reported deaths. This helps in understanding whether the severity of reported cases, as indicated by the number of deaths, is related to the magnitude of reported cases. Time-series analysis was used to provide information about patterns, trends, and changes in data over the years.
2.0. Result and Discussion
2.1. Africa
Cholera remains a significant public health concern in Africa, where inadequate sanitation and access to safe drinking water continue to contribute to its spread (Joshi et al., 2020). Despite the efforts to curb the cholera epidemic, outbreaks continue to occur, causing significant morbidity and mortality in the affected communities (Sivan et al., 2019). A data-driven approach was used to delve into the patterns and trends of cholera outbreaks, identify areas, and provide a better understanding of the burden of cholera in Africa.
According to my analysis, cholera continues to pose a significant public health challenge in Africa. Between 1995 and 2016, Africa experienced 3,010,413 cholera cases and 87,802 cholera deaths. These figures reveal the widespread nature of the cholera epidemic in Africa and the need for urgent interventions to prevent further outbreaks and fatalities.
Furthermore, the Congo, Somalia, and Mozambique were the most affected countries, accounting for a significant proportion of cases and deaths. The high incidence and mortality rates in these countries are major causes of concern, indicating the need for tailored interventions to address the specific factors driving cholera outbreaks in these countries.
Figure 2 : Cholera Case in Africa
In Africa, Nigeria had the fourth-highest number of cholera cases with a total of 204, 000 cases and the second-highest number of cholera deaths with a total of 8, 975 deaths. This demonstrates the severity of the cholera crisis in Nigeria and the urgent need for improved access to clean water, sanitation facilities, and healthcare services to curb the spread of cholera.
Figure 3: Cholera Deaths in Africa
My analysis revealed an interesting observation regarding South Africa's cholera cases. Despite South Africa ranking fifth in the total number of cholera cases with a total of 160, 117, the country ranked only 26th in the number of deaths with a total of 522 deaths. This discrepancy may be due to the country's robust health infrastructure, which facilitates timely diagnosis, prompt treatment, and effective management of cholera.
The remaining African countries also recorded a significant number of cholera cases and deaths, underscoring the importance of implementing effective preventive and control measures, such as improved sanitation and hygiene, vaccination campaigns, and early detection and treatment to curb the spread of cholera in Africa.
2.1.1 Trend in Africa
The time-series analysis of cholera cases and deaths from 1995 to 2016 showed that there was a consistent increase in cholera cases from 1995 to 1998, followed by a steady decrease from 2002 to 2004. However, the highest number of cholera cases was recorded in 2006, with a staggering 234,226 cases, and the highest increase was observed in the same year, compared to 2005. Conversely, the lowest number of cholera cases was reported in 2013, with 56,329 cases; however, the lowest decrease occurred in 2010.
Figure 4 : Trend in Cholera case in Africa
Early detection and continuous monitoring of cholera outbreaks are vital to prevent their spread and reduce fatalities in African communities. The highest number of cholera-related deaths occurred in 1998, with 9,858 fatalities, with the highest increase occurring in 2006. However, the lowest cholera death rate was observed in 2015 and the lowest decrease was observed in 2000. This shows that there has been a slight improvement in the treatment and prevention of cholera in Africa.
Figure 5 : Trend in Cholera Deaths in Africa
The findings of this time-series analysis highlight the need for effective public health interventions, such as vaccination campaigns, safe water supplies, and improved sanitation, to prevent and control cholera outbreaks. The highest rates were observed in 2006, emphasizing the importance of continuous surveillance and early detection of cholera outbreaks to prevent fatality.
2.2 Asia
Cholera is a primary health concern in several Asian countries. Despite medical advancements and treatment strategies, cholera proliferation remains a threat to public health (Buse et al., 2022). In recent years, efforts have been made to address the root causes of cholera, such as poor sanitation and poor quality of water; however, the disease continues to threaten many communities (Zindoga et al., 2022). According to my analysis, from 1995 to 2016, 433,839 cholera cases and 3,722 cholera deaths were reported in Asia. Afghanistan recorded 186,957 cholera cases and 1,338 cholera deaths, making it the worst-affected country in Asia. India had the second-highest number of cases, with a total of 67,979, and the sixth-highest number of deaths with a total of 221 deaths. Yemen recorded 47,895 cholera cases and 305 deaths, making it the third-most affected country in Asia.
