{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:57:43Z","timestamp":1785430663174,"version":"3.56.0"},"reference-count":41,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"unspecified","delay-in-days":119,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Cholera remains a major public health concern in conflict-affected Tigray, Ethiopia, where disrupted water, sanitation, and hygiene (WaSH) services and displacement have increased transmission risk. This study analysed outbreak dynamics, attack rates (AR), and predictors of cholera to inform interventions aligned with Ethiopia\u2019s Cholera Elimination Plan (2022\u20132028). A retrospective analysis was conducted on 802 suspected and confirmed cholera cases reported from 25 July to 4 October 2024 across 25 districts in Central and Northwestern Tigray. Data from the Tigray Health Research Institute line list were analysed using descriptive statistics, Chi-square tests, and Generalized Estimating Equation (GEE) models. Attack rates were highest in Asgede (357.25\/100000) and Endabaguna (88.12\/100000). Significant associations were observed with age, sex, occupation, water source, travel history, vaccination, latrine access, and contact history. GEE analysis showed strong intra-cluster correlation (\u03b1 = 0.949). Higher odds of cholera were associated with males, adults aged 16\u201345 years, and use of unsafe water sources, while vaccination and latrine availability reduced risk. Strengthening WaSH services, vaccination coverage, surveillance, and targeted risk communication is essential to reduce cholera transmission in Tigray.<\/jats:p>","DOI":"10.1017\/s0950268826101514","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T07:44:08Z","timestamp":1777535048000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiological evaluation of cholera outbreak dynamics in conflict-affected Central and Northwestern Tigray, northern Ethiopia: evidence from GEE analysis"],"prefix":"10.1017","volume":"154","author":[{"given":"Haftu Gebrehiwot","family":"Gebremeskel","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04bpyvy69","id-type":"ROR","asserted-by":"publisher"}],"name":"Mekelle University, College of Natural and Computational Sciences"},{"id":[{"id":"https:\/\/ror.org\/00xytbp33","id-type":"ROR","asserted-by":"publisher"}],"name":"Public Health Researcher and Data Reviewer"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyoum","family":"Desta","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00e798h81","id-type":"ROR","asserted-by":"publisher"}],"name":"Tigray Health Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senait Haddis","family":"Abebe","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00e798h81","id-type":"ROR","asserted-by":"publisher"}],"name":"Tigray Health Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mebrahtom Hafte","family":"Amaha","sequence":"additional","affiliation":[{"name":"Tigray Regional Health Bureau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Equbay","family":"Gebregziabher Gebru","sequence":"additional","affiliation":[{"name":"Tigray Regional Health Bureau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goyitom","family":"Gebremedhn","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00e798h81","id-type":"ROR","asserted-by":"publisher"}],"name":"Tigray Health Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele Hagos","family":"Debesay","sequence":"additional","affiliation":[{"name":"Tigray Regional Health Bureau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rieye Esayas","family":"Belay","sequence":"additional","affiliation":[{"name":"Tigray Regional Health Bureau"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1814-2530","authenticated-orcid":false,"given":"Kibrom Gebrehiwot","family":"Gebremeskel","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/003659f07","id-type":"ROR","asserted-by":"publisher"}],"name":"Aksum University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"S0950268826101514_r4","first-page":"1","article-title":"Vibrio cholerae infection","author":"Ramamurthy","year":"2024","journal-title":"Encyclopedia of Food Safety"},{"key":"S0950268826101514_r27","unstructured":"[27] Ethio Demography and Health (2024) Tigray. http:\/\/www.ethiodemographyandhealth.org\/Tigray.html (accessed September 2025) (accessed 12 May 2025)."},{"key":"S0950268826101514_r21","volume-title":"Multi-Sectorial Cholera Elimination Plan Ethiopia 2022-2028","year":"2023"},{"key":"S0950268826101514_r12","unstructured":"[12] World Health Organization (2025) Cholera in the WHO African region. https:\/\/www.afro.who.int\/health-topics\/disease-outbreaks\/cholera-who-african-region (accessed 8 September 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(accessed 8 September 2025)."},{"key":"S0950268826101514_r35","first-page":"145","article-title":"The cholera outbreak in Haiti: Where and how did it begin?","volume":"379","author":"Lantagne","year":"2014","journal-title":"Current Topics in Microbiology and Immunology"},{"key":"S0950268826101514_r1","first-page":"59","article-title":"Cholera epidemiology in Nigeria: An overview","volume":"12","author":"Adagbada","year":"2012","journal-title":"Pan African Medical Journal"},{"key":"S0950268826101514_r15","unstructured":"[15] United Nations OCHA (2024) Ethiopia \u2013 Situation Report, 10 June 2024. https:\/\/www.unocha.org\/publications\/report\/ethiopia\/ethiopia-situation-report-10-june-2024 (accessed 15 September 2025)."},{"key":"S0950268826101514_r34","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0135676"},{"key":"S0950268826101514_r8","doi-asserted-by":"publisher","DOI":"10.1128\/cmr.00211-21"},{"key":"S0950268826101514_r6","unstructured":"[6] World Health Organization (2024) Cholera. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cholera (accessed 6 September 2025)."},{"key":"S0950268826101514_r41","volume-title":"Ending Cholera: A Global Roadmap to 2030","year":"2017"},{"key":"S0950268826101514_r7","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1355613"},{"key":"S0950268826101514_r31","unstructured":"[31] M\u00e9decins Sans Fronti\u00e8res (2025) Investigating the outbreak. 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Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e64"}}