Mozambique: Cholera Outbreak - Dec 2022

On 8th January 2023, the Niassa Daily Cholera Bulletin from the Ministry of Health (MoH) indicated an alarming increase in the number of Cholera cases in the province of the same name, which borders Malawi where the current cholera outbreak is worsening. At the time, Niassa province recorded 379 confirmed cholera cases and six deaths in Lago, 250 in Lichinga district with two deaths reported. As of 13th January 2023, the reports from MoH showed a cumulative caseload of 878 confirmed cases and 14 deaths. This is an 80% increase from the number of cases recorded on 21 December 2022, which was 409 cases confirmed with seven reported deaths. To note, five provinces are facing the cholera outbreak or are at risk of experiencing it given the rate at which the outbreak is spreading. Concerned areas include the districts of Lago, Lichinga , Sanga, Chimbonila and Mecanhelas in Niassa province; the districts of Xai-Xai and Chilaulene in Gaza province; Tete province; Zambezia province and the districts of Caia and Buzi in Sofala province. A similar risk is also considered in other surrounding countries, mainly Malawi, Zimbabwe, Tanzania and Zambia. [...] The upcoming rainy season further poses a threat of the disease spreading nation-wide. Given the surge in cases with the floods season ahead, there is a high risk to exacerbate the Cholera situation and overall humanitarian situation in the coming weeks, until the end of the rain and cyclone season. (IFRC, 24 Jan 2023)

Cholera outbreak has been reported from Sofala and Zambezia provinces of Mozambique. From 14 September 2022 to 5 March 2023, a total of 7 517 cases and 41 deaths (CFR 0.6%) have been reported from six provinces and 33 districts. (WHO, 11 March 2023)

From 14 September 2022 to 16 April 2023, a total of 26 841 cases and 123 deaths (CFR 0.5%) have been reported from 11 provinces and 53 districts. (WHO, 27 Apr 2023)

As of 26 April, health authorities have reported 28,958 cumulative cases of cholera in 10 provinces of the country, with 129 deaths. In the past 24 hours, 143 new cases were registered. Cabo Delgado (district of Namuno with 42 cases) and Nampula (district of Memba with 22 and Cidade de Nampula with 124 cases) are the current hotspots of the cholera outbreak, both reporting additional number of affected districts and cases in the past week. To address this concern, humanitarian partners developed and rolled out cholera community kits to support the response at the household levels in the newly affected districts in both provinces. (OCHA, 29 Apr 2023)

As of 28 May 2023, the country had reported a cumulative of 30 898 cases, with 137 deaths (CFR = 0.4%). The outbreak trend is declining. The main current hotspots of the cholera outbreak in week 20 were in Sofala, Zambezia and Tete provinces. (WHO, 29 May 2023)

New cases in the ongoing cholera outbreak in Mozambique, which started in September 2022, have declined consecutively over several weeks. During epidemiological week 28 (week ending 16 July 2023), 103 new cholera cases with zero deaths were reported from four (4) provinces across the country. This is a slight decline in new cases compared to the preceding week, when 109 cases were reported. Most of the new cases were reported from Nampula (n=54) and Cabo Delgado (n=42) provinces. The other two provinces with cases were Zambézia (n=4) and Sofala (n=3). No cholera deaths have been reported for five consecutive weeks in the country. (WHO, 16 Jul 2023)

In week 30 (week ending 30 July 2023), 91 new cases were reported from two provinces, Nampula (69) and Cabo Delgado (22) in the country. Overall, case numbers have declined consecutively, but Nampula Province reported an increase in new cases compared to the previous week. Cumulatively, 33 534 cases with 141 deaths (CFR 2.2%) have been reported across the country. (WHO, 30 Jul 2023)

As of 27 August 2023, the country had reported a cumulative total of 34 118 cases, with 144 deaths(CFR 0.4%). New cases increased in week 34 by 37% to 158 cases from 115 cases in week 33. No new death was reported in weeks 33 and 34. There are currently three active districts in two provinces(Nampula and Cabo Delgado).(WHO, 27 Aug 2023)

During week 41 (ending 15 October 2023), a total of 109 new cases have been reported in the two active districts, Nampula and Macanga, including two deaths (CFR 1.8%), recorded in Macanga district. Nearly 80.0% (n=87) of reported cases were from Nampula district in Nampula province, while 20.0% (n=22), were from Macanga district, in Tete province. From 14 September 2022 to 15 October 2023, a cumulative total of 34 943 cases, including 146 deaths (CFR 0.4%) were reported in all 67 districts, with Zambezia district reporting majority of the cases, (38.3%, n=13 400), followed by Sofala (21.5%, n= 7 527). Of note, Mozambique is also experiencing an increase in reported cases of acute watery diarrhea (AWD), which is expected to worsen in the coming months due to flooding along with existing poor sanitary conditions. Of the 67 districts, 17 (25.4%) have reported AWD cases and include Erati, Malema, and Mecuburi districts in Nampula province; Mueda and Montepnez districts in Cabo Delgado province; Morrumbala, Gurue, Alto Molocue, Gile, Mulevala, and Pebane districts in Zambezia province, as well as Tete, Magoe, Marara, Zumbo, Doa, and Mutarara districts in Tete province. (WHO, 9 Nov 2023)

The country had reported a cumulative total of 44 316 cases, with 167 deaths (CFR 0.4%) as of 08 February 2024. The provinces with the highest number of cases in week 05 were Nampula (128), Tete (91) and Zambezia (66). The country is currently in its rainy and cyclone season, two factors that significantly exacerbated cholera transmission in 2023. The response efforts have been hindered by security issues, including attacks on health workers and community leaders by some community members. The government is addressing the situation, and measures have been implemented by partners to ensure the safety of those responding to the outbreak. The Ministry of Health decided to restart the counting of cholera cases starting on 1st October 2023, which corresponds with the beginning of the rainy season. Thus, starting from week 47, data from the MOH consider two periods: 1st cholera outbreak from 14 September 2022 until 30 September 2023; and 2nd cholera outbreak from 1st October 2023-ongoing. (WHO, 12 Feb 2024)

The current cholera outbreak in the country began in Niassa province on 14 September 2022. As of 28 April 2024, the country has reported a cumulative total of 7,294 cases, with 12 deaths (CFR 0.2%) for the year 2024. To date, eight provinces have been affected, with 24 districts with active cases. Cases have been declining over the last three weeks of April. Since the onset of the outbreak in September 2022 until 28 April 2024, a cumulative total of 48,181 cases and 174 deaths (CFR 0.4%) have been reported. (WHO, 16 Jun 2024)