Figure 6 : Cholera case in Asia
Furthermore, China, India, Bangladesh, Vietnam, and Cambodia are among the most affected countries, accounting for a significant proportion of cases and deaths. Afghanistan recorded the highest number of cholera deaths in Asia, with 1,338 deaths, whereas the Lao People's Democratic Republic recorded the seventh-highest cholera death toll, with 214 deaths. Iran had the ninth-highest number of deaths, with 129 deaths.
Figure 7 : Cholera deaths in Asia
Despite advances in medical technologies and treatment strategies, these countries continue to face significant public health challenges owing to the spread of cholera. These countries must take necessary measures to prevent the spread of the disease and provide proper medical care and support to those affected.
2.2.1 Trend in Asia
The incidence of cholera in Asia showed an alarming increase and decrease between 1995 and 2016. My time series analysis revealed a steady increase in cholera cases from 1997 to 1999 and from 2013 to 2015. The highest number of cholera cases was recorded in 2015, with a total of 64,509, and the highest increase was observed in 2014, with 45,212 more cases reported than in the previous year. Unfortunately, the highest number of cholera deaths was reported in 1995, with 1,220 deaths recorded. The highest increase in deaths occurred in 2011, with 366 deaths.
Figure 8 : Trend in Cholera case in Asia
The lowest number of cholera cases was recorded in 2009, with only 1,902 cases reported, and the lowest death rate was observed in 2006, with only eight deaths recorded. In contrast, the lowest decrease in cholera cases was observed in 2016, with a decrease of only 46,118 cases, whereas the lowest decrease in death rates was recorded in 1996, with only 1,099 fewer deaths than in the previous year. These findings emphasize the vital need for efficient preventive and control methods to fight cholera across Asia.
Figure 9 : Trend in Cholera deaths in Asia
2.3 North America
Cholera is a rare disease in North America, with only a few isolated cases reported recently (Bahroudi et al., 2021). This may be attributed to advanced sanitation systems, public health education, and rapid outbreak response strategies (Andeobu et al., 2022).
Figure 10 : Cholera case in North America
According to my analysis, from 1995 to 2016, 894,418 cholera cases and 10687 cholera deaths were reported in North America. Haiti had the highest number of cholera cases and deaths, with 795,794 cases and 9,411 deaths respectively. The Dominican Republic had the second-highest number of cholera cases and deaths, with 33,223 cholera cases and 499 deaths. Mexico had the third-highest number of cholera cases and the fifth-highest number of deaths, with 20,158 cases and 144 deaths respectively. Guatemala recorded the fourth-highest cholera cases with 19,475 cholera cases and the fourth-highest cholera deaths with 172 deaths. Nicaragua had the fifth-highest number of cholera cases, with a total of 14,922 cholera cases, and the third-highest number of deaths with 343 deaths.
Figure 11 : Cholera deaths in North America
This emphasizes the need for continuous efforts to implement advanced sanitation systems, public health education, and quick outbreak response strategies to combat the rare but impactful cholera in North America.
2.3.1 Trend in North America
The trend of cholera in North America seems to be declining, with a decrease in reported cases and deaths (Andeobu et al., 2022). For instance, according to the World Health Organization (WHO), in 2020, only three cases of cholera were confirmed in North America.
Figure 12 : Trend in Cholera cases in North America
Based on my time series analysis, the highest number of cholera cases was reported in 2011, with a total of 361,215 cholera case, and the highest number of deaths was recorded in 2010, with a total of 3,990 deaths. A steady decrease in the number of cholera cases was observed from 1999 to 2000. These findings highlight the effectiveness of the sanitation systems, public health education, and outbreak response strategies in North America.
Figure 13: Trend in cholera deaths in North America
2.4 South America
Cholera is a significant health concern in South America, with several major outbreaks occurring over the past century (Gunti et al., 2015). One of the most significant cholera outbreaks occurred in Peru in 1991 and has spread to other countries on the continent (Sivan et al., 2019). However, significant efforts have been made to control the outbreak, and since the outbreak, there have been no major outbreaks in South America (Gilmour et al., 2021).
Figure 14: Cholera Case in South America
According to my analysis, from 1995 to 2016, a total of 135,127 cholera cases and 1,555 cholera-related deaths were reported. Peru had the highest number of cases and deaths, with 75,105 cholera cases and 801 cholera deaths respectively. Brazil had the second highest number of cases and deaths, with 32,133 cases and 282 cholera deaths respectively. Colombia recorded the third-highest number of cases and the fourth-highest number of deaths, with 8,344 cholera cases and 144 cholera deaths, respectively.
Figure 15: Cholera Deaths in South America
Bolivia had the fourth-highest number of cases and third-highest number of deaths, with 7,238 cases and 147 deaths. Ecuador had the sixth-highest number of cases, with 7,164 and 76 deaths, respectively. It is essential to continue monitoring the situation to develop effective strategies for cholera prevention and management.
