{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:57:08Z","timestamp":1792155428272,"version":"4.4.0"},"reference-count":145,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T00:00:00Z","timestamp":1733270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fogarty International Center of the National Institutes of Health","award":["D43TW012487"],"award-info":[{"award-number":["D43TW012487"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Cholera is linked to penury, making low- and middle-income countries (LMICs) particularly vulnerable to outbreaks. In this systematic review, we analyzed the drivers contributing to these outbreaks, focusing on the epidemiology of cholera in LMICs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (ID: CRD42024591613). We searched PubMed, Scopus, Web of Science, and Google Scholar to include studies on cholera outbreaks that occurred in LMICs from 1 January 2014 to 21 September 2024. Studies on outbreaks outside LMICs and focusing on sporadic cases were excluded. The risk of bias among included studies was assessed using a modified Downes et al. appraisal tool. Thematic analysis was used to synthesize the qualitative data, and meta-analyses to estimate the pooled prevalence. From 1662 records, 95 studies met inclusion criteria, primarily documenting outbreaks in Africa (74%) and Asia (26%). Contaminated water was the main route of disease transmission. The pooled fatality prevalence was 1.3% (95% CI: 1.1\u20131.6), and the detection rate among suspected cases was 57.8% (95% CI: 49.2\u201366.4). Vibrio cholerae O1 was the dominant serogroup while Ogawa was the dominant serotype. All studies reporting biotypes indicated El Tor. Although the isolates were 100% susceptible to ofloxacin, levofloxacin, norfloxacin, cefuroxime, and doxycycline, they were also fully resistant to amikacin, sulfamethoxazole, trimethoprim, and furazolidone. The persistence of cholera outbreaks in destitute areas with limited access to clean water and sanitation emphasizes the need for socioeconomic improvements, infrastructure development, and ongoing surveillance to support timely responses and achieve long-term prevention.<\/jats:p>","DOI":"10.3390\/microorganisms12122504","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T06:38:25Z","timestamp":1733294305000},"page":"2504","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Cholera Outbreaks in Low- and Middle-Income Countries in the Last Decade: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1062-8188","authenticated-orcid":false,"given":"Anastasia A.","family":"Asantewaa","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Korle Bu, Accra P.O. Box KB 4236, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5761-1564","authenticated-orcid":false,"given":"Alex","family":"Odoom","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Korle Bu, Accra P.O. Box KB 4236, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4296-1032","authenticated-orcid":false,"given":"Godfred","family":"Owusu-Okyere","sequence":"additional","affiliation":[{"name":"National Public Health & Reference Laboratory (NPHRL), Ghana Health Service-Korle Bu, Accra P.O. Box 300, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S.","family":"Donkor","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Ghana Medical School, Korle Bu, Accra P.O. Box KB 4236, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,4]]},"reference":[{"key":"ref_1","first-page":"116","article-title":"Outbreak of Cholera in the East Akim Municipality of Ghana Following Unhygienic Practices by Small-Scale Gold Miners, November 2010","volume":"46","author":"Opare","year":"2012","journal-title":"Ghana Med. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1097\/JS9.0000000000000222","article-title":"Recent Surge in Cholera Outbreaks Globally during the COVID-19 Pandemic Era: A Potential Threat to the African Continent and Salient Counteracting Strategies","volume":"109","author":"Mohapatra","year":"2023","journal-title":"Int. J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Muzembo, B.A., Kitahara, K., Debnath, A., Ohno, A., Okamoto, K., and Miyoshi, S.-I. (2022). Cholera Outbreaks in India, 2011\u20132020: A Systematic Review. Int. J. 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