2.4.1 Trend in South America
There has been a steady decrease in reported cases and deaths in recent years, which is in line with global efforts to prevent and control cholera outbreaks. (Fabre et al., 2015). According to my analysis, the highest number of cases and deaths was recorded in 1998, with 49,297 cases and 656 deaths, respectively. From 1999 to 2002, there was a steady decrease in the number of cases and deaths.
Figure 16:Trend in Cholera Cases in South America
Peru reported the highest number of cases and deaths followed by Brazil, Colombia, Bolivia, and Ecuador. The decline in cholera cases and deaths can be attributed to various factors including improved access to clean water and sanitation facilities, vaccination campaigns, and public health interventions. It is crucial to maintain these efforts to prevent future cholera outbreaks.
Figure 17: Trend in Cholera Deaths in South America
2.5 Europe
Cholera is not currently a major health concern in Europe but has had a significant effect on Europe in the past (Bahroudi et al., 2021). The last major outbreak of cholera in Europe occurred in 1994 with approximately 100,000 cholera cases and 4,000 cholera deaths (Gilmour et al., 2021). Since then, no major outbreaks have occurred in Europe (Gunti et al., 2015). According to my analysis, 1,523 cholera cases and 29 deaths were recorded. Ukraine had the highest number of cases and deaths, with 560 cases and 10 deaths, respectively.
Figure 18: Trend in Cholera cases in Europe
The United Kingdom had the second-highest number of cases with 318 cases, but no deaths were reported. Moldova had 240 cases and 5 deaths, while Romania had 118 cases and three deaths. Russia had 103 cases and one death, making it the country with the fifth-highest number of cases. It is important to note that, while the number of cases and deaths in Europe is relatively low compared to other continents, it is still crucial to monitor and prevent the spread of cholera. Appropriate sanitation and access to clean water are key factors in preventing outbreaks.
Figure 19 : Trend in Cholera Deaths in Europe
2.5.1 Trend in Europe
The trend of cholera in Europe has shown a significant decline since 1995, with 938 cholera cases and 18 deaths reported that year. Subsequently, there was a steady decrease in the number of reported cases and deaths from 2006 to 2013.
Figure 20: Trend in Cholera cases in Europe
The decline in cholera cases can be attributed to various factors, such as improved sanitation, access to clean water, and effective public health interventions (Gunti et al., 2015). It is important to maintain vigilance and to continue efforts to prevent and control cholera outbreaks in Europe to further reduce the burden of this disease.
Figure 21: Trend in Cholera Deaths in Europe
2.6 Oceania
The most recent cholera outbreak in Oceania has occurred in Papua New Guinea. The outbreak has been linked to contaminated water sources and poor sanitation (Buse et al., 2022). According to my analysis, 16,465 cholera cases and 170 deaths have been recorded in Oceania. Papua New Guinea had the highest number of cholera cases and deaths, with 12, 489 cases and 142 deaths. Micronesia had 3,467 cholera cases and 20 deaths. The Marshall Islands had the third-highest number of cholera cases and deaths, with a total of 300 cholera cases and six deaths. Tonga had a total of 145 cholera cases and two deaths. Australia had the fifth-highest number of cholera cases, with 58 cases and zero deaths.
Figure 22: Trend in Cholera Cases in Oceania
Despite the relatively low number of cases compared with other continents, cholera remains a public health concern in Oceania. Improved access to clean water and sanitation facilities as well as public health interventions such as vaccination campaigns and awareness-raising efforts are necessary to prevent and control cholera outbreaks on the continent (Buse et al., 2022).
Figure 23: Trend in Cholera Deaths in Oceania
2.6.1 Trend in Oceania
In Oceania, the highest number of cholera cases and deaths occurred in 2010, with 9,000 cases and 95 deaths, respectively.
Figure 24: Trend in Cholera Cases in Oceania
However, a steady decrease in the number of cholera cases was observed from 2000 to 2004. It is important to maintain vigilance and to continue efforts to prevent future cholera outbreaks in this region.
Figure 25: Trend in Cholera Deaths in Oceania
3.0 Conclusion
In conclusion, cholera remains a significant public health concern across several continents, including Africa, Asia, North America, South America, and Oceania. However, in recent years, there has been a decreasing trend in the number of reported cholera cases and deaths on several continents, attributed to various factors such as increased access to clean water and sanitation facilities, public health interventions such as vaccination campaigns, and awareness-raising efforts. Notably, there has been a steady decrease in cholera cases and deaths in Africa and Asia, which have the highest cholera burden. In North America, South America, and Oceania, the highest number of cholera cases and deaths was recorded in the past, with steady decreases observed over the years. It is essential to maintain vigilance to prevent future cholera outbreaks, particularly in areas with limited access to clean water and sanitation facilities, by continuing ongoing efforts.
4.0 Recommendation
Several areas of future research can be explored to improve our understanding of cholera and inform effective prevention and control strategies.
Firstly, there is a need for further research into the environmental and socioeconomic factors that contribute to cholera outbreaks, including water and sanitation infrastructure, food safety, and human behavior. This research can help identify key risk factors and inform targeted interventions to reduce the incidence of cholera.
Secondly, there is a need for continued monitoring and surveillance of cholera outbreaks, including the development and implementation of early warning systems to quickly detect and respond to outbreaks. This requires investment in laboratory capacity, disease surveillance systems, and communication networks.
Thirdly, there is a need for research into new and improved cholera vaccines and treatment options, particularly for populations that are most at risk, such as those living in high-risk areas with limited access to healthcare. Also, Future analysis and research should explore the impact of innovative technologies, such as advanced water treatment and sanitation facilities, on reducing cholera incidence rates in high-risk areas.
Overall, continued research on cholera is essential to inform effective prevention and control strategies, reduce the burden of the disease, and ultimately save lives.
5.0 References
Gunti, Deepak et al. (2015, July 24). An outbreak of cholera in Medipally village, Andhra Pradesh, India, 2013. Journal of Health Population and Nutrition, 33(1). https://doi.org/10.1186/s41043-015-0021-1
Mazaba, Lucy, Mazyanga et al. (2019, May 31). Evaluating the costs of cholera illness and cost-effectiveness of a single dose oral vaccination campaign in Lusaka, Zambia. Plos One, 14(5), e0215972. https://doi.org/10.1371/journal.pone.0215972
WHO 2023 https://www.who.int/data/gho/data/indicators/indicator-details/GHO/cholera-case-fatality-rate
Buse, K., Norton, R., Meddings, D. R., & Jagnoor, J.. (2022, July 1). Tracing the emergence of drowning prevention on the global health and development agenda: a policy analysis. The Lancet Global Health, 10(7), e1058-e1066. https://doi.org/10.1016/s2214-109x(22)00074-2
Hur, Y., Chalita, M., Baek, I., & Chun, J.. (2019, November 23). VCGIDB: A Database and Web Resource for the Genomic Islands from Vibrio cholerae. Pathogens, 8(4), 261. https://doi.org/10.3390/pathogens8040261
Joshi, Avatar et al. (2020, June 26). c-di-GMP inhibits LonA-dependent proteolysis of TfoY in Vibrio cholerae. Plos Genetics, 16(6), e1008897. https://doi.org/10.1371/journal.pgen.1008897
Sivan, S. P., Goswami, S., Dambhare, D. G., Gupta, S. S., & Jha, A.. (2019, January 1). Outbreak investigation of cholera outbreak in a slum area of urban Wardha, India: An interventional epidemiological study. Journal of Family Medicine and Primary Care, 8(3), 1112. https://doi.org/10.4103/jfmpc.jfmpc_308_18
Zindoga, Mukandavire et al. (2022, July 31). A Review of the 2008/2009 and 2018/2019 Cholera Outbreaks in Zimbabwe: Call for Public Health Action. Journal of Infectious Diseases and Epidemiology, 8(7). https://doi.org/10.23937/2474-3658/1510269
Bahroudi, M., Bakhshi, B., Soudi, S., & Najar-Peerayeh, S.. (2021, November 3). Immunomodulatory effects of mesenchymal stem cell-conditioned media on lipopolysaccharide of Vibrio cholerae as a vaccine candidate. Stem Cell Research & Therapy, 12(1). https://doi.org/10.1186/s13287-021-02622-0
Andeobu, L., Wibowo, S., & Grandhi, S.. (2022, January 26). Medical Waste from COVID-19 Pandemic—A Systematic Review of Management and Environmental Impacts in Australia. International Journal of Environmental Research and Public Health, 19(3), 1381. https://doi.org/10.3390/ijerph19031381
Gilmour, Stuart et al. (2021, April 26). HIV incidence and sexual behavioral correlates among 4578 men who have sex with men (MSM) in Chengdu, China: a retrospective cohort study. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-10835-4
ECDC https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly 2023
Great work
You are a great analyst. I look forward to meeting you some days